Quality & Science

ASAM Members Mobilize Response to Treatment Cuts

by Susan Awad | March 25, 2013

Justice building

Recently, ASAM members in several states have found themselves playing a new role: in addition to being physicians, they have become educators and activists working to counter harmful state actions that limit access to pharmacotherapies for opioid addiction treatment. These new policies take different forms in different states, but generally they replace a physician’s expertise with a politician’s opinion about the best treatment as they often include limitations on duration of treatment, dosage ceilings or proof of prior authorization and/or medical necessity requirements.

In Maine, Dr. Mark Publicker, FASAM, has worked tirelessly to overturn a state Medicaid regulation which instituted a two-year, retroactive limitation on medication-assisted therapy for opioid dependence. "It is a horrible situation," Dr. Publicker says. "These Medicaid limitations condemn our patients to withdrawal and to the specter of active addiction […] Opiate addiction is a chronic brain disease. As with all chronic illnesses, it requires chronic therapy. There cannot be arbitrary limits on treatments. We know that for significant opiate addiction, long-term opiate agonist therapy with medications, such as buprenorphine and methadone, are necessary to sustain a robust recovery." His efforts helped amend the regulation to allow for six-month, renewable extensions of treatment, but only with onerous prior authorization requirements.

ASAM Member Dr. Jeff Bill

ASAM Member Dr. Jeff Bill

Similarly, a state senator in Indiana introduced legislation early this year that again had politicians determining patient care by limiting treatment in opioid treatment programs to 24 months. ASAM member Dr. Jeff Bill responded swiftly, traveling to Indianapolis to testify before the Senate Committee on Health and Provider Services. “There is no clinical evidence to support a two-year treatment limitation,” says Dr. Bill. “This policy will not only harm patients with the disease of addiction, but will have broader budgetary and social consequences as patients relapse and require emergency care.” Thankfully, the introduced bill has recently been amended to remove the 24 month restriction; it now calls for the formation of a commission to study the use of methadone and other opioids in addiction treatment.

ASAM members may be called upon to stand up for patients in other states as well if similar policies are proposed elsewhere. In the meantime, the ASAM Board of Directors and staff are working diligently with ASAM Chapters to develop a coordinated response. Please contact ASAM’s Director of Government Relations, Alexis Geier-Horan, at ageier@asam.org if you hear of similar legislation in your home state.