Summary/Abstract

MaineCare is proposing to put strict limits on the length of time that patients can receive medication to treat opiate addiction. Maine's treatment providers say the proposal runs counter to established protocols for people in recovery.

Content

Less than a week after state officials held a summit and created a second task force to address Maine's surging rate of opiate abuse, the director of MaineCare is proposing to put strict limits on the length of time that patients can receive medication to treat opiate addiction. Maine's treatment providers say the proposal runs counter to established protocols for people in recovery and will result in soaring rates of relapse. But the state is defending the two-year limit as a financial and medical necessity. The medication, known as Suboxone, is an opiate inhibitor that suppresses an addict's powerful cravings for drugs. In a recent interview with MPBN"s Jay Field, 34-year-old Shane Heathers of Bowdoin said he's been successfully treated with it for several years. Before that, he says, he had a decade long history as an opiate addict. Shane Heathers: "I was on Methadone for awhile, which--it served a purpose, but I feel more clear-headed anyways on the Suboxone than I did on the Methadone." Jay Field: "What would happen if you stopped taking the..." Shane Heathers says: "The Suboxone? I'd be totally flat out, laid out. It would be too much right now, you know." Unlike Methadone, Suboxone can be administered in an office setting and prescribed by a certified physician. And unlike Methadone, Suboxone treatment includes abstinence therapy and counseling. According to the Maine Office of Substance Abuse, Suboxone has now overtaken Methadone as the most used medication to assist patients in recovery: More than 2,000 patients are currently prescribed it in Maine, compared to about 1,800 on Methadone. But Suboxone costs about three times more. And with the state looking to plug a financial gap of at least $25 million, MaineCare Director Stefanie Nadeau says her office has to re-establish priorities. She says the state spent more than $10 million last year for Suboxone prescriptions. "For every dollar we spend above and beyond what the standard of care is, there is somebody else who can't get a service somewhere else," she says. "So for every dollar we're spending on opioid treatment above and beyond what the best practice is, above and beyond what's been proven as an industry standard for treatment, is dollars we're taking away from those most vulnerable and most needy of the population that aren't receiving services today." To try to correct this disparity, Nadeau says her office is recommending to the state's Streamlining Task Force that MaineCare recipients who are treated for opiate addiction with Suboxone be limited to two years on the medication, unless a physician or treatment provider deemed it medically necessary to continue. Nadeau says, if adopted, the policy change would take effect beginning next July, and could save the state close to $1 million a year. She says the two-year guideline is recommended by both the federal Substance Abuse Mental Health Services Administration and the U.S. Department of Health and Human Services. "That is what most states do," Nadeau says. "We are an outlier. So we're trying to say, 'Here's the standard of care for Suboxone. This is what SAMSHA and the U.S. Department of Health and Human Services have published as guidelines. How do we come in line with that to make sure that we're following those guidelines, but also to make sure that people are still receiving the treatment that they need?'" But Brad Stone, a spokesman for SAMSHA, says his agency has no formal guidelines on the timetable for the use of Suboxone. He declined to talk on tape. And Dr. Mark Publicker, an addiction specialist with the Mercy Recovery Center in Westbrook also disagrees with the state's characterization of the two year limit as established "best practices." "I can say affirmatively and positively there absolutely is no standard that would state that an arbitrary two-year limit was the correct way to treat people with opiate addiction," Publicker says. "And I'm part of a national mentor network for Suboxone treatment sponsored by the Center for Substance Abuse Treatment which is the division of SAMSHA that is responsible for Suboxone maintenance." Physicians are not permitted to treat more than 100 patients each with Suboxone. And Dr. Publicker says he and the two partners in his practice see fewer than 300 combined. But he says about 70 percent of his patients have been taking Suboxone for longer than two years, something that is determined on an individual basis, as is typical in chronic disease cases. If the state's proposed limit is accepted, Publicker says, it will result in as much as 90 percent of patients relapsing because they are withdrawn too soon. "It's a guarantee that all of these patients will relapse back to severe addiction, and unfortunately, they will be at heightened risk of drug overdose because their tolerances will be decreased." "Let me be up front and say we definitely know that not everybody is on board with this proposal," says MaineCare Director Stefani Nadeau. Nadeau says she's hearing from a large provider network that it's not the right treatment. "We definitely are not doing this to put people out on the street without any treatment," she says. "Again, we are hoping to --or we will--put the provision in place that if a physician can document medical necessity, than we absolutely will go above and beyond that two-year limit." But that comes as little consolation to Deb Dettor of the Maine Alliance for Addiction Recovery, who attended a statewide summit on opiate addiction last week. "And I was there at that summit and we were talking about how to get more resources and supports to people, and so this is completely contra-indicated given that conference and given what we need to have happen in our community here." As pointed out at the conference, Maine continues to have the highest per capita rate of people seeking treatment for opiate abuse in the country. And Dettor says she's skeptical that any long-term savings will be achieved by arbitrarily setting limits on people's access to treatment.