Drug abuse and addiction has remained an ongoing problem in the United States for decades on end. Within the last 20 some-odd years, opiate abuse and opiate addiction have reached a point of epidemic proportions.
According to the National Institute on Drug Abuse, an estimated 2.1 million Americans struggled with opiate-related substance abuse disorders in 2012, with numbers steadily increasing with each passing year. While considerable efforts have been made to meet this growing need for opiate addiction treatment services, needed supports for ensuring recovering addicts can live drug-free for the long-term are lacking.
More specifically, those in recovery have limited access to the types of medication therapies that make long-term abstinence possible. In this respect, opiate addiction is undertreated.
The Role of Opiate Addiction Medication Therapies
Opiate addiction medication therapies are specifically designed to treat the damage left behind by chronic and long-term opiate abuse. According to the Substance Abuse & Mental Health Services Administration, drugs commonly used as medication therapies include:
Chronic and long-term opiate abuse change the brain’s chemical and structural make-up over time, creating an opiate-dependent environment over time. When a person does stop using opiates, the aftereffects of chronic opiate abuse will leave him or her highly susceptible to relapse if the brain’s condition goes untreated.
Barriers to Opiate Addiction Treatment Access
Since the passing of the Affordable Care Act in 2010 (ACA), Medicaid providers have taken on a primary role in providing needed opiate addiction treatment for low and limited income individuals and families. In essence the requirements and eligibility guidelines put in place by Medicaid programs determine whether a person can access needed opiate addiction treatment services.
In spite of the ACA’s “essential benefits” provision that require insurers to cover substance abuse services in the same way medical treatment is covered, many Medicaid programs have made it difficult for recovering addicts to receive needed medication therapies.
Private Insurer Restrictions
Not unlike Medicaid programs, private health insurance companies have set in place certain measures that make it difficult for people in need of opiate addiction medication therapies to receive these services. According to the American Society of Addiction Medicine, many insurers will require a person to try other forms of treatment before they’ll cover the costs for medication therapies.
Private insurers may also require prior authorization from a person’s general physician or specialist doctor before granting coverage for medication therapy treatment.
State laws regarding health insurance coverage exert a considerable influence over what insurance companies can and cannot do. Currently, only 28 states authorize coverage for opiate addiction medication therapies, though the extent or range of coverage varies from state to state. For example, one state may authorize coverage benefits for methadone treatment, but not for Subutex or Suboxone.
While its understandable that health insurance companies are in the business of making money, these types of barriers to treatment don’t exist for other chronic conditions, such as diabetes and heart disease. In this respect, failure to provide a full range of treatment services for recovering addicts has left a gap in services that may well cause more harm than good in the long run.