Suboxone is Startlingly Under-Prescribed in Medicare Patients

By Zachary Siegel 07/25/16

A recent study found that doctors who specialized in addiction medicine prescribed the most Suboxone, but very few are Medicare prescribers.

Suboxone is Startlingly Under-Prescribed in Medicare Patients

The only opioid agonist therapy (OAT) covered by Medicare—a combination of buprenorphine and naloxone commonly known by its brand name, Suboxone—was found to be vastly underutilized for Medicare patients, according to new research. 

Given the rising tally of opioid-related mortality, this finding is alarming, especially given the most effective treatment for opioid addiction is either methadone or buprenorphine maintenance. However, Medicare does not pay for methadone, so the only option for Medicare patients is Suboxone.   

So just how much of a gap is there? The analysis revealed that only 81,000 Medicare patients are receiving OAT despite more than 300,000 Medicare patients estimated to be struggling with opioid addiction. Moreover, some 211,200 patients per year require hospitalization from opioid misuse. 

Furthering the gap, buprenorphine is prescribed by a mere 1 in 40 family physicians who prescribe opioid painkillers. The data also show that prescribers with a primary specialty in addiction medicine—which is a small number to begin with—prescribed the most Suboxone, with 98.8 claims per year per prescriber. This shortage of prescribers compounds the problem, because so few people have access to addiction specialists. 

"We believe this reflects a significant treatment gap, although we are limited in providing precise estimates,” wrote the study’s investigators, Anna Lembke, MD, and Jonathan H. Chen, MD, PhD, of Stanford University School of Medicine. “Not all patients with an opioid use disorder warrant OAT but, on the other hand, opioid disorders are systematically underdiagnosed and increasing in prevalence." 

The rate of opioid overdoses reached a record high in 2014, and the Medicare population is among the fastest growing groups of people with opioid use disorder. It’s estimated that 6 per 1,000 patients is diagnosed with opioid use disorder. Given these figures, the lack of OAT among this patient group should give us pause. 

These findings may also partially explain the high mortality rates. One study found patients who were treated with buprenorphine or methadone had half the death rate than those who received only psychological, abstinence-based treatment. If more people with opioid use disorder are properly treated with what the World Health Organization, the Institute of Medicine, the National Institute on Drug Abuse and the Office of National Drug Control Policy agree is the best treatment, then fewer people would be prematurely dying from this illness. 

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Zachary Siegel is a freelance journalist specializing in science, health and drug policy. His reporting has also appeared in Slate, The Daily Beast, Salon, Huffington Post, among others. He writes often about addiction, sometimes drawing from his own experience. You can find out more about Zachary on Linkedin or follow him on Twitter.