Pubdate: Sun, 16 Dec 2007
Source: Enterprise, The (MA)
Copyright: 2007 The Enterprise
Contact:  http://enterprise.southofboston.com/
Details: http://www.mapinc.org/media/3231
Author: Maureen Boyle, Enterprise staff writer
Bookmark: http://www.mapinc.org/topic/Suboxone
Bookmark: http://www.mapinc.org/heroin.htm (Heroin)
Bookmark: http://www.mapinc.org/rehab.htm (Treatment)

ADDICTS' CURE HAS FATAL FLAW

BROCKTON -- Heroin addicts are lining up to pay hundreds of dollars a 
week to Massachusetts doctors who refuse to accept medical insurance 
for Suboxone, the FDA-approved drug that allows physicians to treat 
opioid abuse in the privacy of their offices.

Some doctors are charging desperate addicts up to $3,000 for initial 
visits -- and hundreds more for office visits lasting just a few 
minutes -- before handing over a prescription for Suboxone, parents 
and experts in the field said.

"There are doctors meeting people in parking lots, telling them, 'Go 
to the back door of my house,' " said Colleen LaBelle, program 
manager at Boston Medical Center's opioid treatment program. "It is 
just abominable."

It is happening across the country.

The National Alliance of Advocates for Buprenorphine Treatment found 
72 percent of patients were paying cash for treatment, with some 
doctors complaining it was too hard to get reimbursed by insurance 
companies.  Buprenorphine is the active ingredient in Suboxone.

"The doctors say it is not worth the fight," said Timothy Lepak, 
president of the alliance.

Suboxone, approved by the FDA in 2002, is the first approved 
medication for opioid treatment in a doctor's office, and has been 
heralded by some as a wonder drug for people addicted to prescription 
painkillers and heroin.

Those treated with Suboxone take one to two tablets of the medication 
daily to suppress withdrawal symptoms and reduce cravings. The pills 
are placed under the tongue and dissolved.

Doctors can treat up to 100 Suboxone patients if they undergo an 
eight-hour course offered by medical societies, get a waiver from the 
Drug Enforcement Administration, and notify the government of their 
plans. That number was increased from 30 per medical practice -- not 
physician -- last December after complaints that there weren't enough 
slots to treat the growing need.

About 150,000 people were treated with Suboxone in the country as of 
August 2005, according to the makers of Suboxone, and the numbers are growing.

"Parents will pay anything to get their children help," said Joanne 
Peterson, founder of Learn to Cope, a support group for parents of 
opiate-addicted children.

But with the growth -- and hope the drug offers -- comes the 
potential for greed, several said.

"There are a lot of shabby practices," Punyamurtula Kishore, a doctor 
who specializes in drug treatment, said of some doctors. "They take 
calls and they take the ones with the cash."

He said some of the doctors are making up to a half-million dollars a 
year seeing patients who want Suboxone.

"When you are desperate, you do anything and people are desperate for 
help," said Kishore.

One Braintree mother said her 20-year-old son paid $300 for his first 
visit, $150 for the second and $75 each week to one doctor to get a 
Suboxone prescription, even though he had Blue Cross/Blue Shield 
medical insurance.

And when the family questioned the doctor about the treatment, she 
said he got mad.

"He said, 'If you don't want the service and you don't want the drug, 
you can go elsewhere,' " she said.

He wound up relapsing and his drug use escalated, she said. His 
parents recently found him in the bathroom, overdosing on heroin.

"We spent $1,200 to do CPR on our son," his mother said. "It was a 
very traumatic event."

Lepak, who heads the The National Alliance of Advocates for 
Buprenorphine Treatment, said the cash-only policy by some doctors 
casts a good drug in a bad light.

"It takes away the credibility of the treatment. It makes it seem 
like it is something shady," Lepak said.

The doctors that do take insurance -- and insist on counseling -- 
often have long wait lists, parents say.  There are also 15 clinics 
in the state, including one at Boston Medical Center, that provide 
Suboxone treatment. Another health center, The New Bedford Community 
Health Center, is expected to receive a grant to also provide 
Suboxone treatment.

It was the only health center in this area to apply for the money.

Chantel Nouvellon, a Waltham psychiatrist who accepts three different 
forms of insurance for Suboxone treatment, said getting reimbursed 
can take a long time, depending on the insurance, and some doctors 
may not want to deal with the paperwork to get paid.

"For some insurances, sometimes you don't get paid for a year," 
Nouvellon, of Arlington, said.

Christine D'Eramo, formerly of Abington, tried Suboxone and was able 
to stay clean for nearly a year before relapsing.

"I don't think it is a miracle pill," D'Eramo, who is now drug-free 
again, said. "If you already want to get clean, it can help you. If 
you don't want to get clean, you are going to use."

LaBelle said at Boston Medical Center, where she works, older addicts 
who have been battling substance abuse for years appear to have the 
most success with Suboxone.

"It is a great option. It doesn't work for everybody.  It is a lot 
more effective for those who are really done. It is not a medication 
for someone who just wants to still get high."

She said some of the younger addicts may not be ready to get treatment yet.

"It is their parents that are the ones that are dragging them in by 
the hair," LaBelle said. 
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MAP posted-by: Richard Lake