CAPE COD TIMES: Boticelli: “Treat Addiction Early and Often”

The original article can be found here, and was written by KC Meyers for the Cape Cod Times on April 9, 2015

State eyeing better insurance for addicts

WALTHAM — The health care system became the perfect environment for overprescribing of opiates, doctors explained at the Massachusetts Medical Association’s public health leadership forum Wednesday.

Not enough time with patients, not enough insurance coverage for alternative treatment and little to no education in medical schools on addiction has led to this crisis, according to experts who spoke before about 300 medical professionals at the 11th annual forum in Waltham titled, “The Opioid Epidemic: Policy and Public Health.

Keynote speaker Michael Botticelli, director of White House Drug Control Policy, offered solutions on how to rein in the beast unleashed by opiate prescribing, which has led to skyrocketing addiction and overdoses from painkillers and heroin.

From 1991 to 2009, prescriptions for opiate-based drugs increased almost threefold, to more than 200 million, according to the National Institutes of Health.

Dr. Katherine Atkinson, a family doctor from Amherst, pointed out why.

She works in an office that treats opiate-dependent patients with Suboxone, which blocks the effects of opiates and controls cravings. The office also employs traditional doctors, acupuncturists, nutritionists, psychiatrists and therapists. They treat everyone in a community, she said. The office is trying to do everything right by offering physical, mental and behavioral health to patients in a holistic way.

But getting insurance companies to pay for any treatments other than a quick office visit has been a huge battle.

“We’re barely breaking even,” Atkinson said.

She can see a patient for five minutes and give them morphine, and it’s covered without problems, she said. But try to work on a patient’s posture, or provide alternative treatments, and there’s no money in it, she said.

Insurance coverage may improve soon, however, or at least that is the goal of the Massachusetts Attorney General Maura Healey’s office, which has made the opiate epidemic a top priority, said First Assistant Attorney General Christopher Barry-Smith.

He said going after insurance companies to provide coverage for addiction and behavioral health is part of Healey’s strategy.

“We have long talked about parity and we’re trying to breath life into that concept through enforcement,” Barry-Smith said.

Botticelli suggested ways the medical community can help stop the crisis.

More doctors should use medically assisted treatments to help people get a grip on their addictions, he said. These include Suboxone or buprenorphine and methadone. Many are reluctant to treat opiate addicts because of the stigma, Botticelli said.

But “these people” that doctors may not want in their waiting rooms, are people like him, Botticelli said. He’s the first “drug czar” to be in recovery himself, he said.

“We need to destigmatize treatment,” said Cheryl Bartlett, executive director of the Substance Abuse Prevention & Public Health Initiatives at Cape Cod Healthcare, who attended the forum. “Anyone with a chronic brain disease may have to take medications for the rest of their lives and we cannot stigmatize that person.”

Doctors can also help by looking for signs of addiction, and getting those people with a pain pill dependence into treatment before they turn to heroin, Botticelli said.

In other words, mainstream medicine needs to begin to treat addiction “early and often,” he said.

There is some good news: Getting Narcan, on opiate overdose reversal medication, is about to get a lot easier on Cape Cod: CVS pharmacies are going to begin to offer standing prescriptions for Narcan by the end of this month, Botticelli said.

That means anyone can get a Narcan kit without a prescription from a doctor. Narcan, which costs about $70 per kit, is covered by many insurance companies including Mass Health, said Max Sandusky, prevention and education director for the AIDS Support Group of Cape Cod.

Also promising is the fact that deaths from drug overdoses have leveled off nationwide, said Dr. Alexander Walley, assistant professor at the Boston University School of Medicine.

But heroin deaths spiked 172 percent from 2012 to 2013, Walley said.

“I think we can really say starting in 2013, we’ve seen a more erratic and more deadly heroin supply,” Walley added.

— Follow K.C. Myers on Twitter: @kcmyerscct.