Task Force to Fight Limitations on Addiction Treatments

Jutting into the Atlantic at the very northeast corner of the United States, Maine appears to be pointing the way for the other states, and in its reaction to Medicaid budget cuts for treating addiction, it is.

The path Maine is taking, though, is not really forward, but more of a step backward, according to some addiction specialists. Maine has implemented policies that limit patient access to buprenorphine and methadone, medications used to treat opioid dependence. It is not the first state to do so, but its policies are among the most restrictive. Other states have followed suit, but ASAM and its chapters also are taking notes on how to fight a battle that began in Maine.

“Maine is where the firefight was defined,” said Mark L. Kraus, MD, FASAM, Co-chair of the ASAM Patient Advocacy Task Force (PATF) created to lead the fight against other states placing treatment limits on opioid addiction pharmacotherapies such as buprenorphine, methadone, and injectable naltexone. The role of the PATF and ASAM’s efforts to reverse this trend will be addressed in Component Session 7, “Patient Access to Medication Assisted Treatment: Responding to State.” The session will be presented from 2 to 4 pm today in Williford C, on the third floor of the Hilton Chicago.

“We are talking about a personal disaster for the entire population of patients on buprenorphine and methadone. People who are building good lives, raising families, and working would be thrown into withdrawal,” said Mark Publicker, MD, FASAM, a PATF member and President of the Northern New England Society of Addiction Medicine who is leading the fight against restrictions in Maine. “The majority undoubtedly would have a relapse to drug addiction and all of the problems that you would expect, and problems that these medications are very effective at stopping would return—illness, crime, child neglect.

“It was all done for purely fiscal reasons. There wasn’t a clinical basis for believing it was a bad treatment. Rather, it was explicitly looked at as a cost-savings.”

ASAM, through the PATF, has gathered support from a broad range of public and private sector groups. Groups supporting the ASAM effort include the National Institute on Drug Abuse, the Substance Abuse and Mental Health Services Administration, the Office of National Drug Control Policy, and pharmaceutical and insurance companies, Dr. Kraus said.

The PATF is using this support to build a case against, and reverse, the trend toward treatment limitations. The PATF’s efforts also will help to identify good models of access that can be shared with public and private payers.

“We thought we needed to put forward an effort to find the information that is lacking, to really examine the problem,” Dr Kraus said. “We also recognized there wasn’t any comprehensive review of the literature on the treatment efficacy or on the cost benefits of these treatments.

“We are hoping that after this is done and analyzed that we will have proved our point, and then we will bring it out to our sister organizations and the public. After we show there is efficacy and that this is something that needs to be directed, we need to convince policymakers and payers of the efficacy of going forward to use these medications and to understand how certain payers are providing good examples of access to assure optimal patient care.”

Dr. Publicker said the effort to save money now would cost more in the long run.

“The amount of money they were predicting they would save is decimal dust, like $800,000 for the 2013 fiscal year [in Maine],” he said. “The cost in terms of human lives is enormous. We know that every dollar invested in effective addiction treatment returns $7 in savings. They were interested in pharmacy savings, but disregarded the longer term consequences of expansion of illnesses like HIV and hepatitis C, the loss of jobs, the increase in the crime rate, childhood abuse, and neglect. Those were all not considered.

“ASAM is the voice for our patients. Largely, our patients are voiceless because of stigma and the need to protect confidentiality with a disease that is regarded as stigmatized. Our patients, by and large, don’t speak for themselves, so ASAM has to be their voice.”