Access to treatment for opioid addicts hampered by red tape

Medicated-assisted treatment helps people hooked on opioids by using other drugs, such as methadone, Suboxone, and Vivitrol.
Medicated-assisted treatment helps people hooked on opioids by using other drugs, such as methadone, Suboxone, and Vivitrol.
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State officials will soon know, if Ohio will receive more than $50 million from the federal government for heroin and opioid addiction treatment.

There are some 50,000 Ohioans addicted to heroin and another 450,000 misusing prescription pain pills. State officials have a applied for a grant from a massive innovations bill passed by Congress last year -- the 21st Century Cures Act.

They are hopeful a huge infusion of cash  could help improve access to one form of addiction treatment known as medicated-assisted treatment, said  Dr. Mark Hurst, medical director ,Ohio Department of Mental Health & Addiction Services.

Medicated-assisted treatment helps people hooked on opioids by using other drugs, such as methadone, Suboxone, and Vivitrol. These medications reduce the cravings for the high, while keeping addicts from having painful withdrawal symptoms.

“I remember feeling the chills.  That was the worst for me,  the chills hot and cold," said a local women who was once addicted to pain pills.  "Not sleeping for days on end, cause you just have anxiety but you’re just exhausted. It’s horrible. It feels like your skin feels like its crawling,” said the woman who asked to be identified as Missy.

Missy has been on medicated-assisted treatment for over 10 years.  The 31-year-old Medina resident got hooked on pain pills as a teenager after a battle with a painful tumor in her stomach. It was not cancerous but it took several years for it to shrink with the aide of medication, she said. In the meantime, her doctors prescribed opioid pain pills to ease her pain. After taking the pill for several years, Missy found she became addicted when she tried to stop taking them. After years of taking Suboxone under a licensed doctors' supervision, she is now living a normal quiet life.

“If I didn’t have Suboxone, it could a whole different other life of going out trying to find drugs just to feel better,” she said.

Missy drives 45 minutes to a clinic on the West side of Cleveland, once month, to undergo a drug screening and pick up her Suboxone prescription. With the help of this drug, she has never slipped and gone back to abusing pain pills, she said.

Missy is unusual, though, because most people trying to quit opioids, including heroin, relapse many times, Dr. Hurst said.

“Medicated- assisted treatment is important in decreasing the number of relapses and decreasing the harm if a relapse does occur.”

When counseling and psychotherapy are part of the treatment plan,  medicated-assisted treatement reduces the relapse rate substantially – perhaps by two or three fold, he added.

One problem in getting this type of treatment to the people who need it most, however, is the providers are largely concentrated in urban area.

“It’s not an inner city problem.  It is affecting suburban middle class and hitting it hard," said Dr. Jason Jerry who treats patients at Cleveland Clinic's Alcohol and Drug Recovery Center.

Another major barrier is red tape from government and private insurance companies, Dr. Jerry said.   In addition to two local methadone clinics, the federal Substance Abuse And Mental Health Services Administration website lists 58 licensed doctors providing Suboxone treatment in Cuyahoga County.  Federal government regulations require these doctors complete eight hours of training and get a waiver to prescribe the drugs.

One of the reasons these medications are so tightly regulated is concern they could also be abused, or sold by users.

These regulations also limited to the number of patients a licensed doctor can treat. Licensed physicians are allowed to treat up to 30 patinets the first year after certification, 100 patients in the second year and up to 275 total after that.

And most insurance companies, including Medicaid, require patients get prior approval or prior authorization before they can begin treatment.

"Most insurance will cover it but they require doctors’ offices to fill out prior authorization forms in order for the patients to get approved for treatment," Dr. Jerry said.

"The paperwork is extremely onerous. My secretary spends 60 to 70 percent of her day filling out prior authorization forms," he added.

These rules and regulations can make it  more difficult for doctors to prescribe the drugs which help people recover from addiction than to prescribe oxycodone or hydrocodone.

"It’s actually easier to prescribe those bad narcotics than to prescribe the life-saving one," he said.

Dr. Jerry is a huge advocate for government and insurance companies making it easier for doctors to help these patients if the state wants to get this crisis under control.

“Get rid of prior authorization requirements from the insurers. I think that’s the single biggest thing that we can do," he said.

Dr. Hurst said if the federal grant is approve, Ohio will received $26 million this year and another $26 million in 2018 to help with the addiction crisis.  Some of the money would be used to try to solve some of the access problems with medicated- assisted treatment by getting more primary care doctors trained and available to monitor and treat people addicted to opioids.

“This is a chronic disease so we need to treat it as we do any other chronic disease," Dr. Hurst said.

Like heart disease or diabetes, opioid addiction cannot be cured but it can be managed.





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