Treating opioid addiction may be harder than you think

Treating opioid addiction may be harder than you think
© iStock/MoMorad

OHSU study finds it’s easy to get opioids but increasingly difficult to get medical assisted help when it comes to treating opioid addiction.

According to a research letter published in the Journal of the American Medical Association, insurance industry cost-control measures may be worsening America’s opioid epidemic by limiting access to key medication, therefore treating opioid addiction may be harder than necessary.

Insurance rules make it harder treating opioid addiction

Despite the medical profession’s growing acceptance of the need for medications for addiction treatment that give hope to people suffering with opioid use disorder, according to Oregon Health & Science University (OHSU), USA, insurance rules increasingly limited the use of buprenorphine among Medicare beneficiaries between 2007 and 2018.

Todd Korthuis, M.D., M.P.H., professor of medicine and public health and preventative medicine in the OHSU School of Medicine, explains: “Buprenorphine is a safe and effective treatment that decreases deaths due to opioids and stops heroin and other opioid use.

“People on buprenorphine are able to get their lives back together.

“Medicare insurance companies are making it increasingly difficult to prescribe buprenorphine while making it easy to prescribe opioid pain medications that contributed to the opioid epidemic.”

Details of the study

Researchers analysed publicly available formulary files maintained by Medicare Part D prescription drug plan. They focused on examining the rate of pre-authorisation requirements because it’s a commonly used practice that insurance companies use to manage or limit access to certain drugs.

Daniel Hartung, associate professor in the OHSU/OSU College of Pharmacy, explains: “Prior authorisation policies are commonly used to control costs or manage pharmacy utilisation, however they can also disrupt or delay treatment for individuals who are vulnerable to relapse,”

“Access to buprenorphine is vital within the Medicare program because Medicare has not historically covered methadone, which is the other opioid agonist indicated for opioid use disorder.”

Regarding buprenorphine, researchers found that the proportion of insurance plans offering buprenorphine without restriction plummeted from 89% in 2007 to 35% in 2018. By comparison, they found that access to opioids fuelling the epidemic was comparatively easy: 93% to 100% of plans covered prescription opioids with no restrictions.

So, why are there restrictions?

“The reasons for restrictions on buprenorphine might reflect inaccurate perceptions of drug risk, societal norms related to the stigma of addiction, or financial considerations.” the authors write.

Approved by the Food and Drug Administration in 2002, buprenorphine relieves withdrawal symptoms and pain, and normalises brain function by acting on the same targets in the brain as prescription opioids or heroin.

It is one of three medicines approved by the FDA for treating opioid addiction, along with methadone and naltrexone.

Insurance coverage for buprenorphine appears to be falling at exactly the time that medication treatment of opioid use disorder is becoming more widely embraced in the medical profession.

Drugs vs drugs

The U.S. Substance Abuse and Mental Health Services Administration recommends the use of medications such as buprenorphine as an effective response to the opioid crisis.

In September, Oregon enacted a rule that prevents addiction treatment providers from refusing to treat people who are taking buprenorphine or other medication-assisted therapies.

“Many people still believe that medication treatment isn’t really recovery,” Korthuis concludes.

“Overwhelming scientific evidence supports that medicines like buprenorphine are far more successful and safer than abstinence-only approaches. Buprenorphine saves lives. Abstinence-based approaches don’t.”

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