Lessons From Maine’s Fight Against Limits on Addiction Treatment

Maine’s decision to retroactively limit Medicaid payments for buprenorphine to treat opiate addiction is likely to have disastrous consequences, warns the President of the Northern New England Society of Addiction Medicine.

As state budgets continue to tighten, more states are likely to take Maine’s lead, says Mark Publicker, MD. In some states, buprenorphine (Suboxone) and other opiate agonists may not be covered for addiction treatment, while other states are imposing prescribing and refill limits, says Publicker, who is also Medical Director of Mercy Recovery Center in Portland. He is calling on addiction treatment professionals to lead the battle to maintain the availability of medical treatment for addiction.

At the recent American Society of Addiction Medicine (ASAM) annual meeting, Dr. Publicker spoke about the new Medicaid limits on buprenorphine in Maine. He noted patients face a cutoff in medication after a maximum of two years of treatment. The limitations are retroactive, meaning patients on long-term therapy will be hit first and hardest, he said.

“The intent of the new limitations is to save money, but legislators had no concern about the fiscal consequences of such a move, such as increases in crime rates, illnesses, child neglect and an increased number of premature births, which are all anticipated to be far more costly than medications,” he says.

Targeting addiction treatment for budget cuts is an easy move for legislators, he adds. “Addiction is a highly stigmatized condition, and there is no grassroots organization that will rise up to oppose treatment limitations. There is a fundamental misunderstanding about addiction as a chronic disease, and the role of medication in maintenance management.”

Dr. Publicker and colleagues, with the help of ASAM and a number of other medical groups, lobbied against the limits in Maine, but were only able to get a one-year delay in the implementation of the retroactive limit.

“The impact will be disastrous,” he states. “Many of my patients have been on buprenorphine for more than two years, and are leading successful, healthy lives. Many, if not most, of my patients who have achieved sobriety on buprenorphine will go into withdrawal, and the relapse rate will be extremely high. My patients’ lives are at stake.”

In Maine, which is largely rural and poor, opiate addiction is endemic, according to Dr. Publicker. “In many areas, there are no alternatives to medication-assisted treatment. This is a treatment that primary care providers can offer in their offices.”

ASAM is developing a state-by-state survey about the status of buprenorphine limitations, Dr. Publicker notes. At the annual meeting, he urged his colleagues around the country to take action against legislative attempts to cut funding for medication-assisted treatment for addiction.

“The fight against limitations requires coalitions,” he says. “It requires a comprehensive approach involving organizational support and cooperation, effective lobbying, developing personal relationships with legislators and the executive branch, and public information involving the media. It is important to make the clinical case and the economic case against limitations. It is just as important to take this issue to the public, to enlist patients, patients’ families, and other advocacy organizations to join in the fight.”

10 Responses to Lessons From Maine’s Fight Against Limits on Addiction Treatment

  1. Sharon Dembinski | August 3, 2012 at 11:47 am

    Incredible stupidity and shortsightedness! We take 3 steps forward and 4 steps back in the fight against stigma- soooo frustrating! Let’s limit 2 years for the treatment of diabetes or heart disease too why don’t we? Addiction is a chronic. relapsing DISEASE people!

  2. Corina Hall | August 3, 2012 at 2:15 pm

    You know I comew from a long line of addicts so yes it is a disease and yes it can very well be heriditary. I think instead of trying to take it away they should help people like me who does not have health insurance to be able to be on a program that does the suboxone or, methadone for atleast 1 or 2 years depending on the person. I know it is costly and if I were to be able to pay for a doctor to guide it I surely could not afford to fill the prescription. They are very expensive here in Ohio. My baby sister had a herion addiction and 7 suboxone cost almost 100.00$ Now how can our country help us without insurance and money? I am a psych. student and I want to graduate and go on to help those with sddictions. Mine started because of my back, knees, hand , and neck. I cannot even afford my doctors appointments and prescriptions anymore. I am trying to get into a place that helps but it is a long waiting list and they only keep you for 7 days not nearly enough. What is wrong with our country, other countries have help for those with this disease, and IT IS A DISEASE!!! I think they like the money they make from locking people up. Do not stop supporting any good medications or programs that help and do not forget, the CHILDREN who need their parents to be drug free

  3. Dave | August 3, 2012 at 2:16 pm

    I wonder if Dr Publicker has taken a look at whether this action on limiting MaineCare payment for suboxone may be a violation of the Wellstone/Domenici Mental Health and Addictions Equity Act? As the previous comment suggests, we would not dream of limiting insulin for diabetes. So it may be illegal to limit medicine for Opiate Dependence. One quibble with Dr Publicker: if we begin tapering suboxone patients well before the cutoff, we won’t see much withdrawal. But we probably will see a lot of relapse.

    • Carlos | August 6, 2012 at 3:44 pm

      Thank you for the information on this act. I was not familiar with it.

  4. perryrants | August 3, 2012 at 7:05 pm

    I’m thinking that taking a med long term for addiction IS the problem unlike taking meds to keep a medical condition in check. and don’t give me the silly notion that it is a medical issue like diabetes. if you stop taking meds for the latter, you won’t rob people, you won’t steal, you won’t prostitute. you will have a good chance of dying. but drugs and alcohol are the reverse. you don’t die from not taking bube!

    • Carlos | August 6, 2012 at 3:36 pm

      Well, lets do that, let take diabetics of their meds. We’ll see if there soon will there be an underground sells of insuline. Maybe not, but we’ll put it to the test? (I am not sure it will past AMA’s committe on ethics) Inspite of professionals delusions, Hester and Miller has found that patients do have knowledge about what works for them. We can do the same thing with Naltrexone and Acamprosate for alcoholism treatment. Let’s see how the patients react.

    • Michael Sheehan md | August 7, 2012 at 10:21 am

      Yes addicts do die if not on maintenance treatment. Here in Florda there are 7 deaths per day from Opiate overdose, and a 5% annual mortality rate in Iv opiate users. Opiate dependence is a chronic relapsing potentially fatal disease with an effective medical treatment. I do not subscribe to the “pull yourself together school of addiction treatment”. Medication works. Nyswander and Dole showed this in the 1960s. Your personal opinion is contradicted by the 40 years of scientific evidence that has accumulated since.

    • Mkitty | September 19, 2012 at 2:06 pm

      To Perryrant
      Yes people do die. It’s the idea that you are perpetuating that is the problem. Everything is not black and white. Buprenorphrine withdrawal is deadly to pregnant women, for their babies. The withdrawal is also worse than heroin withdrawal. Please be open to information. We are all human beings.

  5. Carlos | August 6, 2012 at 3:28 pm

    Florida for the most part ignores what the patients tell them. They also ignore SAMHSA guidelines, and have taken patients of medication for one time relapse. They want patient to go to Narcotics Anonymous meetings ignoring that the word Anonymous means other people are not to snoop into the patients attendance or not (hell, the courts do the same) and the fact that it has been rule religious by 7 federal courts. What ever happened to the constitution? I understand Massachusets still one of the most reasonable states for Bupernorphine treatment.

  6. Mkitty | September 19, 2012 at 2:00 pm

    In Wisconsin this is already happening and it’s so refreshing to hear someone nail the problem on the head! I have been fighting with pharmacies and insurance for a decade and it’s only getting worse! There are no treatment centers left here where I live and the policy now is to jail all people using or not if they are even around drugs. So much for trying to help, its now against the law to be associated with anyone using. And anyone on a controlled substance is treated like a criminal by pharmacies, police and anyone involved in state or goverment, or insurance. It’s easier to get street drugs than to obtain a legitimate prescription. How is any of this helping?

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