MONTGOMERY — Some members of a rules group working on guidelines and regulations for physicians who prescribe buprenorphine to opioid drug addicts say cash payments for treatment need to be allowed.
Nicole Walden, the director of substance abuse treatment for the Alabama Department of Mental Health, is on the rules group and says taking away a cash payment option limits access to care for low-income individuals. Prohibiting cash payments had been a recent suggestion by at least some in the group.
“We’ve got patients who are in the throes of addiction who don’t have a driver’s license, so now you say I have to have a debit card or have a check, which costs money, but they also don’t have a driver’s license to go get that. So basically what you’ve said is ‘good luck’ to them because we’re not going to help you,” Walden said during a meeting Tuesday.
But other physicians worry that cash payments can lead to people taking advantage of system and selling the drug on the street.
“I don’t want to penalize people who are already down on their luck but I know that people who sell one of the buprenorphine strips for $20, and when you are given 90 strips in a month, they can start making a lot of money,” Dr. Jerry Harrison told Alabama Daily News.
Harrison is a physician in Haleyville and said he was one of the first physicians in Alabama to start prescribing buprenorphine as a way to fight opioid addiction.
Buprenorphine is a low-grade opiate that is meant to block cravings for opioids, without the same level high as methadone.
In May, the Alabama Legislature approved the creation of increased regulations on buprenorphine, The bill outlines several areas to be addressed through new rules, including dosage and minimum requirements for counseling, behavioral therapy and case management.
Dr. Brent Boyett is an addiction medicine specialist from Hamilton and founder of a treatment center with five locations in the state. He helped draft the legislation with Sen. Larry Stutts, R-Tuscumbia, He now leads the 17-member commission the legislation created that is drafting the rules. Last month, Boyett said the group wanted to eliminate the “cash culture” of some clinics that prescribe buprenorphine.
Along with the cash payment question, the group on Tuesday also considered the number of in-person visits the patient is required to make in order to continue receiving prescriptions.
Walden said she was concerned for those patients on Medicaid who are only allotted 14 visits to a physician a year.
“Patients then either have to make the choice of staying sick or going to the emergency room because they’ve used up all their visits on this very necessary service and that’s not what we want,” Walden told ADN.
Boyett said those dealing with an opioid abuse disorder are dealing with a chronic disease that can never be fully cured.
“Some patients will cycle on and off the medication throughout many points in their lives, others will get on it and stay on it long term, and there are some who will taper off and maintain a long-term recovery, but even those patients are not cured,” Boyett said.
Figuring out a way that those on Medicaid can afford long-term treatment without having to also pay cash out of pocket is something Boyett hopes to figure out before the next meeting.
The group will meet again on Jan. 7 in hopes of creating a finalized list of rules that will then be submitted to the Alabama Board of Medical Examiners for approval.