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The Medicaid program in Maryland used to pay for a drug to treat opioid addiction that comes in the form of a dissolvable film. The program is now steering patients to the tablet form of the drug which doctors say isn't always as effective. NPR's Alison Kodjak reports the change is having a profound effect on people who are struggling to stay off opioids.
ALISON KODJAK, BYLINE: Last month Maryland told doctors that Medicaid will no longer pay for Suboxone strips, a drug that's used by people addicted to opioids to keep their cravings at bay. The reason...
SHANNON MCMAHON: Those Suboxone strips were diverted and smuggled into jails and then later sold or traded in criminal activity that was happening in jails.
KODJAK: That's Shannon McMahon, who runs Maryland's Medicaid program.
MCMAHON: The numbers were frankly staggering of the amount of diversion that was happening in the jails.
KODJAK: She says that so far this year, more than 23 hundred hits of Suboxone have been seized in Maryland's jails and prisons. That's about 40 percent more than at this time last year. You see, Suboxone is itself an opioid. It doesn't produce a high as strong as many opioid painkillers that have turned into popular street drugs, but it does stave off cravings and can create a mild sense of euphoria. It comes as a tiny dissolvable film that's transparent and easy to hide.
MCMAHON: They have been cut up into multiple different pieces. They're about the size of a Listerine strip, if you can use that as a visual. They were coming into prisons through letters, or they were, like, on the backs of stamps. They were coming in in the corners of folks' eyeglasses.
KODJAK: So at the recommendation of the Department of Corrections along with the panel that advises on medications, Medicaid officials decided to replace the Suboxone strip with a tablet called Zubsolv. The choice is raising eyebrows. That's because Maryland's health secretary, Van Mitchell, used to work for the lobbying firm that represents Orexo Pharmaceuticals which makes Zubsolv. Mitchell's spokeswoman says he left the firm before Orexo became a client.
The change has wreaked havoc on some people with substance abuse problems who use the Suboxone film like Nicole, a mother of two who has been in recovery for about eight years. She doesn't want us to use her full name because her history of addiction is not common knowledge.
NICOLE: When I got on Suboxone, I didn't even have custody of my son. And after I got clean, then I got put on Suboxone, and I have both my kids now. We have our own house. I'm working. They're doing good in school. I finished school. And that's why it's so scary to me that they just completely switched me over.
KODJAK: Nicole became addicted to painkillers after she was injured in a car accident. She was stable on Suboxone strips but switched to Zubsolv 10 days ago.
NICOLE: It's been a nightmare ever since. I haven't been feeling good, and I cannot sleep at night on this certain medicine. I'm actually having cravings again.
KODJAK: Nicole's doctor, Michael Fingerhood, has a primary care practice at Johns Hopkins in Baltimore. It welcomes people with substance abuse problems and treats about 450 patients who until this month were using Suboxone strips. He says just two weeks into the change, many of his patients, like Nicole, are struggling.
MICHAEL FINGERHOOD: These are taking patients who are stable, who are doing really well and saying, we're going to do something to disturb how well you're doing.
KODJAK: Many have been clean for years, and for the first time, they're feeling sick again because Zubsolv is not exactly the same as Suboxone. He says some are in real danger.
FINGERHOOD: So in midst of addiction, people are searching for a high. They're in withdrawal. They're running the streets. Their lives are horrible. So having withdrawal brings back all those memories and flashbacks of how horrible life had been, and it's a terrible feeling to be in withdrawal.
KODJAK: Shaking up all the Suboxone patients across the state to keep a relatively safe drug away from a handful of inmates doesn't make sense, Fingerhood says. And the numbers are pretty small. If those 2,300 Suboxone hits seized in prison were whole strips - and prison officials say they weren't - that's still only the equivalent of 10 prescriptions from January through last week. A better strategy, he says...
FINGERHOOD: We should be providing treatment in the prison system.
KODJAK: But for now that's not happening. So Fingerhood and other doctors across Maryland are trying to keep their patients clean while they adjust to the change. State officials say patients can still get Suboxone if they really need it. Doctors just fill out a form and get an answer the next day. Fingerhood made that request for Nicole, and five days later, he still has no response. Allison Kodjak, NPR News, Baltimore, Md.
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