Cap recommended on addiction treatment

Maine state budget task force recommended a two-year MaineCare limit on Suboxone – a replacement drug used for the treatment of opiate addiction – as part of an effort to trim $25 million from the state budget.

The recommendation was one of the many cuts submitted to the Streamline and Prioritize Core Government Services Task Force by the Department of Health and Human Services, which was asked to submit proposed cuts to the task force. The overall package included administrative efficiencies like reduction of the cost of leased space and reduced travel expenditures and reductions in funding of certain programs.

The task force was scheduled to report its recommendations to the Joint Standing Committee on Appropriations and Financial Affairs by Dec. 15. The recommendations need approval of the Legislature, which reconvenes in January.

The proposed cuts are for fiscal year 2012-13, and according to the draft bill, the two-year MaineCare limit on Suboxone would save the state just over $787,000.

The recommendation has been criticized by addiction specialists and those who receive Suboxone treatment.

Guy R. Cousins, LCSW, LADC, CCS, director of the state’s Office of Substance Abuse, says MaineCare, the state’s Medicaid program, proposed the cap be two years.

“They had looked at national information and they found that to be the average,” Cousins says. “It’s not based on a national standard, just based on what they were coming up with in terms of the average length people were actually taking (Suboxone).”

Ronald Breazeale, Ph.D., a clinical psychologist in Maine with more than 30 years of experience in the fields of mental health and alcohol and drug abuse treatment, thinks a two-year limit is arbitrary.

“That’s not a standard of care I would want to see,” he says. “Open-end treatment in my experience is the medical standard for care. I don’t think one size fits everyone.”

Cousins says that if deemed a medical necessity by the prescribing physician, treatment could continue past the two-year cap.

Suboxone is considered most effective when paired with behavioral health therapy. Cousins says there is a challenge in terms of helping prescribing physicians become aware of what resources are available to them when prescribing Suboxone. “Best practice model is to have behavioral health intervention counseling as a conjunction to the medication itself.”

Breazeale says counseling in treatment clinics alone is sometimes inadequate. “There’s a lot more that needs to be done in psychological treatments and counseling. More physicians seem to be requiring someone in this treatment to see someone and work with someone, if they are going to prescribe the Suboxone.

He fears a limit on Suboxone might push some people back into addiction. “These are people who are trying to put their lives back together,” he says. “It takes quite a while to do that. I don’t think the pressure of putting a limit on treatment is a good idea.”