OKLAHOMA CITY – After losing two sons to drug overdoses, an Edmond mother said she’s pressing forward with an effort to get Oklahoma Medicaid patients better access to one of the nation’s top opioid treatment medications.
Denise Roberts said the state’s Medicaid program only allows doctors to prescribe one form of the “gold standard” in addiction care – buprenorphine – without prior authorization. In order to access two other types, she said patients have to await preapproval, which “could mean death.”
In her family's case, she said limits on access cost her sons their lives. She said her sons were 19 and 28 when they overdosed. Roberts said their addiction started with marijuana and escalated to opioids before they both overdosed on heroin.
“Not being able to find the resources to (treat a sick kid) is just heartbreaking,” she said. “I just wish more people could realize that.”
In addition, federal caps limit the number of patients doctors can treat. Roberts said that makes it hard for Medicaid patients to find doctors who can even administer the medicated treatment.
Buprenorphine, known in the medical community by the slang “bup,” is used to help treat heroin or opiate addiction. It is the first opioid addition medication that can be prescribed or dispensed in a doctor’s office, according to the federal Substance Abuse and Mental Health Services Administration.
“The nice thing about the bup products is (patients) never have to go through withdrawal,” said Julie Croff, executive director of the Oklahoma State University Center of Wellness and Recovery. “Some of the other products require you to go through withdrawal.”
But experts say there are not enough physicians authorized to prescribe buprenorphine in Oklahoma.
Oklahoma has 147 certified providers capped at 30 patients each, and 24 with a cap of 100 patients, said Jo Stainsby, an Oklahoma Health Care Authority spokeswoman, in an email.
Federal law restricts who can prescribe the controlled substance. Prescribers must first go through a waiver process and take classes. They also must be licensed by the Drug Enforcement Agency to show they are certified to prescribe in an office-based setting.
The first year, prescribers are limited to 30 patients a month. Then prescribers can request that the cap increase to 100. The most a board-certified addiction specialist can treat is 275, Croff said.
Physician assistants and nurse practitioners also can prescribe, but must complete 24 hours of training.
“They want to make sure you’re not prescribing opioids in a way that will hurt patients and not via telemed(icine),” Croff said. “It’s very challenging from a prescriber perspective because we don’t have the same restrictions on prescribing opioids that got people addicted in the first place.”
Croff said medical professionals are pushing back against the federal regulations.
Stainsby said her agency, which runs the state’s Medicaid program, does prefer one particular buprenorphine product – Suboxone – but does offer two others with prior authorization.
“Suboxone is preferred because it is the best priced option, and while some of the generics are not preferred, the tablets are, so you have the option of films or tablets,” she said.
She said the agency tracks all the Oklahoma doctors currently certified to prescribe buprenorphine for opioid use disorder.
“Access and availability of specialized services can be more challenging in rural Oklahoma,” she said. “In instances when the specialized addiction treatment provider is a distance from the member’s residence, additional resources such as SoonerRide are available to assist with transportation to scheduled appointments, if needed.”
Janelle Stecklein covers the Oklahoma Statehouse for CNHI's newspapers and websites.