Doctor: Treat drug addiction with high bar

Timothy Gammons

Opioid addiction is an epidemic that is growing by the day. Michigan has been disproportionately affected despite increased state funding driven by community uproar. Effective treatments are available, and evidence-based Food and Drug Administration-approved medications exist. Despite these positive developments, opioid overdose deaths in Michigan are at an all-time high.

As physician with 16 years of clinical experience on the front lines of this epidemic, I am not surprised.

Unfortunately, many physicians treating addiction lack the interest in learning how to do it properly. These providers are too frequently financially driven and have dubious motives. To learn and implement current standards of care requires time and money and the willingness to provide appropriate care for patients. For some, complying with state requirements to obtain authorizations for prescription medicine or other services is viewed as a nuisance that impedes quick profits.

Here’s why: Providers bill and receive reimbursement from all insurers including Michigan Medicaid for treatment services whether or not they comply with standards of care of addiction medicine.

Imagine a cardiologist receiving payment to place a stent in a coronary artery incorrectly and outside standards of care thereby creating one bad outcome after another. No insurer would reimburse such a doctor, they would quickly be dropped from the plan’s panel of providers and likely be subject to sanction.

However, this is tantamount to what occurs in addiction medicine offices state-wide. Except that reimbursement is provided with little concern for outcomes and there are no sanctions. Addiction Medicine is a legitimate medical specialty. There are standards of care and defined guidelines based on clinical and biopsychosocial dimensions. Contingency management exists for patient non-compliance and sub-optimal outcomes. A standard of care exists and implementation is plausible.

Physicians who prescribe medications to treat opioid dependency (which are, in fact, often opioids), without adopting evidence-based practices will commonly have patients misuse or divert these drugs to the black market where they have significant street value. The illicit use of drugs designed to promote recovery from opioid addiction has become, to me, truly disheartening — not only as a physician but also as a taxpayer. Millions of dollars of state-bought medications are resold on the street — sometimes underwriting the individual’s addiction.

There is a legitimate state-wide outcry for access to treatment and treatment on demand, however, access to bad treatment may be worse than no treatment at all. Beginning with Michigan Medicaid, treatment must be intelligently regulated and conceived with an opportunity for good long-term outcomes. The state needs to create quality measures and compensate treatment providers based on quality care. Providers must be incentivized to train appropriately and demonstrate knowledge of evidence based practices.

This means ending the practice of physicians requiring cash payment for services rendered. Putting closer scrutiny on offices that prescribe alprazolam (Xanax) in conjunction with buprenorphine products, eliminate reimbursement to offices that fail to offer counseling services either on site or in such a way the compliance with counseling is tracked. Finally, providers that fail to utilize random urine drug screening and prescription monitoring programs to track doctor shopping must be removed from the network.

To be clear, an individual in active addiction is not a bad person and addiction is not a moral failure. Appropriate care should include counseling and psychosocial support designed to encourage behavioral change and appropriate use of medication.

Quality care works — it saves lives and money. Michigan residents deserve quality care. Paying for addiction treatment inconsistent with established standards of care and without quality measures, however, is a cost society can no longer afford.

Timothy Gammons is a board-certified addiction medicine physician and the founder of Gammons Medical with three offices in Metro Detroit.