Several people have asked me to delineate the particulars concerning this Parity Law and TN Care restrictions. If you can bear with me to the end, I think the position will be clear.
As you know, TNCare limits the amount of Suboxone they will pay for for a recipient. They allow 16mg (2 tabs or film) a day for 6 months, then they cut it to 8mg a day for six months, and then they stop. That is the lifetime allotment for Suboxone.
Their motives are strictly financial. Suboxone was the largest payout for a non-formulary drug in the TNCare budget. One of the main reasons for this was gross over-prescribing by physicians, often writing for 32-40mg a day.
We all know that addiction is a chronic, relapsing brain disease involving the reward pathways. Abstinence based programs are 100 percent effective for those who go to meetings and work their program, but back here on earth, only 18% of addicts make it into recovery, even after prolonged inpatient stays. Many addicts suffer many years, go through multiple rehabs, and are in and out of 12 step programs before they finally “get it”– if they live long enough.
Those of us who have worked extensively with Suboxone KNOW how well it works. People’s lives are dramatically changed. They get jobs, get their kids back, get cars, get GEDS, and go to college. They often say that “for the first time in my life, I have money in my pocket! I can take my kids to McDonald’s!” And at my clinic, many of them attend their very first 12-step meeting, ever. They go to meetings, get sponsors, work the steps, and often get off Suboxone completely… but not all of them, and not often in one year.
So, here we have a relatively benign drug, with a ceiling effect, that you can’t overdose on, can’t chop and inject, can’t snort, and that any good addict will tell you, doesn’t really get you high. Patients who take it and work the program become functional members of society!
Here are some fundamental points of argument against these TNCare restrictions:
1. Many patients will relapse. We are condemning people to a slow, or often immediate death.
2. What is the actual dollar cost of returning these people to active addiction? Diversion, jail, crimes, illness, health costs, psychiatric costs…
3. What is the cost to TNCARE of a single new case of HIV, treated for 40 years.
4. How about HepC? Hepatorenal syndrome, ICU, liver cancer?
5. Any given day that you can keep the needle out of 10,000 arms, how many cases of HepC and HIV do we prevent???
6. Addicts on TNCare are a HUGE burden on the emergency departments through drug seeking, injuries, overdoses…
7. What is the cost to TNCare of a single narcotics OD that ends up intubated in the ICU, then a vegetable for the next 10 years? A million dollars? 10 times that?
8. How about the dead families and children from the impaired drivers? what does this cost society?
TREATING ADDICTION IS THE SINGLE MOST COST EFFECTIVE WAY TO REDUCE TENNCARE COSTS!! WITHOUT QUESTION. And suboxone is the most effective treatment for narcotics addiction!
Government should be actively promoting the expansion of appropriate, effective outpatient narcotics treatment centers, not limiting the numbers of patients seen, or limiting the doses of medications, or passing local restrictions on the prescribing of Suboxone!! “Sure Doctor A, B and C can write for 180 Percocet a month to as many patients as they want in the middle of our town, but by golly we don’t want one of them Suboxone Clinics in our town!!”
The Federal Parity Laws specifically prohibit restrictions on mental health care unless the same restictions are applied to other areas of medicine.
For example, John Doe was put on disability at age 19 for his “nerves”, and after smoking 3 packs of cigarettes for 20 years and eating pork skins and fried chicken, he had a massive MI. After his CABG and inpatient care, he ran up a TNCARE bill of $300,000. He was discharged on $900/ month of cardiac meds and gets routine follow up for his implantable device. TN Care will pay for his meds till he dies at 67, after a dozen more hospitalizations for COPD and CHF, because he won’t, of course, quit smoking or change his diet.
Meanwhile, my 26 year old single Mom, who presented at my door covered with track marks and having lost all hope is placed on Suboxone. After a month, her tracks are gone, and she has a job. soon, she has a government house, and is on track to get her kids back. 6 months later, she comes in smiling with her GED. She goes to 4 meetings a week, has a sponsor, and is active in her church. She has rebuilt her life, and is excited about going to college. IF SHE HAS TO PUT TWO LITTLE SUBOXONE TABS UNDER HER TONGUE FOR THE NEXT 5 YEARS, IS THAT A BAD THING??? HOW ABOUT FOR THE REST OF HER LIFE??
Sorry honey. TNCare has cut you off. You only get this medicine for 1 year. If you don’t “get it” in one year, you are out of luck.
Imagine doing that to all the COPD patients on Advair and Singulair who continue to smoke. How about the diabetic on insulin who eats snack cakes and candy bars??
The example are endless, but the point is clear.
If addiction is a primary, chronic brain disease, then it should be treated as such. Parity Laws apply.
If you think addiction is a matter of choice, no will power, or sin, you have that right. But it flies in the face of all the evidence and international expert opinion, and should NOT enter into public policy decisions.
I went to Nashville to meet with the TNCare representatives. I brought several letters of support from the East Tennessee area. I encourage ANY concerned doctor to do the same.
Time to step up to the plate.
Tom Reach, M.D.
Watauga Recovery Center