January 1st, 2012

Cap recommended on addiction treatment

Maine state budget task force recommended a two-year MaineCare limit on Suboxone – a replacement drug used for the treatment of opiate addiction – as part of an effort to trim $25 million from the state budget.

The recommendation was one of the many cuts submitted to the Streamline and Prioritize Core Government Services Task Force by the Department of Health and Human Services, which was asked to submit proposed cuts to the task force. The overall package included administrative efficiencies like reduction of the cost of leased space and reduced travel expenditures and reductions in funding of certain programs.

The task force was scheduled to report its recommendations to the Joint Standing Committee on Appropriations and Financial Affairs by Dec. 15. The recommendations need approval of the Legislature, which reconvenes in January.

The proposed cuts are for fiscal year 2012-13, and according to the draft bill, the two-year MaineCare limit on Suboxone would save the state just over $787,000.

The recommendation has been criticized by addiction specialists and those who receive Suboxone treatment.

Guy R. Cousins, LCSW, LADC, CCS, director of the state’s Office of Substance Abuse, says MaineCare, the state’s Medicaid program, proposed the cap be two years.

“They had looked at national information and they found that to be the average,” Cousins says. “It’s not based on a national standard, just based on what they were coming up with in terms of the average length people were actually taking (Suboxone).”

Ronald Breazeale, Ph.D., a clinical psychologist in Maine with more than 30 years of experience in the fields of mental health and alcohol and drug abuse treatment, thinks a two-year limit is arbitrary.

“That’s not a standard of care I would want to see,” he says. “Open-end treatment in my experience is the medical standard for care. I don’t think one size fits everyone.”

Cousins says that if deemed a medical necessity by the prescribing physician, treatment could continue past the two-year cap.

Suboxone is considered most effective when paired with behavioral health therapy. Cousins says there is a challenge in terms of helping prescribing physicians become aware of what resources are available to them when prescribing Suboxone. “Best practice model is to have behavioral health intervention counseling as a conjunction to the medication itself.”

Breazeale says counseling in treatment clinics alone is sometimes inadequate. “There’s a lot more that needs to be done in psychological treatments and counseling. More physicians seem to be requiring someone in this treatment to see someone and work with someone, if they are going to prescribe the Suboxone.

He fears a limit on Suboxone might push some people back into addiction. “These are people who are trying to put their lives back together,” he says. “It takes quite a while to do that. I don’t think the pressure of putting a limit on treatment is a good idea.”

By Pamela Berard

One Response to Cap recommended on addiction treatment

  • January 9th, 2012 at 9:16 pm Trishina posted:

    My doctor informed me of this proposal a couple of weeks ago. I do not understand why there wasn’t any research into the lives of people who have literally been SAVED from either being on Suboxone or related to someone who is being treated with it. I personally know several people who have gone through doctors that have a 12-18month prescribing limit and those patients don’t just stop. They either get Suboxone off the street,go to the methadone clinic or worse…begin using again. Speaking personally as a patient and as a Substance Abuse Counselor, I agree that “one size” does not fit everyone. Opiate addiction is a lifelong battle that can be fought with counseling, meetings, a good support system and Suboxone. I know that there are patients on Suboxone that are not taking their prescriptions properly and some that are even selling their medication, but they only make up a very small percentage of Suboxone patients. If mainecare really wanted to make a difference on the amount of money being spent on prescriptions they should take a look at ALL the patients being prescribed actual opiates; Oxycontin,Roxycodone,Oxycodone,Morphine and such. Why aren’t there time limits on those medications? The length of time these are prescribed along with the high doses allowed by the prescribers is obnoxious. It is my opinion that these two issues should be addressed first when looking for somewhere to make budget cuts. Just think of how many people wouldn’t even have the option to try these drugs if there were strict guidelines and time limits. Suboxone has helped me in my battle against opiate addiction, it is like I have my life back. It is such an amazing thing to be able to live my life like I’m supposed to…a daughter,a sister,a cousin,a niece,a grand daughter,a friend,a positively contributing person in society and most importantly a MOTHER!

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