Are Insurance Companies Making Opiate Treatment More Difficult?

Are Insurance Companies Making Opiate Treatment More Difficult?


One of the hurdles that struggling opiate addicts have to deal with is in getting the medication that could help them to beat their addiction.

This is unfortunate, because it could be so much easier. But it’s not.

The News and Observer says that “BCBS requires providers to request prior authorization to start buprenorphine. These prior authorizations can require days of back-and-forth discussions until approval, during which time a person seeking treatment is at risk of overdose.”

It is also unfortunate that less helpful forms of MAT, such as methadone maintenance, are cheaper and far easier to get than Suboxone.

For some reason they did not want doctors being able to prescribe Suboxone easily, even though it is far safer than traditional opiates or other forms of MAT like methadone. So what they have done is to make it so that far more hoops have to be jumped through in order to prescribe it.

Insurance companies do not really want to pay the money for a medication such as Suboxone, so their goal (it would seem) is to deny people the medication. They know that this is a maintenance type of medication that might be taken for a long period of time, and therefore they know that if they put people on this medication then they are going to be paying out a lot of money for it. Their goal, it seems, is to make the process of getting authorized to get on Suboxone maintenance as difficult as possible.

This is the basic economics of the opiate crisis–nobody really wants to pay for it, and we also don’t really know what to do about it.

One thing that demonstrates decent results–especially in the short run–is MAT approaches such as using Suboxone. We can send people to inpatient treatment, and they can go through a medical detox process, get some counseling, and be exposed to group therapy, but without a solid plan in place for aftercare, they are likely just going to go back out and relapse.

This is where MAT comes into play. The new standard of addiction treatment is both inpatient treatment, counseling, support meetings, and MAT–all combined into one big effort. But in order for this to be viable we need to make the medication more accessible. If we have something that even comes close to being a real “cure” for the opiate crisis, wouldn’t we want to get that solution to as many people as possible?

Part of the problem when it comes to treating opiate addiction is that many people who are struggling are not yet in a state of full surrender. In order for treatment to be effective the person really has to be at “rock bottom” in their addiction, and they have to be nearly out of hope completely. This is the state of surrender that seems to produce good results–regardless of the treatment or methodology that is used.

It is important to realize that opiate addiction has a strong physical dependence component to it that goes beyond most other substances. The opiate addict is literally rewiring their brain on a physical level when they abuse opiates for an extended period of time. So when the struggling opiate user finally attempts to get clean, they have an extra difficult struggle ahead of them because their body is now working against them.

Consider for a moment how the human body regulates its own dopamine. Your brain has certain receptors that will accept dopamine molecules, and your body can–in times of extreme stress–deliver an extra dose of natural dopamine to your body in order to get you through a flight or fight situation.

Because your body has this ability, it must also have a baseline that allows this system to exist in the first place. So that baseline means that every human body has a small amount of dopamine flowing through it at all times. Your body produces this dopamine and it trickles it out to your brain, every second of every day. It is always there so that you have a baseline for natural pain relief.

When the opiate addict starts abusing opiates, the opiate molecules that they put into their body–whether it is vicodin or heroin or fentanyl–go into the receptor sites in the brain and they provide instant pain relief. The problem is that if you are consistently abusing opiates then at some point the human body will realize that the natural dopamine production is no longer needed. So at that point your body stops producing the natural dopamine that it creates every day, and instead it just relies on the drugs you are abusing.

This works great until the addict stops abusing opiates, at which time their brain is going to cry out in protest: “Where are my opiate molecules? Where is my dopamine? I need something to fill in these hungry opiate receptors!”

And that is what produces withdrawal symptoms, and sends the opiate addict into a miserable state of existence that prompts them to want to relapse.

So a struggling opiate addict can deal with this withdrawal by going to an inpatient detox center, where they would be treated with medications to help ease them through the detoxification process. However, even after the opiate addict has been fully detoxified and is completely clean, they still have a problem: Their body has not really started to produce its own natural dopamine again.

After a week or so, the body will turn that natural dopamine production back on. However, because the opiate addict has abused drugs for an extended time period, their brain is now rewired to require greater and greater amounts of dopamine or opiates in order to satisfy it. So what happens is that the person is going to feel slightly sick, lethargic, and unmotivated due to a lack of opiates. And this phase of their long term withdrawal symptoms can last for over a year.

So you can see why there might be a strong case to be made for Suboxone therapy. Struggling opiate addicts who cannot feel normal and healthy without it will have much better chances of success in recovery if they have access to this medication.

The opiate crisis shows no signs of slowing down, and it is up to us to find new solutions and new ways to treat opiate addiction. The more methods we can test, the more we can learn about what the best practices truly are for treating the crisis.