Opinion: How to stop abuse of prescription opioids

By Mary Jo Cannon, M.D., MA

For MarylandReporter.com

As a physician on the front lines of the battle against heroin and prescription opioid abuse, I have seen the triumphs and the tragedies that epitomize Maryland’s fight against addiction.

That experience has taught me that the best way Maryland policymakers can combat addiction is to treat it as a disease of the brain. As Gov. Larry Hogan has said, “this is a disease, and we will not be able to just arrest our way out of that crisis.”  The governor is right, and there are key steps state government can take to bolster its fight against addiction even after the 2017 legislative session has concluded.

Like all diseases, heroin addiction has symptoms. One of the most troubling symptoms I encounter with patients is a phenomenon called diversion, which occurs when a patient sells their prescription opioid treatment on the black market rather than taking it as directed to aid their addiction recovery.

Reducing drug diversion

To combat addiction more effectively, Maryland policymakers must focus on choosing the best treatment options and reducing drug diversion. Fortunately, Maryland’s Department of Health and Mental Hygiene took a positive first step recently when it chose Zubsolv as the preferred medication for Out Patient ambulatory care.

Zubsolv, a combination of buprenorphine and naloxone,  is more bioavailable, more quickly absorbed and comes in multiple doses allowing greater opportunities to find just the right dose for each patient.

Zubsolv is less easily diverted and less attractive on the street in that it is a tiny tablet and cannot be easily cut, divided, repackaged and sold. Zubsolv has become the “go to” product to launch treatment for those eligible for OP ambulatory care for opiate dependency.

The lesson from this crisis is that Maryland must treat diversion as part of a disease, not simply criminalize it. Treatment that ignores or criminalizes diversion is not adequately addressing the patient’s needs. Diversion is a reflection of inadequate treatment that is not appropriately addressing this major behavioral symptom. Let’s help stop diversion by continuing the offer of Zubsolv as our main medication to institute induction to Medication Assisted Treatment.

Committee takes up addiction medication reimbursement

On May 4th, Maryland’s Pharmacy & Therapeutics Committee will meet to consider which opioid addiction treatments will be reimbursable under Medicaid for the following year. Their decision will have broad ramifications for patients, families, physicians and public safety officials statewide.

I encourage them to continue combating the diversion crisis in Maryland by keeping Zubsolv at the top of the preferred drug list. Maryland must compassionately treat the disease of addiction, Zubsolv should remain our primary choice of medication to start our patients off and easily facilitates the weaning process once stabilization has taken place.

All of us — doctors, policymakers and patients — must continuously work toward better treatment, improved policies and less drug diversion on the street. The stability of our homes, workplaces and communities depends on this unified effort.

Mary Jo Cannon, M.D., is the physician medical director of Main Place Treatment Center, addiction treatment provider with offices in Frederick and Cumberland.

RELATED STORY: Eric Eyre, the statehouse reporter for the Charleston, W.Va., Gazette-Mail won the Pulitzer Prize last week for a two-part investigation into the flood of prescription pain killers into rural West Virginia.