Answer Addiction

Tag: Medicare

  • Inside The Methadone Clinic Boom

    Inside The Methadone Clinic Boom

    “We haven’t seen such a dramatic increase in the industry since the 1970s,” says one expert.

    The methadone treatment industry has exploded from 2014 to 2018, growing more in those four years than in the past two decades, the Boston Globe reports. 

    In the past four years, according to Drug Enforcement Administration (DEA) data, the industry has added 254 new clinics. The clinics allow for the administration of methadone, which is a type of long-acting opioid that can help short-acting opioid users manage withdrawals and allow them more time to detox, WebMD states.

    “We haven’t seen such a dramatic increase in the industry since the 1970s,” Mark Parrino, president of the American Association for the Treatment of Opioid Dependence, told the Globe. 

    Critics of methadone treatment say it is just replacing one substance for another. Yngvild Olsen, an addiction doctor in Baltimore and board member of the American Society of Addiction Medicine, tells the Globe that needs to change.

    “There has been an underlying stigma against methadone for so many years that the industry naturally maintains a low profile,” she said. “Even now, access to methadone is highly geographic. It depends on where you live.”

    Indiana, Maryland, and New York have been at the forefront of states with access to methadone treatment, implementing dozens of new clinics in the past two years alone. Ohio and Florida plan to follow suit with expansions in the works.

    There are some states where laws limit the availability of such clinics. These include Georgia, Indiana, Louisiana, Mississippi, West Virginia, and Wyoming. 

    Even so, the clinics are becoming more common, as in the past four years Medicaid has expanded its coverage and reimbursement for such services for low-income adults. And, in 2020, Medicare coverage of the treatment for those 65 and older will begin as part of the Opioid Crisis Response Act, meaning the need could become even greater. 

    If a state wishes to open such a clinic, they must apply for a license, Parrino tells the Globe.

    While there are other medications to assist in curbing opioid withdrawals, such as buprenorphine, methadone is the most highly regulated. 

    The Globe reports that often, patients are given methadone through a plexiglass shield. Patients are often screened to make sure they are not combining methadone with other drugs. At first, they are only given the medication in the clinic, under the watch of a professional. Eventually, some patients are allowed take-home doses. 

    In contrast, buprenorphine can be prescribed for 30 days at a time by doctors, nurse practitioners, and physician assistants and is viewed as the more obvious treatment by some. 

    “There’s no question that better access to methadone maintenance would save lives,” Andrew Kolodny, co-director of opioid treatment research at Brandeis University, told the Globe. “But for an addiction epidemic that is disproportionately rural and suburban, an intervention that relies on people visiting a clinic every day isn’t the best option. Buprenorphine would be better, but it’s not growing quickly enough.”

    View the original article at thefix.com

  • Pain Patients Turn To Controversial Injection After Cuts To Opioid Coverage

    Pain Patients Turn To Controversial Injection After Cuts To Opioid Coverage

    The anti-inflammatory drug has been banned in Australia, Brazil, Canada, France, Italy, New Zealand and Switzerland.

    Back problems are the most common cause of chronic pain, and at the time when Medicare is cutting coverage for many opioid pain relievers, lawmakers are increasing Medicare coverage for a potentially dangerous off-label treatment for back pain. 

    Depo-Medrol is an injectable anti-inflammatory drug made by Pfizer. When it is injected into muscles and joints it can provide pain relief, but the drug is not supposed to be injected into or near the spinal chord. In fact, in 2013 Pfizer asked the Food and Drug Administration to ban back injections.

    The FDA declined to issue the ban, despite the fact that Australia, Brazil, Canada, France, Italy, New Zealand and Switzerland all issued bans, according to The New York Times. 

    “Serious neurologic events, some resulting in death, have been reported with epidural injection of corticosteroids,” Pfizer told the FDA. “Specific events reported include, but are not limited to, spinal cord infarction, paraplegia, quadriplegia, cortical blindness, and stroke.”

    In June, legislators approved an increase in reimbursements for the Depo-Medrol shot.

    At the same time, Medicare finalized a restrictive plan for covering opioids that will make it difficult for all but the most severe patients to access opioids long-term. This combination could make injectables a more appealing treatment, despite their risks. 

    “The victims of our era of aggressive opioid prescribing are being exploited in some cases by interventional pain doctors, who will continue them on opioids in exchange for allowing them to perform expensive procedures that they don’t need,” said Dr. Andrew Kolodny, co-director of opioid policy research at Brandeis University and executive director of Physicians for Responsible Opioid Prescribing. “These are not benign procedures. Patients can be harmed and are harmed.”

    Despite this, use of Depo-Medrol and similar drugs increased 7.5% among Medicare patients between 2012 and 2016. Dr. James P. Rathmell, chairman of anesthesiology, perioperative and pain medicine at Brigham and Women’s Hospital, said that Medicare coverage policies have the potential to make the shots even more popular. 

    “The truth underlying it is that doing an injection is faster and results in higher reimbursements, compared to other ways of managing the same pain,” he said. “The use of injections has increased dramatically, yet the prevalence of back pain has remained relatively unchanged.”

    Dr. Brian Yee, an anesthesiologist who practices in West Virginia, said that injections have the potential to be useful, but that they need to be handled carefully in order to ensure that they are being used responsibly. 

    “With people trying to take away opioids now, we are opening up another doorway for people to overutilize other options that can be helpful with the right doctors and the right patients,” he said.

    View the original article at thefix.com

  • Medication-Assisted Treatment Options Limited For Medicare Recipients

    Medication-Assisted Treatment Options Limited For Medicare Recipients

    “Medicare beneficiaries have among the fastest growing rate of opioid use disorder, but they don’t currently have coverage for the most effective treatment,” says one official.

    Medication-assisted treatment (MAT) for opioid addiction and dependence is now seen as the gold standard of care by many addiction treatment professionals, but barriers to treatment make it difficult for many Americans over the age of 65 to access medication-assisted treatment on Medicare. 

    According to a report by the Associated Press, Medicare, the federal health insurance program for seniors, will not cover treatment with methadone, one of the oldest and most effective forms of medication-assisted treatment.

    The program covers buprenorphine, another form of MAT, but only a fraction of doctors who accept Medicare have obtained a federal waiver that allows them to prescribe buprenorphine. 

    This combination leaves a vulnerable population at risk. The AP reports that 300,000 Medicare patients have been diagnosed with opioid addiction, but only 81,000 prescriptions for buprenorphine have been written for Medicare patients. 

    “Medicare beneficiaries have among the highest and fastest growing rate of opioid use disorder, but they don’t currently have coverage for the most effective treatment,” said Rep. George Holding, a Republican from North Carolina. Holding is sponsoring a bill that would recommend changes to Medicare’s policy toward methadone. 

    Some patients on Medicaid can access methadone treatment, either by paying about $80 per week out of pocket or qualifying for state programs that cover the treatment. However, worrying about how and if their treatment will be covered can take a real toll on their mental health. 

    Joseph Purvis, a former heroin and prescription painkiller user, said he became depressed when he realized that Medicare might not cover his methadone treatment. “I was terrified that I might have to leave the program,” he said. “There’s no way I wanted to go back to addiction on the streets.” 

    Luckily, he was able to access treatment, thanks to a state program. However, he believes that Medicaid should cover this important treatment. “Some people think of methadone as a crutch for addiction but it’s not,” Purvis said. “It’s a tool that allows people to live a somewhat normal life.”

    The issue of access to MAT is especially important given that Medicaid just passed regulations drastically tightening access to opioid pills. The restrictions passed despite objections from some medical professionals who said that many seniors are on high levels of opioids that need to be carefully reduced. 

    “The decision to taper opioids should be based on whether the benefits for pain and function outweigh the harm for that patient,” Dr. Joanna L. Starrels, an opioid researcher and associate professor at Albert Einstein College of Medicine, said in response to the regulations. “That takes a lot of clinical judgment. It’s individualized and nuanced. We can’t codify it with an arbitrary threshold.”

    View the original article at thefix.com

  • Are Health Insurers Driving The Opioid Crisis?

    Are Health Insurers Driving The Opioid Crisis?

    While the brunt of the negative attention has focused on drug suppliers and prescribers, experts are now examining the role that insurers have played in the epidemic.

    Health insurers could be stoking the opioid epidemic, according to a new study published Friday in the journal JAMA Network Open.

    “Our findings suggest that both public and private insurers, at least unwittingly, have contributed importantly to the epidemic,” said study senior author Dr. G. Caleb Alexander, an associate professor in the Bloomberg School’s Department of Epidemiology.

    That’s based on a 2017 analysis of 15 Medicaid plans, 15 Medicare plans and 20 private insurers, which revealed that many aren’t applying evidence-based “utilization management” rules that could cut down on opioid overuse.

    “Opioids are just one tool in the pain management tool box, and unfortunately, many of the plans that we examined didn’t have well-developed policies in place to limit their overuse,” Alexander said. 

    The study comes even as a long-term uptick in opioid-related deaths has pushed dozens of states, counties, and cities to launch lawsuits against drug companies and distributors that make and provide the addictive prescription painkillers fueling the overdose crisis. 

    For the most part, the brunt of the negative attention has focused on drug suppliers and prescribers rather than on insurers, but the new findings by the Johns Hopkins Bloomberg School of Public Health probes what roles insurance plans could play in the epidemic.

    The researchers identified specific utilization management tools that insurers may not be relying on enough, such as restricting the quantity of drugs doctors can prescribe, requiring prior authorization or mandating that providers begin with less risky drug alternatives. 

    Quantity limits are commonly used for opioids—but those limits might still be higher than they should be, the researchers found. Generally, insurers capped scripts at a 30-day supply instead of the shorter limit recommended by the CDC. 

    Across all the plans studied in Medicare, Medicaid and commercial insurers, doctors typically weren’t required to start with less addictive alternatives like over-the-counter NSAIDs before doling out more powerful opioids.

    A median of just 9% of the covered opioids in Medicaid plans required doctors to start with something less risky first, the researchers found. For commercial plans, the median number was around 4%. Medicare plans typically had almost no so-called “step therapy” requirement. 

    The majority of opioid prescriptions didn’t require prior authorization, which is when the prescriber has to call the insurer for approval before writing the prescription. Some insurers, however, have begun putting such policies in place for patients with chronic, non-cancer pain. 

    “Insurers can either be part of the problem, or part of the solution,” Alexander said. “The good news is that an increasing number of health plans are recognizing their contribution to the epidemic and developing new policies to address it. The bad news is that we have a very long way to go.”

    The analysis comes on the heels of a 2017 deep-dive by the New York Times and ProPublica, which found that many insurers limited access to less addictive —but more expensive—alternatives. 

    “This is not a hypothetical problem,” Rep. Elijah Cummings (D-Maryland), later wrote in a letter to insurance companies. “In my home state of Maryland, 550 people died of an overdose in the first three months of 2017 alone. Synthetic opioids like fentanyl are driving up the epidemic’s death toll, but prescription opioids contribute significantly to this crisis by fostering addiction and causing fatal overdoses.”

    View the original article at thefix.com