Morning Sentinel
December 3, 2011
Doctors, Addicts Decry Drug Limit
A proposed two-year limit on Medicaid coverage for a widely used medicine for opiate addicts would lead to increased addiction and overdose deaths at a time when the state is trying to turn the tide on a prescription drug abuse epidemic, according to physicians and addicts.
The proposal to limit Suboxone prescriptions would save the state an estimated $787,000 a year, according to the Streamline and Prioritize Core Government Services Task Force. Task force members included the limit in a $25 million package of proposed cuts submitted to the Legislature this week.
Opponents say it would ultimately cost the state much more in health care and crime costs related to addiction, however.
"They are not going to see the savings they expect to see form this strategy," said Eric Haram, president of the Maine Association of Substance Abuse Programs and director of the Addiction Resource Center at Mid Coast Hospital in Brunswick.
Some recovering addicts need longer than others to taper off the medication, just like some diabetics need to take insulin longer than others, Haram said. "If you make everybody get off insulin (at the same time), my guess is the health care costs would go up."
And cutting off addiction treatment will cost more than dollars, the doctors said."Ninety percent of my patients will relapse and a significant percentage of them will die from overdoses," said Dr. Mark Publicker, addiction specialist with Mercy Recovery Center in Westbrook.
While a relatively small piece of the $25 million streamlining package, the proposal has been one of the most controversial. Opponents plan to take their case to the Legislature's Appropriations Committee when it holds a yet-to-be scheduled hearing in the package in the coming weeks.
The proposal is moving forward a little more than one month after a statewide summit to address a growing prescription drug abuse epidemic that has caused more than 1,000 fatal overdoses in Maine in the past decade. Gov. Paul LePage appeared at the summit and pledged to support renewed efforts to fight addiction, including treatment for addicts.
"We need to get these drugs out of the hands of the wrong people. Those who have addictions, we need to treat them," LePage said at the time.
Administration officials supported the proposal during meetings of the task force. But a spokeswoman in the governor's office said Friday LePage may be open to alternatives.
"The governor did sign off on that recommendation. However, the governor has continued to get more information surrounding this since the recommendation has been put forward," Adrienne Bennett said. "It's important to note that while the two year limit is the task force's recommendation, this is not set in stone."
Bennett also said the governor wants to make sure there is a strategy to move people off of the treatments over time. "This is treatment that is being paid for by taxpayers forever and that's not something the Governor supports," she said.About 12,000 Mainers received a prescription for Suboxone or another form of buprenorphine, its active ingredient, in the past year, according to the Maine Office of Substance Abuse. Treatments cost about $300 per month for each patient and a large percentage of those patients are covered by MaineCare.
The treatment limit is one of many difficult cuts that are necessary given the state's financial situation, said Joseph Bruno, a former House Republican leader and member of the task force who supported the two-year limit.
Bruno, a parmacy owner, said he believes a significant number of patients getting suboxone are abusing it or other drugs. Those are the people the task force wants to cut off, he said.
The task force has agreed to include an exception to the two-year limit when a physician believes it is a medical necessity to continue Suboxone treatment beyond two years.
"It's not like we're cutting people off cold turkey," Bruno said. "If there's a medical necessity and an explanation of why they need to go beyond two years (and) if somebody is working and doing well," they should be allowed to stay in treatment.
Guy Cousins, director of the Maine Office of Substance Avenue, said the medical necessity exception means the limit could be imposed without worsening the state's addiction problem. "We felt like this was certainly something that could make the proposal workable," he said.
However, physicians who treat addicts say such exceptions would likely be restricted and difficult to get. If not, every patient would qualify, they said.
"What's medical necessity? If I have somebody who is stable, living a great life, supporting a family, has great health? The benefit of the drug is long-term chronic care," Publicker said. "Everyone who's on it who is going to be abruptly withdrawn is going to relapse."Doctors said they try to taper addicts off Suboxone as soon as they can, starting a few months into treatment. The physicians are limited to 100 Suboxone patients each and most have waiting lists of addicts who want treatment.
Steven Weisberger, a primary care doctor in Jonesport, said he has 30 people waiting for treatment but it can take a long time for an addict to recover when they face joblessness and other problems that fueled their addiction in the first place.
James Cox of Jonesboro has been taking Suboxone for three years after a 10-year addiction to painkillers. The 33-year-old has tapered down to just three miligrams a day.
"I've tried going a couple of days without (Suboxone) before and it's tough. Your bones hurt and you feel sick and you can't do anything," he said. He said he and other recovering addicts would likely have to travel to a methadone clinic or buy drugs on the street again.
"It's going to be a real big temptation," he said. "I'll need something for a while."
I guess Ms Kelley was just growing for herself here. She just has a bad habit.
