October 5th, 2015

Government Aid With Access To Buprenorphine

Kolmac does not receive government funds, but governmental assistance is sometimes welcome to help overcome barriers to treatment. At the Annual Meeting of MDSAM, the Maryland Chapter of the American Society of Addiction Medicine, I asked for help from Boyd Rutherford, the Maryland Lieutenant Governor. He was there giving a keynote speech about the importance of increasing access to addiction treatment in response to the upsurge of opioid problems in the state. This includes access to buprenorphine.

Buprenorphine is a medication that has improved treatment outcomes for opioid addictions as well as reducing the number of overdose deaths. Several problems exist, however, for patients to gain access to it. Some insurance companies, for example, have instituted pre-authorization procedures that can delay the filling of prescriptions for up to three days. These delays can lead to relapses by patients who are motivated to begin treatment but who cannot be reasonably expected to tolerate the extreme discomfort of opioid withdrawal symptoms while waiting for the prescription to be approved. Moreover, the prescription requests are never denied, and there is no evidence that there is any economic benefit derived from the process.

In my role as Co-Chair of the Addiction Committee of MedChi, I submitted a resolution for adoption by the Medical Society House of Delegates to ban such pre-authorization procedures in Maryland. I am told that the likelihood of adoption this fall is high, after which the resolution would be submitted to the Maryland State Legislature. Support for this proposal is what I requested from the Lieutenant Governor, who responded positively. Two other speakers at the event, Dr. Leana Wen and Stephanie Garrity, the chief health officers of Baltimore City and Cecil County respectively, expressed their support for such a ban.

On a Federal level, Health and Human Services Secretary Sylvia Burwell indicated that she will exercise her regulatory power to improve access to buprenorphine. My best guess is that she will loosen the regulation that limits physicians to treating 100 addiction patients with this medication. Although there is a danger that such a change could lead to the development of high volume “buprenorphine mills,” the alleviation of the access problems caused by the current limit would probably outweigh this danger.

The best news is that buprenorphine is being more widely used; there are now approximately one million addicts in this country who are taking it. Furthermore, there are more meetings of Narcotics Anonymous that are considering these people to be “in recovery” and are therefore granting them the full privileges in that organization. Finally, more traditional 12-step, abstinence-based residential treatment programs are beginning to expand their use of buprenorphine. One example is Hazelden Betty Ford, which will be featured in Modern Addiction Recovery later this month.

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