Heroin Invades New England


Last week the New York Times ran an article on heroin, describing how it’s infiltrated not only big cities, but also New England’s smaller towns and suburbs. http://www.nytimes.com/2013/07/19/us/heroin-in-new-england-more-abundant-and-deadly.html?pagewanted=all&_r=0
This Colombian heroin has a higher purity than users have seen in the past, meaning it can be snorted for an opioid high. Addicts who wouldn’t consider using a needle are willing to snort this heroin. And addiction being what it is, some of these addicts do eventually inject the drug.

In Maine, New Hampshire, Vermont, and Massachusetts, heroin is causing increased numbers of overdose deaths. Some experts say heroin is now being used by pain pill addicts. Since regulations around opioid prescribing have tightened, fewer (and more expensive) prescription opioid pills are diverted to the black market. Low-priced, high-grade heroin has been released into this void, creating ideal conditions for rampant heroin use. This Times article quoted law enforcement officials as saying they are seeing triple the number of overdose deaths from heroin this year as compared to several years ago.

Wow, I thought when I read the article. This is a bad situation, and it’s been brewing for years. Maine was one of the first states to see a sharp increase in opioid addiction and opioid overdose deaths around ten years ago. So of course, their conscientious state officials did the right thing, and worked together to assure evidence-based addiction treatment would be available for all who ….…oh wait. No.

No, that’s NOT what Maine’s state legislature did. In fact, they did the opposite. Duh.

Last year, Maine passed a law last year limiting Medicaid payment for treatment with methadone or buprenorphine. Against this backdrop of addiction and death, state officials decided to limit payment of treatment to two years of maintenance with either buprenorphine or methadone, and even made it retroactive to the date the patient started. After addiction medicine specialists decried the stupidity, not to mention the illegality of this, government officials backed off somewhat from their two-year limit. But the Maine legislature cut coverage and funding for opioid addiction treatment with buprenorphine and methadone in order to save money.

As I never seem to get tired of repeating: Medication-assisted treatment of opioid addiction with buprenorphine and methadone is one of the most heavily evidenced -based treatment in all of medicine.

Earlier this year, the American Society of Addiction Medicine, better known as ASAM, issued a public policy statement regarding pharmacological therapies for opioid addiction, which can be read in its entirety here: http://asam.org/advocacy/find-a-policy-statement/view-policy-statement/public-policy-statements/2013/04/25/pharmacological-therapies-for-opioid-use-disorders

ASAM’s statement says limitation of coverage for opioid addiction will cost lives. It will disrupt families and communities. It warns against limits on duration of treatment, number of times of treatment, and any other limit imposed by non-physicians on the medical care of patients with opioid addiction.

ASAM is a society of the most highly educated and experienced physicians who work in the field of Addiction Medicine. In other words, these are the best brains in the country when it comes to treatment of opioid addiction that exists in our nation. One would think that federal, state, and local governments would pay attention to what they had to say. One would think insurance plans would do the same.

The federal Mental Health Parity and Addiction Equity Act, passed in 2008, was intended to entitle patients with mental illness and substance abuse issues the same medical coverage as patients with other illnesses. Clearly the Act is being violated in Maine and other states, but so far the federal government hasn’t enforced the law.

I rarely advocate for the involvement of lawyers into any situation, as they can complicate the simplest of situations. However, here’s a situation ripe for picking. It’s going to take legal action by patients who have been denied federally mandated medical coverage to get the attention of insurance payers. This is against the law. This includes federal and state coverage as well as private insurance, because all have put some limits on coverage of the treatment of addiction.

It’s important to try to educate state legislators and to let them know you are watching to see if they are doing the right thing. But when they don’t do the right thing, maybe it’s time to call in the lawyers.

6 responses to this post.

  1. Posted by kevin on July 25, 2013 at 8:18 pm

    I thought most clinics wouldn’t take insurance or even medicaid for that matter


  2. Posted by Chenoa Brown on July 27, 2013 at 1:46 am

    Wow, interesting article. You would think those scary facts alone would force them to confront this issue with adequate treatment given that there is, in fact, adequate treatment for opioid addiction! Let’s hope more people will learn and use their rights. Too many people of authority will play on that many citizens do not know their rights and will not use them. Thanks for sharing this information!

    Your blog is my primary source of information for MAT even though it’s been quite a while since I’ve really needed it for anything more than just my own knowledge. I tell people what I did before the Navy and of course there are tons of questions that I like to be able to answer with some accuracy at least! I can say, I am finding my way back to this field and quite possibly with MAT one day. I actually did feel like I had a purpose there and that I had helped some amazing people.

    As always, thanks for writing your blog, Dr. Burson!


  3. Posted by William Taylor, MD on July 29, 2013 at 10:39 am

    1. Idiotic regulators think that addicts will stop using just because of tightening restrictions on opiate prescribing by MDs.
    2. Other idiotic regulators and cheapskate insurance companies quash treatment options.
    3. It’s time to say a good word for private for-profit Opiate Treatment Programs, where you walk in, pay your daily fee (the cost of a couple of packs of cigarettes) and get proven effective treatment. Usually there’s no waiting list. Addiction treatment is a matter of life and death, and is way too important to be left to the caprice of politicians and insurance companies. Rant off.


  4. Your work is admirable! We would love to collaborate on policy.


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