The June 23 op-ed "State action limits opioid addiction treatments" mischaracterized the way Maryland Medicaid has changed its coverage of buprenorphine treatment. We have done so out of a desire to help both our communities and incarcerated populations break the cycles of substance-use disorder that have beset them for too long.
The move of Suboxone Film to a "non-preferred" category on our Preferred Drug List will significantly reduce trafficking of a medication intended to treat substance-use disorder — particularly among incarcerated populations. Others in the treatment community have praised our decision.
Evidence-based practices shaped this decision: Maryland's Pharmacy and Therapeutics Committee, a nonpartisan group of clinical experts deliberated this choice based on a review of extensive medical and financial data. At its May public meeting, the committee received briefings from clinical advisers, as well as a presentation from the Centers for Medicare and Medicaid Services about their recommendations for Medicaid payment of opioid and opioid-dependence drugs.
The Department of Health and Mental Hygiene, which operates the Medicaid program, is allowing a three-month transition for opioid treatment programs that dispense Suboxone Film. This will allow clinicians and their patients to make treatment adjustments and for providers to deplete their stocks of the film.
Partnering with the Department of Public Safety and Corrections, we are combating Suboxone smuggling in jails and prisons. Smuggling has been extremely problematic: Not only does it jeopardize prisoners' health and safety but it also jeopardizes the security of correctional staff. Suboxone Film has been the most prevalent controlled dangerous substance paraphernalia found in Maryland correctional facilities since 2014. The film is easy to smuggle: Public Safety seized 2,160 smuggled strips from January 1 to May 31, 2016, 64.9 percent more than the same period in 2015. Since 2010, the correctional system has seen 13 fatal overdoses.
These figures are a byproduct of the wide availability of opioid replacement therapies — including Suboxone — within the Medicaid program. Since 2010, the Medicaid program noted the numbers of buprenorphine prescriptions (in film and tablet forms) and participants filling these prescriptions per month were 5,631 and 3,448, respectively. The average of monthly buprenorphine prescriptions increased to 11,132 in 2015. At the same time, the average number of enrollees filling these prescriptions per month increased to 7,198 — a 108 percent increase over 2010. These figures illustrate that Maryland offers robust access to opioid replacement therapies — many of which are not captured in these statistics, including naltrexone and methadone.
Last year, 1,259 fatal overdoses occurred in Maryland. We want the deaths to end. People in need of treatment should call our 24/7 hotline, 1-800-422-0009.
Van T. Mitchell and Steve T. Moyer, Baltimore
The writers are secretaries of the Maryland departments of Health and Mental Hygiene and Public Safety and Correctional Services, respectively.