The expanding opioid epidemic has been the focus of much media coverage over the past year, with over 21 million Americans suffering from addiction and spiraling death counts splashed across newspaper front pages. Last year, Congress passed the Comprehensive Addiction and Recovery Act to provide tools to address the crisis, but much work remains. Many states have made progress, most notably by increasing access to Naloxone, the drug that reverses overdose effects and saves lives. But state governments often come up short in providing early medical assistance to addicts, by covering outdated and problematic treatments. It is crucial that states, and the Medicaid programs they oversee, ensure that patients have access to efficient medication in order to reverse the rising tide of addiction and death without further burdening public health and law enforcement officials.
Communities ravaged by this serious and growing problem have worked to shed the “incarcerate first” mentality of the 1990s that only exacerbated the problem. This has created an increasing awareness among physicians treating addicts that holistic treatment of addiction includes medically-assisted treatments such as buprenorphine, a bridge prescription drug used to reduce withdrawal symptoms and cravings for patients in treatment. MATs such as buprenorphine are a key tool for public health officials to combat addiction; A recent Surgeon General report stated that “studies have repeatedly demonstrated the efficacy of MAT at reducing illicit drug use and overdose deaths, improving retention in treatment, and reducing HIV transmission.”
Yet many of these doctors are unable to prescribe new, more efficient treatments to their patients due to the massive market share enjoyed by one buprenorphine treatment, Suboxone. The drug was first approved in pill form by the FDA in 2002 and subsequently gamed the patent system to box out competition and ensure a functional monopoly on the buprenorphine market.
In September 2015, 35 state attorneys general and the District of Columbia sued Indivior, the makers of Suboxone, for having “gamed the pharmaceutical regulatory process using a variety of ‘deceptive and unconscionable’ practices to maintain a chokehold on the emerging market for medicine-based addition treatment.” As one attorney general noted, “The circumstances alleged in this case are particularly egregious in that, in the midst of an epidemic of opioid abuse and addiction…consumers and taxpayers have had to pay more for a drug that may help to mitigate some of the problem.”
Beyond Indivior’s anti-competitive practices, the issues with Suboxone film strips are many, including rampant prison smuggling and black market sales of the drug. Inmates have termed Suboxone film strips “prison heroin” and consider it to be ideal contraband because of the easily concealed dissolvable filmstrip form. According to one report, “a volatile subculture has arisen, with cash-only buprenorphine clinics feeding a thriving underground market that caters to addicts who buy it to stave off withdrawal or treat themselves because they cannot find or afford a doctor; to recreational users who report a potent, durable buzz.” Suboxone smuggling is exacerbated because it is only available in limited dosage amounts, making patient dose specialization far more difficult and increasing the drug’s over-prescription, with excess product diverted to the black market.
Even though the producer and state officials are well aware of these abuses, only a few state Medicaid Preferred Drug Lists have been updated to shift to more efficient buprenorphine treatments that drastically reduce the possibility of smuggling and black market sales. Newer treatments come in tablet form with greater flexibility for specific dosing, allowing doctors to prescribe more precise dosages. This prevents over-prescription and further reduces the potential for diversion.
While it will take a multi-faceted approach to truly curb the opioid epidemic, it is imperative that government gets each individual piece correct. In the case of treatment, many states are creating more problems with their preferred buprenorphine treatments. State officials determining Medicaid formulary lists of preferred drugs must act quickly to address this major contraband and prescription drug abuse issue. They should do so by removing Suboxone film strips from the market in favor of better, more efficient options less prone to smuggling and illegal street sales.
Brian Robertson is CEO of Crispin Solutions, a public affairs and communications consulting firm, and co-founder of The Common Trust, a public policy group. Thinking of submitting an op-ed to the Washington Examiner? Be sure to read our guidelines on submissions.
