Traverse City Record-Eagle


May 16, 2014

Forum: Opioid addiction treatable, but not curable

At the recent American Society of Addiction Medicine conference I attended there was a great sense of enthusiasm that relief is on the way for many of our patients who suffer from addictive disorders.

As in other chronic illnesses, many cases of opioid addiction cannot be cured. Fortunately, like other chronic diseases, opioid addiction can be treated and patients can maintain an improved and essentially normal quality of life. The key is to interrupt the cycle of addiction, which allows patients to gain control over their use and engage in full recovery.

There are currently two FDA-approved medications that are widely used for opioid dependence in the United States: 1.) Methadone — which can only be used at methadone treatment facilities, and 2.) Buprenorphine — which can be prescribed by doctors who obtain a special waiver to allow them to provide clinic-based treatment.

Both medications have shown substantive evidence of effectiveness and safety as evidenced by increased patient retention in treatment, reduced risk of infectious disease transmission, reduced criminal activities, improved social functioning, and reduced risk of overdose and death.

In 2014 two significant health care policies should greatly help patients get the care they need: 1.) The Affordable Care Act is helping those who were uninsured (or uninsurable) obtain quality health insurance. 2.) The Mental Health Parity and Addiction Equity Act requires insurance groups that offer coverage for mental health or substance use disorders to provide the same level of benefits that they do for general medical treatment.

Unfortunately, the State of Michigan is lagging behind in regards to allowing access to evidenced-based treatment for opioid dependence. A prior authorization process for buprenorphine is currently in place by Michigan Medicaid’s pharmacy benefit manager (Magellan) that is arbitrarily restrictive and can lead to a delay in care. Remarkably, on the prior authorization form there is a statement that medication assisted treatment longer than 12 months is not (generally) supported. Does this mean that there is the expectation of having a cure within 12 months? What other chronic disease would have such a discriminatory statement linked to a potentially life-saving medication? Would it seem appropriate to arbitrarily limit a medication for depression, high cholesterol, diabetes, seizures, hypertension, or rheumatoid arthritis? Of course not.

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