Treating opioid addiction can be harder than you think

An OHSU study shows that it is easy to get opioids, but increasingly difficult to get medical help to treat opioid addiction.

According to a research letter published in the Journal of the American Medical Association, the cost-control measures of the insurance industry could worsen the opioid epidemic in America by limiting access to essential drugs; therefore, the treatment of opioid dependence may be more difficult than necessary.

Insurance rules make it harder to treat opioid addiction

Despite the growing acceptance by the medical profession of the need for drugs for the treatment of drug addiction that give hope to people with a disorder of use. Opioids, according to the Oregon Health & Science University (OHSU), USA, insurance rules were increasingly limiting the use of buprenorphine by the 2007 and 2018.

Todd Korthuis, MD, MPH, Professor of Medicine, Public Health and Preventive Medicine at the OHSU School of Medicine, explains, "Buprenorphine is a safe and effective treatment that reduces the number of deaths from opioids and stops the consumption of drugs. Heroin and other opioids.

"People taking buprenorphine are able to resume their lives.

"Medicare companies are making it increasingly difficult to prescribe buprenorphine, while facilitating the prescription of opioid pain medications that have contributed to the opioid epidemic."

Details of the study

The researchers badyzed the publicly available form files managed by the Medicare Part D prescription drug plan. They focused on the pre-approval rate review as it is a practice commonly used by insurance companies to manage or limit access to certain drugs.

Daniel Hartung, badociate professor at the OHSU / OSU College of Pharmacy, explains: "Pre-authorization policies are commonly used to control costs or manage the use of the pharmacy, but they can also disrupt or delay the use of pharmacy. treatment of people vulnerable to relapse ".

"Access to buprenorphine is vital to the Medicare program because Medicare has never covered methadone, which is the other opioid agonist indicated for opioid disorder."

With respect to buprenorphine, researchers found that the proportion of insurance plans offering unrestricted buprenorphine dropped from 89% in 2007 to 35% in 2018. In comparison, they found that access to opioids that fueled the epidemic was relatively easy: 93% to 100% of opioid prescription regimens covered without restrictions.

So why are there restrictions?

"The reasons for the buprenorphine restrictions may reflect a misperception of drug risk, social norms related to the stigma of addiction, or financial considerations," write the authors.

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

It is one of three FDA-approved drugs for the treatment of opioid addiction, alongside methadone and naltrexone.

The insurance coverage for buprenorphine appears to be diminishing just as the medical treatment of opioid use disorder is increasingly being adopted by the medical profession.

Drugs vs drugs

The US administration of addiction treatment and mental health services recommends the use of drugs such as buprenorphine as an effective response to the opioid crisis.

In September, Oregon adopted a rule preventing drug treatment providers from refusing to treat people taking buprenorphine or other drug-badisted therapies.

"Many people still believe that drug treatment is not really a cure," Korthuis concludes.

"The overwhelming scientific evidence shows that drugs like buprenorphine are much more successful and safer than abstinence-only approaches. Buprenorphine saves lives. Abstinence-based approaches do not. "