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Opioid treatment gap in Medicare: Methadone clinics | health



One in three older Americans using Medicare medication is prescribed opioid analgesics, but for those who develop a dangerous addiction, there is one treatment that Medicare will not cover: Methadone

Methadone is the oldest and experts say , the most effective of the three approved drugs for the treatment of opioid dependence. It relieves cravings without an intense high and allows patients to work with counselors to rebuild their lives.

Federal money will flow to states to open new methadone clinics through the 21

st Century Remedies Act, but despite the nation's deepening opioid crisis, the Medicare drug program for the elderly only covers methadone when prescribed for pain [19659003] Joseph Purvis, a former heroin and prescription analgesic, said he was depressed because he initially feared he would have to stop methadone treatment by 65.

"I was afraid I would have to leave the program There's no way I wanted to go back to addiction on the street, "said Purvis, 66, from Gaithersburg, Maryland.

Methadone Not Meets the requirements of the Medicare Part-D Medicines Program, as they can not be sold in a retail pharmacy.

Instead, patients in the highly regulated methadone system are first assessed by a physician and then emerge at state-certified methadone clinics to take their doses of pink fluid. Or, like Purvis in Maryland, they prove through repeated urine screens that they have earned the right to weekly house tins.

In Congress, legislation was introduced in the House and Senate and a White House commission on the opioid epidemic also recommended the change.

The epidemic "affects all sections of the population, including our seniors," said Rep. George Holding, R-North Carolina, a house-bill sponsor. "Medicare beneficiaries are among the fastest growing opioid consumption bugs, but currently have no coverage for the most effective treatment."

"We have a sacred responsibility to find solutions that will help anyone who may be affected," said Sen. Bob Casey, D-Pennsylvania, senior member of the Special Committee on Aging and Chief Sponsor of the Senate Bill.

An estimated 300,000 Medicare patients were diagnosed with opioid dependence, and health officials estimate that nearly 90,000 are at high risk for opioid abuse or overdose.

Buprenorphine, a more expensive and less regulated treatment drug, is covered by Medicare, but few doctors who accept new Medicare patients have received government waivers. A recent study by Medicare claims that buprenorphine was prescribed for only 81,000 patients

More evidence that the crisis affects seniors: Opioid overdoses killed 1,354 Americans aged 65 and over in 2016, about 3 percent of the 42,000 opioid Overdoses this year. 19659003] Medicare policy means that clinics often seek to treat elderly patients if they have commercial insurance covering their care before the age of 65, said counselor Angela Caldwell of Montgomery Recovery Services of Rockville, Maryland.

A national organization for methadone clinics says the clinics now have 25,000 Medicare beneficiaries who either pay out of pocket (about $ 80 a week) or are treated by state Medicaid or block grant programs.

Mark Parrino, president of the American Association for Treatment of Opioid Dependence, thinks more people would seek methadone treatment if Medicare covers it.

Many elderly patients rely on surprisingly hi doses of opioids for pain relief, which may become addictive, Dr. Anna Lembke, a search specialist at the Faculty of Medicine at Stanford University.

One of her addict patients, a woman in her mid-70s, was named her because her daily dose of opioids had climbed to a much greater potency over the years than that of a typical heroin user, Lembke said.

"It has developed a gradual tolerance development over many decades and is now on an astronomical dose, Lembke said." If you took any chance human and gave them (so much), they would die. "

Lembke said Normally, she would not consider methadone for this patient because of the stigma associated with the clinics, but Medicare coverage might make her more acceptable, Lembke said, and her patients "could actually do better with methadone."

Stayed in Maryland Purvis on methadone treatment because his income is low enough to qualify for federal Medicaid insurance coverage for the poor and disabled Medicaid covers methadone treatment in Maryland and about 35 other states.

Purvis, who in his teens more than Heroin had been consumed for a decade, later taking opioids prescribed by back pain specialists When his pain clinic was closed due to overwriting, he started methadone treatment.

"Some people think of methadone as a crutch for addiction, but it's not," said Purvis. "It's a tool that allows people to lead a reasonably normal life."

AP author Ricardo Alonso-Zaldivar in Washington has contributed to this report.

Follow AP Medical Writer Carla K. Johnson on Twitter: @CarlaKJohnson

The Associated Press Health & Science Department receives support from the Department of Science Education of the Howard Hughes Medical Institute. The AP is solely responsible for all content.


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