Access to medications designed to treat opioid addiction is being routinely denied because of a myriad of restrictions by state Medicaid plans and insurance companies, according to a new report by the American Society of Addiction Medicine (ASAM).
The ASAM says an easing of bureaucratic red tape could help reverse an epidemic of opioid addiction and overdoses that claim 15,000 lives each year. An estimated 4 million Americans are addicted to prescription or illegal opioids.
“These reports show that we could be saving lives and effectively treating the disease of addiction if state governments and insurance companies remove roadblocks to the use of these medications,” said Stuart Gitlow, MD, President of ASAM.
“Treatment professionals need every evidence-based tool available to end suffering from this chronic disease. State lawmakers and insurance company administrators would never deny needed medication to people suffering from other chronic diseases, like diabetes and hypertension. But it happens every day to people with addiction.”
The report examined 642 studies that evaluated buprenorphine, methadone and naltrexone, the three primary medications approved by the FDA for treating opioid addiction. Buprenorphine is more widely known under the brand name Suboxone, which is produced by Reckitt Benckiser, one of several drug companies that funded the ASAM report.
The report found that the use of addiction medications shows substantial evidence of their effectiveness in reducing the frequency of drug use, as well as withdrawal symptoms, drug craving and overdoses. Researchers say use of the drugs also reduces the spread of infectious diseases and criminal behavior, and improves social functioning.
Despite their effectiveness, restrictions on use of the drugs vary widely from state to state. Coverage limits for lifetime benefits and daily dosages are common, creating what the authors describe as a “de facto denial of access.”
Restrictive prior authorizations add another level of obstacles, with many states and insurance companies requiring that other addiction treatment plans “fail first” before addiction medications are covered.
“The fact that patients are frequently denied access to the full spectrum of treatment options for addiction is unethical and would constitute malpractice in other medical specialties and chronic disease treatment,” said Thomas McLellan, a report author who is CEO of the Treatment Research Institute and former Deputy Director of the White House Office of National Drug Control Policy.
“Treatment of addiction must be raised to the same medical and ethical standards as treatment for other chronic diseases. This needs to be acknowledged by the treatment community, medical specialties, insurance companies and all levels of government.”
The report noted that in one southern state only one methadone treatment clinic was eligible for Medicaid reimbursement.
A report earlier this year found that abuse of buprenorphine (Suboxone), is sending ten times as many people to hospital emergency rooms as it did a few years ago. Over half of the hospitalizations were for non-medical use with some taking the drug to get high.
While naltrexone helps patients overcome opioid addiction by blocking the drugs’ euphoric effects, it is considered generally safe and non-addictive. Methadone is a synthetic opioid that can stabilize a patient by mitigating withdrawal symptoms, but is also addictive and often abused.
Nonetheless, researchers say despite the potential danger, the medications raise addiction treatment success rates.
“Medical science supports the use of addiction medications to effectively treat the disease of addiction. This science must be the basis of state policies, insurance coverage and national standards for the treatment of addiction,” said Dr. Gitlow.
“Restrictions by states and insurance companies make no sense when opioid addiction and overdose deaths have grown into a national epidemic.”