Insurers Thwart Treatment for Opioid Addicts, Report Finds

Prescription drug addiction—especially to opiate painkiller medicines like fentanyl—is killing Americans in alarming numbers. In 2010, more than 12 million Americans reported using a prescription painkiller non-medically, and the rates of overdose deaths have more than tripled since 1990. Painkillers are responsible for more deaths than heroin and cocaine combined—so the legitimately prescribed medicines sitting in your cabinet currently pose a bigger public health risk than the illicit narcotics found on street corners.

Since drug addiction is a disease that does significant damage to the health and lives of those affected, many people would like to believe that their insurance provider will look out for them if they spiral into self-destruction. A new report reveals, however, that this is far from the truth. In reality, insurers place numerous restrictions on those seeking medicines that have been shown to help people struggling with opiate addiction.

The Epidemic of Prescription Painkiller Abuse

More and more people are becoming aware of the risks of prescription painkiller abuse, but the death rates still paint a shocking picture of the state of pain management in the U.S. The main issue is that we’re still dependent on opiate medicines (which bear close chemical similarities to illicit drugs such as heroin) and these have a significant risk of addiction and also a notable potential for overdose. Taking too much of a prescription painkiller can produce euphoria. As a result, many people who are prescribed these medications find themselves regularly exceeding the recommended dosage from their doctor.  According to the CDC, sales of prescription painkillers like Vicodin, OxyContin, Percocet and Duragesic have increased by 300 percent since 1999, providing a startling parallel to the rates of overdose death.

The key point is that drug addiction is a chronic, relapsing disease just like asthma and diabetes, and users (while they may have chosen to take the substance initially) quickly lose control over their behavior and are unable to stop taking the drugs. Their brains have adjusted to the continuous supply of opiates, so that without them they’re left unbalanced and can experience unpleasant withdrawal symptoms. This means that patients experiencing chronic pain are given medicines that can easily lead them into addiction—even if they have a legitimate reason for taking large doses of the medicine. Just like asthmatics can’t choose to re-open their airways and diabetics can’t increase their insulin levels through sheer willpower, those struggling with addiction can’t just stop craving drugs.

Treatment Is Available

This is why, alongside psychological interventions, drugs such as methadone, buprenorphine and naloxone have been developed to help people struggling with opiate addictions. While methadone and buprenorphine are used to help users gradually decrease their opiate consumption, naloxone is used specifically to counter the effects of an overdose. The key point here is that medicine that could help with the epidemic is available; it isn’t that the medicine doesn’t work or hasn’t been invented.

Insurer Restrictions

It is clear that while opiate painkiller abuse is one of the most significant causes of death in the U.S. today, a mixture of psychological and pharmacological interventions can be used to treat anybody affected. The only problem is that they often aren’t being used and the paper from the Avisa Group—which was commissioned by the American Society of Addiction Medicine—reveals the reasons in undeniable detail.

Firstly, it shows that rural or especially poor areas have higher rates of overdose from prescription medicines, and that Medicaid users are also at an increased risk. The Affordable Care Act, due to come into effect in January, will dramatically increase the numbers of drug-addicted Americans enrolled with Medicaid and other health insurance plans. This sounds like a good thing, but the benefits are limited when you consider the wide range of restrictions placed by providers on the users of medicines like methadone, buprenorphine and naloxone.

The list of restrictions is unfortunately long and inevitably causes a great deal of harm by making it harder to access potentially life-saving medicines. Some medicines aren’t covered by specific insurers or state Medicaid programs, there are limits on the dosages allowed (which don’t always allow for the recommended dosage of the medicine), unrealistic limits on refills and limits on the amount of medicines such as buprenorphine and methadone that you can be prescribed over the course of your lifetime (which are unheard of for other medicines).

Perhaps most shockingly, the insurance companies require authorization and re-authorization processes to be completed, which become more complex the more times a patient has to complete them. These include things like the requirement of counseling before authorization is granted, and this often also involves the insurance companies demanding the counselor’s treatment notes and the patient’s attendance records before making a decision. In many cases, cheaper treatments (which are considerably less likely to be effective) must be tried before authorization is granted, and the entire process can take several days or even weeks. During this time, it’s inevitable that some drug abusers relapse, overdose and die as a result.

Still Fighting Stigma?

The fact that such restrictions don’t exist for other medicines is the worst point revealed by this report, because it essentially shows that addiction is still being stigmatized. How you can morally justify imposing a lifetime restriction on treatment for somebody suffering from a chronic condition is completely beyond comprehension. Nobody would tell a diabetic that they’ve used up their lifetime supply of insulin, yet it’s commonplace for drug users to be told the equivalent. It reflects a deep-seated assumption that drug addiction is somehow a “choice,” and this assumption must be shattered if we’re ever to reduce the public health impact of prescription painkiller addiction.