On July 1, 2016, many Maryland residents who are taking Suboxone were switched to a different form or medication-assisted treatment. The state’s Medicaid program has cut Suboxone—a drug used to reduce cravings associated with long-term opioid withdrawal—and replaced it with a medication called Zubsolv. Zubsolv is similar to Suboxone but comes in a tablet form, rather than the film in which Suboxone comes.
According to state officials, the decision was made in large part as a result of the increased influx of Suboxone strips into prisons and jails where are they are often either diverted or abused, a problem that Maryland Department of Health and Hygiene Secretary Shannon McMahon has described as “staggering”. Thus far in 2016, over 2,300 doses of Suboxone have been discovered and confiscated in Maryland correctional facilities, an increase of nearly 40 percent from last year.
What This Means for Current Patients
The decision to replace Suboxone with Zubsolv, which was made in partnership with the state’s Department of Corrections and a special Medicaid advisory panel, has many former Suboxone patients worrying about the day-to-day obstacles this creates in an already difficult recovery process. While officials say that the drug will provide the same level or craving relief and diminish the possibility of diversion and abuse, many in the clinical substance abuse treatment community are decrying the change. Many treatment providers and prevention advocates are already reporting heightened difficulty for patients who, up until a few weeks ago, were thriving on Suboxone.
Some patients have reported feeling sick and once again experiencing withdrawal symptoms. The anecdotal reality is that Zubsolv isn’t working for some patients that were able to get their lives together with the help of Suboxone. Physicians are reporting almost immediate setbacks for their patients, saying many of them aren’t reacting positively to the adjustment. State officials insist that patients can still acquire Suboxone with a physician-signed waiver, but some of who have tried say that it can take days to get a response one way or the other.
The issue is further complicated by the fact that Maryland Health Secretary Van Mitchell has ties to the lobbying firm that represents Zubsolv’s manufacturer.
A Possible Trend?
The fact is that if this could happen in Maryland, it could happen anywhere. If this change does become a trend, it could cut off struggling addicts from a proven and vital treatment resource, or make it very hard for them to access it. States like Kentucky have already tried to cut Suboxone from their Medicaid program, and although they were unsuccessful. This move could give many states the impetus to try again. The change also mirrors the struggle that many methadone patients encountered when the treatment standard became Suboxone. The difference here is that Suboxone is more accessible than methadone ever was. In a climate in which the federal government is planning to increase the number of patients to whom they prescribe Suboxone simultaneously, this is a conflict that is likely to inform the continued evolution of long-term opioid addiction treatment.