Suboxone Underused, Opioids Overused in Medicare

Medicare patients who are addicted to opioids may not be getting the help they need

http://www.medpagetoday.com/Psychiatry/Addictions/59206

Medicare prescribers don’t use buprenorphine-naloxone (Suboxone) as much as they should, given the high prevalence of opioid use disorder among their patients, researchers reported.

In 2013, only 81,000 Medicare patients received buprenorphine-naloxone, even though more than 300,000 Medicare patients are estimated to have an opioid use disorder and more than 200,000 are hospitalized each year for opioid overuse, Anne Lembke, MD, and Jonathan Chen, MD, PhD, of Stanford University, reported in a research letter in JAMA Psychiatry.

The data are important especially when considering the high rates of opioid use disorder among Medicare patients compared with privately insured patients (six out of every 1,000 have an opioid use disorder compared with one in 1,000 with private insurance), they said.

“We believe this reflects a significant treatment gap,” Lembke and Chen wrote. “Opioid disorders are systematically underdiagnosed and increasing in prevalence.”

Since Medicare Part D (which covers 68% of those on Medicare) does not cover the cost of methadone maintenance treatment, buprenorphine-naloxone is the only opioid agonist therapy (OAT) that the organization will pay for.

For their study, the researchers analyzed Medicare Part D claims from 2013. Overall, 6,707 prescribers filed 485,099 claims for buprenorphine-naloxone, while 381,575 prescribers filed 56,516,854 claims for Schedule II opioids.

“More than one-third of Part D enrollees fill at least 1 prescription for an opioid in any given year, putting many more patients at risk for iatrogenic addiction,” they wrote.

For every 40 physicians who prescribed an opioid, only one prescribed buprenorphine-naloxone, the researchers noted.

“Physicians who prescribe high volumes of opioids and thus already have an established therapeutic alliance and prior experience with opioid prescribing are especially well-situated, with some additional training, to intervene when cases of prescription opioid misuse, overuse, and use disorders arise,” the researchers wrote.

The study also found that physicians who had a primary specialty in addiction medicine prescribed the most buprenorphine-naloxone in 2013. Yet only 100 Medicare prescribers actually had this specialty.

Lembke and Chen wrote that it’s important for all physicians — not only those who specialize in addiction — to utilize OATs in opioid addiction treatment.

They also called for better addiction prevention efforts, but noted that there remain hundreds of thousands of Medicare patients for whom those efforts would come too late.