New PA Medicaid Rules Aim To Quash Black Market For Opioid Recovery Drug

Mar 10, 2017

The Wolf administration this week released new rules around prescribing buprenorphine to Medicaid recipients. The drug is often prescribed to people who are addicted to opioids as a part of medication assisted treatment.

Buprenorphine activates the same opioid receptors in the brain as drugs like heroin and oxycodone, but to a much lesser degree, in order to alleviate withdrawal symptoms. It also serves as an opioid blocker much like the life-saving drug naloxone, so users won’t feel euphoric effects from taking other opioids while on buprenorphine.

There are multiple forms of buprenorphine. Suboxone is a thin film that dissolves in the mouth. Subutex is a pill version, Butrans is a patch, Buprenex is an injection and Cizdol is a tablet.

Though buprenorphine is primarily used to help people who are in recovery for an opioid addiction, some experts said there is a street market for the drug.

“Most often the individual buying Suboxone ‘off the streets’ is someone who struggles with an opiate addiction themselves, but either don’t want to get involved in treatment and follow treatment plan or maybe they don’t have the finances or resources to get involved in treatment,” said Alexander Perla, addiction specialist with Jade Wellness Center, a substance abuse recovery center with locations in Wexford and Monroeville.

U.S. Drug Enforcement Agency Special Agent Patrick Trainor said Suboxone is often cheaper than other opioids sold on the street.

“When (users) don’t currently have the money to buy heroin, they can buy a Suboxone (film) for a little as $7 and very often that’s enough to hold off withdrawal so they don’t get sick,” he said.

Pennsylvania Department of Human Services Secretary Ted Dallas said some providers are writing buprenorphine prescriptions for cash, without an office appointment or wraparound services such as behavioral therapy, which some experts argue are vital to recovery from addiction.

“Some folks can take advantage of that to then sell buprenorphine to get cash to buy heroin or to buy other drugs, and that’s the activity we want to clamp down on,” Dallas said.

Jade Wellness Center CEO Lucy Garrighan confirmed that such diversion of the drug is a problem.

“The problem is much bigger than people realize,” Garrighan said. “I have heard of places in Monroeville and Washington County that patients have said they just had to call in a credit card to get a (prescription).”

Three Philadelphia doctors were indicted last year for illegally prescribing selling buprenorphine and other drugs. The ringleader, Alan Summers, pleaded guilty last month.

The new rules would require that providers prescribing buprenorphine to Medicaid recipients be enrolled in the Medicaid program. Providers who prescribe the drug without an office visit would be subject to an audit and potentially un-enrolled from Medicaid. Providers would also not be allowed to accept cash payments from Medicaid recipients.

“We want to make sure that if you’re getting these services that it’s through a qualified provider, one that’s making sure you get the wraparound therapy you need in addition to the medication, because medication alone is not likely to help you beat your addiction,” Dallas said.

But some say the new rules won’t be difficult to get around, providers and patients could simply choose not to submit a claim to Medicaid for the prescription in the first place.

“You can sell anything for cash and it will be difficult to identify,” said Mike Lynch, director of the Pittsburgh Poison Control Center.

He said he suspects the new rules will serve as a deterrent to doctors who would take advantage of people addicted to opioids in order to make a buck.

“Especially if you’re running a regular clinic whose files can be audited and so forth, eventually if you’re practicing in that way, under these rules it makes it quite clear that you will suffer consequences,” Lynch said.

Garrighan said she’s pleased with the new rules, and is hopeful that they will make other doctors more comfortable with participating in medication assisted treatment.

“Doctors like this (who break the rules) give the medication … a bad name,” she said. “It is not the medication, it is how it is distributed. Suboxone saves lives.”