Northern Kentucky’s only provider of methadone treatment for heroin addicts is losing patients who can’t afford to pay for their medicine.
For the 90-plus patients at the NKY Med Clinic who can’t pay the $450 per month, it means a high risk of relapse and heroin overdose.
Cathy Daines of Bellevue said her son is among those who will lose what she considers a life-saving treatment for him. He has asked to be weaned off methadone because of the expense. It was a treatment that was working.
“I am so afraid,” she said.
Unlike Ohio, Kentucky’s Medicaid program won’t pick up the cost. And, the state Cabinet for Health and Family Services did not expand Medicaid to include the drug this year. There is “opposition and fear” and need for education about methadone, said Jill Midkiff, spokeswoman for the Cabinet. Kentucky also did not have money budgeted for such a high-cost program, she said.
NKY Med Clinic, which has 900-plus patients, recently asked the state about getting Medicaid reimbursement for its 10- to 15 percent of patients who can’t afford it – but that’s not an option in Kentucky.
They’re exploring another option: The state’s Medicaid program will pay for the required counseling at treatment clinics if the clinic gets a special license, Midkiff said, noting the methadone itself is “relatively inexpensive” at about $50 per month.
Daines is worried a licensing process will take too long for her son to benefit from it, and Northern Kentucky doctors say there is no time to waste with a heroin epidemic raging.
NKY Med Clinic keeps expanding
NKY Med Clinic is the only medicine-assisted treatment group in Northern Kentucky that has expanded greatly during the heroin epidemic that grips Northern Kentucky.
The clinic opened in August of 2013 with about 600 patients, and now has about 900.
“Methadone treatment is not perfect, but it’s good enough for now, and it’s a lot better than heroin,” said Dr. Jeremy Engel, a St. Elizabeth family doctor at the forefront of the heroin epidemic in the region.
It stabilizes patients, giving them back the ability to function normally, working and caring for families without persistent cravings and withdrawal symptoms that propel addicts to seek more heroin.
Kentucky does cover other medicines, including Suboxone, which also can stabilize users. But the region has only a handful of doctors who can prescribe Suboxone and by law they can each only treat a limited number of patients. And Suboxone doesn’t work for everyone.
It’s a catch-22 that the region’s heroin-response leaders say could cost lives.
“When you have an epidemic, you triage,” Engel said, stabilizing people and then, as soon as possible, moving onto other treatments if necessary.
“This is a human disaster that is a medically based disaster,” Engel said. “Medicine-assisted treatment is the cornerstone addressing heroin.”
Methadone: fears and fact
The fear about methadone use to combat heroin addiction is unfounded, experts say.
“It is a matter of belief, not science,” said Dr. Adam Bisaga, professor of psychiatry with Columbia University. “Treatment with methadone or buprenorphine (the generic form of Suboxone) is approved by FDA as safe and effective treatment of opioid dependence.”
The questions surrounding the use of methadone as a treatment for opiate addiction is based on nothing medical and a belief that methadone treatment for heroin is simply “trading a drug for a drug,” said Dr. Mina “Mike” Kalfas, an addiction specialist and family doctor.
Daines’ son has been doing well with methadone, but she said other attempts he’s made to stay clean of heroin and prescription painkillers have failed.
Reducing the methadone dosage too soon into treatment leads to a high risk of relapsing to heroin use.
Kalfas said using methadone does not create another addiction. Instead, it helps the patient withdraw from drug use and relieve narcotic craving.
“Some people just don’t see it as a life-saving treatment,” Kalfas said. “They see it in a negative sense.”
Jim Thaxton, coordinator for the NKY Heroin Impact Response Work Group, said he’s perplexed by the Cabinet’s decision not to cover methadone.
“If I’m a physician and I treat someone with Suboxone, Medicaid will cover that cost and therapy,” Thaxton said. “Medicaid will cover the cost of opioids for pain management. Why not for treating people with methadone who’ve become an addict?”
Kentucky’s Cabinet for Health and Family Services consulted with the department for Behavioral Health, Developmental and Intellectual Disabilities and the Department for Medicaid Services before making its decision, Midkiff said.
Cabinet for Health and Family Services Secretary Audrey Haynes said she could not recommend that Medicaid cover methadone, Midkiff said, noting that methadone and costs associated with the treatment and delivery of it are “significant, and funds to cover these costs were not budgeted,” as well as the concerns about people being treated with the drug, another narcotic.
Midkiff said the cabinet is working to increase services and improve policies and regulations surrounding medicine-assisted treatment.
Seeking other kinds of coverage
NKY Med Clinic is also seeking other ways to help patients, said Holly Broce, regional director for Pinnacle Treatment Centers, which owns the clinic.
“Earlier this year we attempted to apply to become a Medicaid provider and there was not a mechanism in place to become a treatment provider,” Broce said.
So now, the clinic is trying to help patients cut down transportation costs – which also are covered under Medicaid for substance abuse – by opening treatment offices in Georgetown, Carrollton and Maysville.
Mother says son can’t afford methadone
Daines said she’s frustrated that the state won’t cover methadone as a treatment. Her son has a job, goes to work every day and has stable while on the treatment.
He was prescribed Suboxone for a while, but “he said it made him sick,” she said.
A motorcycle accident five years ago left her son with nerve damage and dealing with chronic pain. He first became addicted to painkillers, then heroin.
Daines’ son did not want to talk to the Enquirer.
What about alternative medicines?
Nine physicians in Boone, Campbell and Kenton counties are certified to prescribe Suboxone, according to the Substance Abuse and Mental Health Treatment Services Administration; however, not all are actively prescribing the treatment.
Those who do so bemoan limitations they are given: In their first year they can’t treat more than 30 patients with Suboxone. After that, the cap is raised, to 100. Sen. Sherrod Brown, D-Ohio, is pushing legislation to lift the current cap and allow nurse practitioners and physician assistants to treat patients with the drug.
Kalfas has topped out on the number of patients he can treat with Suboxone. Engel has 15 in a St. Elizabeth Healthcare pilot program.
Midkiff said the state is working on best practices for medicines other than methadone, and working to recruit and retain substance abuse treatment providers.
“This is a huge step forward on the path to recovering for many Kentuckians,” Midkiff said.
She said the cabinet is monitoring outcomes in other states that are covering methadone and might revisit it in the future.
Ohio Medicaid has offered methadone to treat of opiate addiction since July 1, 1991. As of July 1, 2012, Medicaid coverage was expanded to include generic buprenorphine (Suboxone) and injectable naltrexone, more commonly known by its brand name Vivitrol, which blocks opiate receptors. The Ohio coverage includes transportation for methadone patients.
Ohio also expanded Medicaid eligibility as of Jan. 1, expanding access to alcohol and other drug treatment; including the three medications, said Eric Wandersleben, spokesman for the Ohio Department of Mental Health & Addiction Services.
More medicine options on the way in NKY
There are other ways Northern Kentucky is working to provide more access to medicine for heroin addiction – the biggest of which is St. Elizabeth Healthcare’s plans to open a Suboxone clinic.
So far, St. Elizabeth has attracted interest from six to eight physicians who’d be willing to prescribe Suboxone, said Guy Karrick, spokesman for the hospital system. But he said it takes time to prepare for and open a clinic, and St. Elizabeth hopes theirs will open at the beginning of 2015.
A Suboxone clinic will help, Kalfas said, but it’s not going to help everyone.
He’s worried about patients who fail with Suboxone or Vivitrol, a pharmaceutical that blocks opiate receptors in the brain and won’t allow people to get high.
“What do I do with them? I’ve got to have somewhere to send them,” Kalfas said. “The sad reality is that methadone is the backup.”
“I’m lucky with 60 percent success rates,” Kalfas said. “Methadone is my umbrella.”
Top five Kentucky counties for heroin detected in overdose deaths in 2013:
1) Jefferson County 105
2) Fayette County 35
3) Kenton County 34
4) Boone County 22
5) Campbell County 16
Of the 722 deaths autopsied by the Kentucky Medical Examiner last year that were determined to be from a drug overdose, 230, or 31.9 percent, were attributed to heroin, compared to 143, or 19.6 percent, in 2012.
Source: Kentucky Office of Drug Control Policy via Kentucky Medical Examiner and coroner reports.
Medicine assisted treatment drugs:
• Methadone was discovered by the Germans toward the end of World War II and became used in the United States to cure what was then called “opioid abstinence syndrome.”
In the 1960s the U.S. Bureau of Narcotics accepted it as a drug that could be taken routinely to fight addiction.
An opioid itself, it replaces heroin, binding to the same receptors in the brain that yearn for the drug. Methadone can help addicts reclaim “normal” lives while warding off cravings and dope sickness that drives so many to relapse.
Also well-documented is its track record of being sold illegally, abused and contributing to overdoses. In addition, some methadone patients are on it for a lifetime. Proponents argue that they need it to function normally and not relapse into heroin.
Suboxone (brand name for buprenorphine)
• Suboxone or burprenorphine is also a narcotic, but it acts differently in the brain than methadone because it includes an opioid antagonist, which blocks the ability to get high from other opioids. Some addicts report euphoria when taking Suboxone, but it doesn’t have the properties of methadone that lead to dependence. One problem associated is that there is a black market for Suboxone, as addicts try to self-treat symptoms of heroin withdrawal.
Vivitrol (brand name for naltrexone)
• Vivitrol is which is neither opioid nor narcotic. Instead of binding to the receptors in the brain, Vivitrol blocks them. Even if the patient takes an opiate after Vivitrol, the second drug won’t take affect. It’s usually not prescribed to long-term heroin addicts who have been heavy users.
Original article can be found here.