Harriet Blair Rowan
Buprenorphine, a relative newcomer within the remedy of opioid habit, is rising in recognition amongst California docs as regulatory adjustments, doctor coaching and different initiatives make the remedy extra broadly accessible.
The fee of Medi-Cal enrollees who obtained buprenorphine almost quadrupled from the tip of 2014 to the third quarter of 2018, in accordance with data released by Medi-Cal, the state’s Medicaid program. The fee for methadone — an older and extra generally used drug — was virtually unchanged from the tip of 2014 via the final quarter of 2017, the newest interval for which knowledge can be found.
Buprenorphine and methadone are each opioids. Both cut back cravings for heroin and artificial opioids whereas minimizing withdrawal signs. But buprenorphine is much less potent and less likely to result in fatal overdoses than methadone. California docs have extra flexibility in prescribing it than with methadone or naltrexone, one other remedy used to deal with habit.
The Food and Drug Administration accepted buprenorphine for treating opioid dependency in 2002. In 2015, Medi-Cal eliminated a rule requiring docs to get prior authorization for every affected person. That requirement was an extra barrier for a lot of physicians who needed to first acquire a federal waiver to deal with sufferers with the remedy — a course of that requires eight hours of coaching.
The waiver continues to be required. But since 2017, the state’s California Medication Assisted Treatment (MAT) Expansion Project has helped practice docs who want to acquire it.
Once they get the waiver, physicians can prescribe buprenorphine in a range of settings, together with major care workplaces, group hospitals and correctional amenities. By distinction, methadone will be allotted solely in federally accredited opioid treatment programs.
A invoice lately launched in Congress would get rid of the federal waiver requirement for buprenorphine, giving docs much more flexibility.
California’s MAT growth program additionally funds radio and TV advertisements, at the moment airing across the state, that encourage folks with opioid addictions to hunt medication-assisted remedy. The program sponsors an internet site, choosemat.org, which directs folks to remedy.
“When you can get someone on [MAT], the evidence is that it works really well,” stated Brian Hurley, director of habit medication for the Los Angeles County Department of Health Services. “But getting started is the biggest barrier.”
The MAT growth initiative, launched with two federal grants totaling $264 million, helps to cowl the price of remedy not just for Medi-Cal enrollees but in addition for folks with no insurance coverage and people with non-public insurance coverage that gained’t pay for the remedy.
Marlies Perez, chief of the Substance Use Disorder Compliance Division at California’s Department of Health Care Services, stated an growth of methadone applications is underway, and she or he expects to see the speed of Medi-Cal methadone claims rise.
The MAT program additionally seeks to develop remedy choices for the state’s Native American and Alaska Native teams, which have been hit disproportionately exhausting by the opioid epidemic, Perez stated.
California’s opioid overdose loss of life fee in 2017 was 5.3 deaths per 100,000 residents — solely about one-third of the U.S. fee. But some rural Northern California counties — together with Modoc, Humboldt, Mendocino and Lake — had charges three or 4 occasions the statewide common.
Despite enhancements in entry to buprenorphine, Perez stated, numerous work stays. “I don’t want to diminish the fact that we still have too many people dying from a treatable disease,” she stated.
The knowledge we used, from the California Department of Health Care Services, present the variety of sufferers for whom claims had been submitted to Medi-Cal for buprenorphine and methadone.
The division counts the variety of folks with claims for these drugs by quarter. Our evaluation started with the fourth quarter of 2014 and, for buprenorphine, it ended with the third quarter of 2018. For methadone, the out there knowledge go solely via the tip of 2017.
For every quarter, KHN calculated the speed of people, per 10,000 Medi-Cal enrollees, who obtained methadone and buprenorphine. That allowed us to manage for the Affordable Care Act’s Medicaid growth, which swelled the ranks of Medi-Cal from eight.6 million on the finish of 2013 to about 13 million as of September 2018.
The quarterly totals are probably an undercount, as a result of the DHCS excludes knowledge for a medicine in any county the place the quantity of people that obtained that remedy is 10 or fewer.
Kaiser Health News (KHN) is a nationwide well being coverage information service. It is an editorially unbiased program of the Henry J. Kaiser Family Foundation which isn’t affiliated with Kaiser Permanente.