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Author: Justin Mckibben
Addiction is not an easy problem to address. It is a complex issue with many variables, so of course there is no simple answer to fix it. There is no one-size-fits-all solution; no monopoly on the right kind of treatment. It is understandable that there is a degree of effectiveness with utilizing any medical means available to try and address addiction, but are maintenance drugs really the answer?
Surely medication assisted treatment is useful, and it helps a lot of people. Most inpatient treatment programs utilize some form of medication to ease withdrawal symptoms and other side-effects of long-term drug use. The detox period of treatment usually focuses on medically assisting someone struggling with drugs in this transition.
However, is getting people off of one drug by making them dependent on another really the best case scenario? It seems now insurance companies are putting more effort into using maintenance drugs to treat addiction. Is this really a better strategy?
Maintenance Drugs
Firstly, let us make a clear definition of what maintenance drugs are. Typically, the definition of maintenance drugs is along the lines of prescriptions commonly used to treat conditions that are considered chronic or long-term. These conditions usually require regular, daily use of medicines.
Examples of common maintenance drugs are medications such as:
- Fluticasone and salmeterol (Advair Diskus) which is used to treat asthma
- Insulin glargine (Lantus) used to treat diabetes
If you consider these examples the point is that people use these medications to “manage” their illness, not to overcome or remedy it. So looking at the issue of addiction, there are some well-known maintenance drugs, specifically concerning opioid addiction.
- Methadone
- Buprenorphine
- Naltrexone
These medications can be effective, but they also present a level of danger themselves. Even though doctors prescribe them to combat withdrawals, they actually can create their own devastating withdrawals, especially with long term use.
Aetna Aims for Maintenance Drugs
Aetna is one of the nation’s largest insurance companies. In a recent Aetna report, the company is prepared to remove a major restriction for patients seeking maintenance drugs for opioid addiction. The change is set to begin this coming March. Aetna is the third major health insurer to announce such a shift in policy in recent months, now in league with Anthem and Cigna insurers.
To be more specific, this insurance company will stop requiring doctors to seek approval before they prescribe particular medications that are used to combat withdrawal symptoms. One of these medications is suboxone, a well-known medication that many people use to fight opiate addiction.
The common insurance practice is known as “prior authorization”. The reason they are seeking to eliminate this policy is because it sometimes results in delays of hours to days before a patient can get the medications.
This new approach to regulation of maintenance drugs impacts all its private insurance plans, an Aetna spokeswoman confirmed.
Advocates of Maintenance Drugs
Addiction treatment advocates to support having expanded access to maintenance drugs. Dr. Corey Waller, an emergency physician who chairs the American Society of Addiction Medicine’s legislative advocacy committee, states:
“It’s a first-line, Food and Drug Administration-approved therapy for a disease with a known mortality. [For] every other disease with a known mortality, the first-line drugs are available right away.”
Essentially, the idea that parity laws require insurers to cover addiction treatments at the same level as other kinds of healthcare means these kinds of medication should be available for immediate access. This should be the same for all forms of addiction treatment.
Opinion: Treatment over Maintenance
While many would argue that maintenance drugs are a form of treatment, it is still a relevant argument that maintenance drugs are also imperfect and could actually be harmful if they become the cookie-cutter answer implemented by most insurers.
While harm reduction is understandable, and maintenance drugs can help people struggling with heroin or other dangerous opioids avoid other serious risks, the fact is many maintenance drugs include their own side-effects. Some often become subject to abuse themselves.
For instance, suboxone can be useful as a harm reduction tactic, but it can also be abused. Many people who have used suboxone as a long-term solution have found themselves battling suboxone withdrawal symptoms. The dangers of suboxone are very relevant.
The same, if not worse, has often been said about methadone maintenance drugs. While they may keep someone alive to get treatment, there should still be a strong emphasis on treatment itself. Maintenance drugs are most effective when part of a program. They are not a substitute for a treatment program.
Treatment should focus on finding solutions, not prolonging the suffering. Drug and alcohol addiction treatment should come from a holistic approach that addresses more than just physical ailments. Holistic treatment focuses on providing extensive and personalized therapy, combined with physical and emotional heal. If insurance companies want to focus on combining rational medical resources with comprehensive treatment, then this could be a great thing. However, if the focus becomes a quick-fix drug option opposing a full recovery through treatment, it only adds to the danger.