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Bad Medicine: TriCare’s Noncoverage of Evidence-based Opiate Maintenance Therapy

This week, The New York Times gave heart-wrenching accounts of newborn babies enduring opiate drug withdrawal because of their mothers’ addictions. The story provided only one cause for optimism: Both babies and their painkiller-dependent mothers can benefit dramatically from being maintained on medications such as methadone or buprenorphine.

Unless, of course, these mothers were members of a military family, in which case such essential, life-saving care would be denied to them.

The most effective treatment for opiate addiction — long-term buprenorphine or methadone maintenance — is not covered by the Department of Defense’s TRICARE insurance program. The program limits methadone and buprenorphine prescriptions to short-term detoxification, and its regulations state, “Drug maintenance programs when one addictive drug is substituted for another on a maintenance basis (such as methadone substituting for heroin) are not covered.” The premise that prescribing opiate substitutes is no different from uncontrolled opiate abuse goes back to the anti-methadone hysteria of the 1970s. Since then, opiate-substitution treatment has become a staple of modern addiction medicine, particularly with the addition of buprenorphine in 2002. Unlike methadone, burenorphine can be prescribed for maintenance by patients’ regular primary physicians, outside traditional venues of addiction treatment, which had long posed forbidding barriers for many patients.

In fact, many of the best clinical trials of methadone and buprenorphine were conducted in Veterans Health Administration studies with former military personnel as patients. The treatment is so established that in 1997, the National Institutes of Health called for an end to the unnecessary regulation of these medications and for these medications to be included in public and private insurance coverage. These treatments are now standard within the addiction field, are FDA-approved and have been used to treat opiate dependence disorders for several decades. Long-term methadone and buprenorphine maintenance are now available to patients through Medicaid, through many state-funded programs, and, increasingly, through private insurance.Continue reading…

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