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Responses of State Medicaid Programs to Buprenorphine Diversion:  Doing More Harm Than Good?

Robin E. Clark, PhD1,2,3; Jeffrey D. Baxter, MD1,2
[+] Author Affiliations
1Department of Family Medicine and Community Health, University of Massachusetts Medical School, Shrewsbury
2Center for Health Policy and Research, University of Massachusetts Medical School, Shrewsbury
3Department of Quantitative Health Sciences, University of Massachusetts Medical School, Shrewsbury
JAMA Intern Med. 2013;173(17):1571-1572. doi:10.1001/jamainternmed.2013.9059.
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Abuse of prescription opioids is an increasing national concern. Recent reports point to growing rates of overdose, addiction, emergency department visits, and death attributable to nonmedical use of prescription pain medications.1,2

Opioid misuse and addiction has an especially important impact on Medicaid programs; rates of drug abuse among covered individuals exceed those of other insured populations.3 Opioid agonist treatment with methadone hydrochloride or buprenorphine hydrochloride is the most effective way to treat opioid addiction.4 Medicaid programs in most states cover methadone treatment and in all states cover buprenorphine, but there is concern that either medication can be abused. As a consequence, daily on-site dosing is required for most patients who are prescribed methadone. Buprenorphine carries a lower risk of sedation and overdose; it can more safely be dispensed for unsupervised use at home. Prescriptions for the leading sublingual buprenorphine hydrochloride–naloxone hydrochloride product (Suboxone; Reckitt-Benckiser) have risen sharply since 2002, when the US Food and Drug Administration (FDA) approved its use for treatment of opioid addiction. At present, more than 20 000 physicians are certified to prescribe buprenorphine. Patients filled an estimated 9 million prescriptions for buprenorphine in 2012. For a typical patient, the medication costs about $325 a month.

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