Somerset —
LOUISVILLE, Ky. — Kentucky is spending millions of Medicaid dollars on a prescription drug used to help people with drug addictions while refusing to pay for the counseling necessary to complete the treatment.
Because of the cost, Kentucky's $5.5 billion-a-year Medicaid program for the poor and disabled does not cover most substance abuse treatment.
Suboxone, a narcotic used to help addicts ease drug cravings, cost the cash-strapped Medicaid program nearly $11 million last year.
In addition, some of the pills are being seen on the streets, Dale Morton, a spokesman for Operation UNITE, a federally funded drug enforcement and education agency that operates in 29 southeastern Kentucky counties, told The Courier-Journal.
A single Suboxone tablet that costs about $7.50 is being sold illegally for about $20, drug enforcement officials told The Courier-Journal.
Guidelines from the federal government and the Kentucky Board of Medical Licensure call for treatment with Suboxone to be accompanied by other types of services such as counseling.
"The majority of people who have serious opiate addictions, they're going to need more than just a pill to get through it," said Dr. Robert Walker of the University of Kentucky Center on Drug and Alcohol Research. "I think the concern of the addiction treatment professionals from the get-go is that this is more than just a medication issue."
"Absolutely. Counseling is an essential part," said Dr. Bill Barclay, a University of Louisville psychiatrist and addiction specialist who prescribes Suboxone to some patients.
Suboxone is not recommended for pregnant women, and Kentucky's Medicaid program only covers substance abuse treat-ment for pregnant women or women up to 90 days after childbirth.
Leaders of the state's system of regional mental health services have long lobbied state officials to add substance abuse treatment to the array of services covered by Medicaid. But officials have declined, saying the state couldn't come up with its share of the money needed to attract federal funds, which pay 70 percent to 80 percent of the state's Medicaid costs.
"With the budget the way it is, I don't anticipate any expansion of substance abuse treatment in the Medicaid program at this time," Johnson said.
Suboxone costs have risen steadily since 2004, the first year Medicaid covered the drug, when the state spent about $2,600 on it.
Today's price of nearly $11 million, for about 1,800 patients a month, makes it the state Medicaid program's seventh costliest prescription medicine. It is exceeded by drugs such as the antacid Nexium, the schizophrenia drug Abilify and the asthma medication Singulair, according to a recent state analysis of pharmaceutical costs.
State Medicaid Commissioner Elizabeth Johnson said she thinks Suboxone is a good medication that, when properly used, can help the many Kentuckians who are addicted to drugs.
"Its intended purpose is a very good one," she said. "It's to get people off illegal opiates. We unfortunately have a very serious drug abuse problem in this state."
Still, struck by the sharp increase in use of the drug, Johnson said that Medicaid officials for the past year have been looking for ways to ensure that it is being used appropriately, including new rules that the department implemented this year to tighten controls.
Suboxone, approved for drug addiction treatment in 2002 a synthetic opiate, like methadone, used to help people abstain from other narcotics. Methadone, however, is usually dispensed at a licensed clinic that patients must visit to receive a daily dose. Suboxone can be prescribed in pill form by any authorized physician.
Patients generally take a single dose per day, and many must continue on it indefinitely to avoid relapsing into drug abuse, said Barclay. With proper supervision and treat-ment, he said, Suboxone is a highly effective medication for people desperate for help.
"Opiate addiction is terrible plague that's reached epidemic prop-ortions around the country, certainly in Kentucky," he said. "When you have a serious epidemic that is killing people and causing all sorts of misery, is it honorable not to treat people?"
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