A better way to treat opioid dependence

The heroin and prescription opioid abuse epidemic ravaging North Carolina and the nation has received considerable attention from the media and lawmakers throughout the country. As a physician on the front lines treating addiction in rural North Carolina, I can personally attest to the devastating impact this disease has had on our communities and the lack of quality treatment available for our loved ones afflicted with this disease. Part of the reason there are so few physicians available to minister to this disease is that the state places too many burdensome requirements and restrictions on trained physicians treating these stigmatized patients.

As a concerned physician, I recently planned to attend a scheduled meeting in Raleigh on behalf of my colleagues to request the state expand its buprenorphine (the leading medication for treating opioid dependency) offerings to include all FDA-approved products for Medicaid. Access to all medications to treat addiction in the face of this epidemic is a prudent approach.

By expanding medication offerings, my peers and I will be able to more easily match the best medication for each of our patients without burdensome prior authorizations which will ultimately promote what we need to strive for – “treatment on demand.” Although the state is required to review these medications annually, this year, N.C. Secretary of the Department of Health and Human Services Rick Brajer unilaterally decided not to entertain any testimony on this critical drug class. This decision effectively leaves only a single product – the Suboxone Film - as the lone preferred buprenorphine product available for another year – robbing me and my colleagues’ of greater therapeutic choices in addressing our epidemic without going through unnecessary bureaucratic hurdles.

This is simply unconscionable in a state that is losing as many as four residents every day to opioid-related overdose deaths.

My disappointment in being disinvited from the opportunity to share my front-line experiences turned to chagrin when subsequent news accounts reported that attorney generals from 35 states, including North Carolina, filed a class action suit asserting that the manufacturer of the aforementioned Suboxone Film engaged in questionable business practices to gain and protect a near-monopoly in the medication prescribed to treat opioid use disorder.

In a news release issued by the North Carolina Department of Justice, entitled “Drug Makers Conspired to Keep Addiction Treatment Price High” the attorney general detailed how the maker of Suboxone (previously offered as a tablet) developed the film formulation of the drug as its FDA-granted market exclusivity approached expiration. According to the lawsuit, Suboxone’s manufacturer used marketing, price adjustments and other methods to get health care providers to prescribe the film instead of the tablet even though the film “provided no real benefit” over the tablet. Once the majority of Suboxone prescriptions were written for the film, the drug company asserted “unfounded safety concerns” and withdrew the tablet from the market in the U.S. yet continued to sell it in other countries.

The state’s lawsuit asserts that the drug maker’s conduct deprived consumers and the government of treatment options while “defendants continue to reap monopoly profits from the sale of Suboxone.”

For North Carolina, the costs associated with the Suboxone Film are substantial. As the sole “preferred” buprenorphine-based medication to treat opioid addiction North Carolina spends $17 to $20 million annually.

Election season often reminds us that common-sense government is in high demand. In this case it is evident. To exclude all other buprenorphine products, while conferring special status to the manufacturer of the one medication that our own attorney general has alleged used illegal business practices certainly suggests that this is the classic left hand doesn’t know what the right hand is doing scenario so common in government.

This can be repaired.

All stakeholders must remain committed to quality treatment and to providing easy access to the full array of medications available to treat this disease. North Carolina’s opioid use disorder patients, and its taxpayers, deserve the benefit of treatment options in a competitive market and today’s patients deserve – and need – access to all the products most likely to help their individual recovery now!

We have no time to waste.

John Woodyear MD is a physician in Troy in Montgomery County.