An opioid epidemic in NC with too many barriers to treatment

At the turn of the 20th century, the country was in the grips of a deadly epidemic – tuberculosis. While the disease had been present since early settlement days, high-density living and lax sanitation standards prevalent in the early 1900s caused a widespread epidemic making tuberculosis a leading cause of death in North Carolina and the nation.

In response to this epidemic, North Carolina leaders acted swiftly and with purpose, deploying all resources available to address the deadly outbreak. In 1907, the General Assembly appropriated funds to establish North Carolina’s first Sanatorium for the Treatment of Tuberculosis. The western part of our state became an ideal location for these facilities as it provided patients with an abundance of pure, cool and dry air, while the hospitals provided improved sanitary standards.

But state action didn’t end there. By 1913, the sanatorium system was placed under the aegis of the State Board of Health, tuberculosis was declared a reportable disease and a Bureau of Tuberculosis was established, in part to “encourage methods for obtaining cures and to curb the spread of the disease.”

Once again, our nation and state face an epidemic that has been raging for nearly two decades: the opioid epidemic. The most fatal drug crisis in United States history, until recently, has gone virtually ignored by our elected officials and bureaucrats. The outcome has been disastrous. Today, more than three North Carolinians die every day from an overdose – now the leading cause of accidental deaths in the state – a nearly 50 percent higher mortality rate than car accidents.

As one of the few physicians treating opioid dependency in the state, I ask for the same commitment from our leaders to effectively treat this epidemic, including the deployment of all available resources. Our loved ones in need of treatment in ever growing numbers and our communities that have been decimated by this epidemic deserve no less.

Restoring an addicted patient’s life is one of the most challenging and ultimately rewarding experiences I have had in medicine. While we have no cures for this chronic brain disease, we do have effective interventions. Their use is restricted, and they need to be unleashed. However, several significant administrative barriers are placed on physicians and severely undermine our efforts to provide broad access to the best care.

For instance, our state Medicaid program and other insurers require a patient with opioid dependency to obtain a prior authorization in advance of receiving treatment. Many times, this process delays the patients getting their medications, sometimes for days, which places the addicted patient in the position of either suffering through withdrawal or, more likely, returning to illicit drug use in the interim.

Lost opportunities

The result is a lost opportunity to get that patient into recovery, and all too often the patient succumbs to the disease before treatment can be initiated. Prior authorization certainly should not be a requirement for commencing treatment – the window to engage these patients and move them toward recovery is simply too narrow for such a protocol

Payers also limit options in treating this epidemic. Most notably, the North Carolina Medicaid program offer physicians only a single “preferred” buprenorphine medication option – even though several agents – including generics – with differing qualities and attributes are available to patients with commercial plans. This limitation undermines our ability to best match the medications to the patient’s needs, putting the patient at risk of relapse, a costly outcome for all stakeholders.

This is an epidemic! I urge the state to reform this policy at the next Medicaid Pharmacy and Therapeutics Committee in September and make all such products “preferred.”

We have a disease that, like tuberculosis in the 1900s – if left untreated – will continue to kill more than a thousand residents each year. Beleaguered physicians on the frontlines need relief from bureaucratic rules that further limit the quality and timeliness to care. We look to our leaders to rededicate themselves to addressing the epidemic with the seriousness it warrants.

This story was originally published August 12, 2016 at 4:41 PM with the headline "An opioid epidemic in NC with too many barriers to treatment."