First, Maine imposed two-year caps on methadone and buprenorphine treatment, if paid for by MaineCare, the state’s Medicaid program. The caps were due to take effect January 1, but treatment advocates were able to work out a medical-necessity exemption, which said that as long as patients were doing well, they could stay past the two-year limit.
Never mind that this made no sense—patients who are not doing well should be kicked off treatment—to go where, the streets? In any event, it was better than nothing. But in March, a new bill was introduced that would have eliminated even the medical necessity exemption. Two years on treatment, and that’s it.
Mark Publicker, MD, president of the Northern New England Society of Addiction Medicine, who helped lead the advocates’ battle for the medical necessity exemption, is “back in the saddle”—pressing the state legislature and the regulators for a reasonable approach.
Under the proposed bill, as of January 1, 2015 no patient would be allowed to be on methadone or buprenorphine for more than two years, if paid for by Medicaid.
“It’s outrageous,” he told AT Forum.
Global Addiction and EUROPAD Conference 
Methadone treatment for opioid dependence remains widely unavailable behind bars in the United States, and many inmates are forced to discontinue this evidence-based therapy, which lessens painful withdrawal symptoms. Now a new study by researchers from the Center for Prisoner Health and Human Rights, a collaboration of The Miriam Hospital and Brown University, offers some insight on the consequences of these mandatory withdrawal policies.
“Dealing with uninformed obstetricians is getting old. Overall, about four percent of opioid addicts are pregnant, according to past data. At one of the opioid treatment programs where I’m medical director, the percentage is a bit higher at five or six percent, but it seems like many more. Maybe it seems like more because of the unpleasantness I encounter when I contact these patients’ obstetricians, to coordinate care with them. Aside from a few pleasant exceptions, I dread calling these OB’s.”
“A four-rod subdermal implant that slowly releases buprenorphine over 6 months should be approved for maintenance treatment of opioid dependence, although more work is needed to determine optimal dosing strategies and how to address the potential risks of the treatment, the majority of a Food and Drug Administration advisory panel recommended.
“Kids born between the years 1984 and 1990 abuse painkillers (the cause of three of every four overdoses) 40 percent more than any other age group or time before them. A study published in Health Affairs suggests that the increase in fatal drug overdoses among youth has grown so severe that it is a major contributor” in the gap between life expectancy in the U.S. and other high-income countries.
A bill introduced in the House of Representatives would ban from circulation certain pharmaceuticals that could be easily abused as recreational drugs. The bill would require the Food and Drug Administration to refuse to approve any new pharmaceuticals that did not use formulas resistant to tampering. For example, pills should not be able to be easily crushed into powders that could be snorted, or melted down into a liquid form that could be taken through injection.
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