Obtaining Effective Treatment For Addiction Big Challenge For Low-Income Americans
Back in 2014, the Affordable Care Act began requiring that Medicaid pay for all available substance abuse treatments. This provision was meant to help those in low income households who needed help for alcoholism or addiction.
But effective treatment for addiction, particularly opioid abuse, still isn’t easy to allocate for Medicaid recipients. This is partially due to rigid coverage restrictions, and the fact many physicians don’t want to treat Medicaid patients for addiction because of the low pay structure involved.
And unfortunately, Medicaid recipients suffer from opioid addiction and other substance use disorders at a higher rate that the rest of the population.
Dr. Kelly Clark, president-elect of the American Society of Addiction Medicine (ASAM):
“What we see in far too many Medicaid plans are restrictions and approaches to addiction treatment that are not in line with the way we treat other diseases. Some plans require patients to wean off of their addiction medications. Would you tell a heart patient he needs to taper off of his medication after a year?”
Barriers to Treatment
All states reimburse for addiction treatment medicine. However, in some states, the fees paid to physicians by Medicaid are low, and the resulting paperwork is time-consuming. Thus, few providers are willing to offer treatment for addiction to Medicaid participants.
Furthermore, Medicaid provisions have a myriad of requirements. These include prior authorizations, limitations on dosage and duration, prior failure at other treatments, high co-pays, and excessive counseling.
According to a new report on prescription sales nationwide, Medicaid pays for around 25% of all buprenorphine prescriptions (buprenorphine is an effective treatment for opioid addiction.) However, depending on the state, coverage limitations vary, and as a result many lower income people who need this treatment just aren’t getting it.
The report was funded by the non-profit group Advocates for Opioid Recovery. The report was conducted by IMS Institute for Healthcare Informatics, an organization that collects nationwide data on prescription drug sales.
On a state level, Mississippi pays for only about 4% of buprenorphine prescriptions. Other states such as Alabama, Arkansas, Florida, Georgia, Kansas, Louisiana, Montana, Nebraska, Tennessee, Texas, Oklahoma and Utah pay for no more than 10% of buprenorphine prescriptions.
In the past year ending June, 2016, pharmacies sold 12.5 million buprenorphine prescriptions. Fifty-seven percent were paid by commercial insurance companies, 11% were paid out-of-pocket by patients, and only 7% were paid by Medicaid.
Advocates for Opioid Recovery is asking federal and state officials to alter Medicaid policies which may prevent those with opioid addiction from receiving the appropriate medication. Indeed, outcomes have shown to be improved with the use of medication in conjunction with other treatment for addiction, such as counseling and therapy.
However, obtaining a sizable provider network has been challenging for Medicaid programs. Additionally, concern has been raised about drug diversion potential – that is, it may end up on the streets. Note, however, that no such concern seems to exist for opioids themselves.
“There’s a lot of concern, some legitimate and some misguided, about the abuse and diversion of buprenorphine. Some of the rules designed to decrease misuse are really not evidence-based and often have unintended consequences.”
And finally, 19 states opted against expansion of their Medicaid programs to low income adults under the Affordable Care Act. This left uninsured residents responsible for paying for medication-assisted treatment out of pocket, or reliant on federally subsidized treatment programs, which often do not pay for medications.
A Population Prone to Use
And what’s the worst part about all this is? Lower income persons are more prone to substance abuse that the general population. There are a few reasons for this – one, poverty is stressful.
Two, people with low incomes tend to work more manual labor jobs, setting them up for work-related injuries and day-to-day labor that takes a toll on their bodies long-term.
This leads them to self-medicate for physical reasons, in addition to mental escape.
And here’s the final kicker – Medicaid recipients are prescribed painkillers at twice the rate of other patients, and are up to 6 times more likely to overdose on prescription drugs. In 2010, a survey revealed that Medicaid recipients represented about 20% of the overall population. However, they account for one-third of overdose deaths.
It’s really interesting that such concern for drug diversion exists, when in reality, it is the opioids themselves that are being diverted and falling into the wrong hands. The system is set up to supply drugs, but not the treatment for addiction after drug dependency occurs.
In the case of buprenorphine, I do understand that it’s about trading one drug for another. But this is part of an approach known as harm reduction, of which I’m a big advocate. According to harmreduction.org, harm reduction is “a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use.“
That’s what we need. To reduce the harm done by pharmaceutical companies, doctors, and the patients themselves. Not all of us can be perfect – but if we can be a little better, and help others to be a little better, isn’t that the whole point of pharmaceutical therapy in the first place?
Just Believe Recovery of Carbondale, PA accepts Medicaid coverage in the following counties: Lackawanna, Susquehanna, Luzerne, and Wyoming.
~ G. Nathalee Serrels, M.A., Psychology