Suboxone, a medication to treat opioid use disorder, was the second-most-prescribed drug in Maine in 2016-17, according to new data released by the state this week.
The fact that Suboxone would be listed alongside common medications for hypertension, asthma, acid reflux and allergies reflects the depth of the opioid crisis in Maine, experts say. Maine had a record 418 drug overdose deaths in 2017 and 180 through the first six months of 2018. A law passed in May by the Maine Legislature required the Maine Health Data Organization to publish a list of the most prescribed and most expensive medications, and the organization published the list this week, using data from Sept. 1, 2016 to June 30, 2017.
“It was surprising to see Suboxone be so ubiquitous, sandwiched between two medications that provide treatments for common conditions like hypertension and asthma,” said pharmacist Stephanie Nichols, an associate professor of pharmacy at Husson University.
Suboxone prescriptions will most likely increase in 2019 when Gov.-elect Janet Mills rolls out Medicaid expansion, providing access to Suboxone treatment for 70,000 Mainers. Many of those newly eligible for Medicaid – low-income adults – were previously uninsured and probably unable to afford the treatment.
SUBOXONE DESCRIBED AS ‘MOST EFFECTIVE’
In the Medicaid program, Suboxone is a “preferred” medication for treating opioid use disorder. So starting in January, thousands of Mainers – some rough estimates say 10,000 to 25,000 people – who suffer from substance use disorder would be newly eligible for Suboxone treatment.
In the 10 months when data was collected during 2016 and 2017, doctors in Maine wrote 81,586 Suboxone prescriptions for 6,207 patients at a total cost of $16.8 million, according to the data. The most-prescribed medication – hydrochlorothiazide, which is used for hypertension – was prescribed 87,695 times to 33,174 patients. The most expensive medication, Humira, which is used to treat arthritis, colitis and other diseases, cost Mainers $74.5 million during the same span.
Suboxone or methadone, combined with therapy and other supports, are considered the “gold standard” for effective treatment of opioid use disorder.
One reason why Suboxone medication results in so many prescriptions is because most doctors prescribe them for short periods such as a week or two, whereas other medications are more typically prescribed for 30, 60 or 90 days at a time. There are many reasons for short-term Suboxone prescriptions, such as limiting the possibility of diverting the drug to illegal street sales and to encourage patients to show up for counseling sessions.
Dr. Lisa Letourneau, associate medical director at Maine Quality Counts and a Suboxone prescriber, said Suboxone or generic buprenorphine pills are by far the most common treatments for opioid use disorder, apart from methadone, which has to be taken at a methadone clinic. For other conditions, many different medications may work to alleviate symptoms.
“(Suboxone) is by far the most readily available and effective drug for its condition,” Letourneau said. “You’re concentrating most of the treatment into one drug.”
Letourneau said for uninsured patients who have to pay out of pocket, the generic equivalent – buprenorphine – is usually preferable to brand-name Suboxone for affordability reasons. With rebates, buprenorphine costs about $20 to $50 per week for the uninsured, depending on dosage and other factors.
‘PRESCRIBING PRACTICES HAVE CHANGED’
Dr. Jeffrey Barkin, associate medical director of Change Health Care, which operates pharmacy benefits for 16 states, including Maine, helps negotiate medication contracts for state Medicaid programs. He said the law prevents him from disclosing what states pay for Suboxone, but it’s far less than the $16.8 million that Mainers paid during the 10 months the data was collected.
“The industry term for Average Wholesale Price? We refer to that as ‘Ain’t What’s Paid,’ ” Barkin said.
With rebates, he said, Suboxone treatment is far less expensive for the health care system than having untreated patients, who end up with other health problems, show up in emergency departments with overdoses or die.
“This is in the middle of an opioid crisis, so it’s great to see that the most effective treatment for opioid dependence is in such wide use,” Barkin said.
At the same time, the most-prescribed opioid used for pain relief, hydrocodone, was the 14th-most prescribed medication in Maine in 2016-17. Data of this type has not been published before, but experts say that if the state had tracked the data several years ago, more opioids likely would have shown up higher on the list.
A strict new law passed in Maine in 2016 clamped down on prescribing opioids for chronic pain patients. Research has shown that over-the-counter pain medications or treatments such as using ice or physical therapy are equally or more effective than opioids for chronic pain and do not carry the risk of addiction, according to a Canadian scholarly review published this week summarizing the findings of 96 studies.
Nichols, the Husson professor, said it was common a few years ago for pharmacists to dispense opioids for a number of conditions, but not so much anymore.
“Our prescribing practices have changed dramatically,” he said.
Overall opioid prescribing fell in Maine 32 percent from 2013 to 2017, according to a national report by IQVIA, which does not use the state health organization data, but draws on prescribing data from pharmacies across the country.
The Maine law requiring publication of the drug data, sponsored by state Sen. Eloise Vitelli, D-Arrowsic, aims to provide transparency in drug pricing, and could lead to further state reforms that would keep prescription prices in check, according to a news release from state Democrats.
“The report highlights that too many Mainers are paying high prices just to survive,” Vitelli said in a written statement. “Individuals with chronic conditions don’t have a choice when it comes to taking regularly prescribed medication. We need to do more to drive down costs and make it easier for people to get by.”
Joe Lawlor can be contacted at 791-6376 or at:
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