Doctors question limits on opioid addiction treatments

When opioid users need help battling addiction, doctors often prescribe a class of drugs called Buprenorphine to manage withdrawal.

WRAL Documentary: Searching for a Fix

For those on Medicaid, there are basically two choices: Suboxone, which comes in a thin, dissolving film and Sublocade, which is a longer acting injection. Both are made by the same company and both can be prescribed for Medicaid patients without the requirement for extra approvals.

That is key, said Dr. Michael Trombley, a family doctor certified to treat pain-killer addition.

"Prior authorization can take up to five days. By that time, a patient is going to go into withdrawal and probably go back to their old ways," he said.

Trombley says Suboxone works, but if he feels another drug would work even better, he'd like to have that choice.

The North Carolina Department of Health and Human Services, which gives Suboxone its preferred status, defended that choice. In a statement, the DHHS wrote: "Following clinical and financial review, Suboxone was recommended for preferred status. DHHS supported their recommendation that Suboxone provided the best value to beneficiaries and providers."

Meanwhile, North Carolina and 41 other states are suing the company, Indivior, accusing it of trying to block generics and driving up prices. Attorney General Josh Stein said, "NCDOJ took this company to court because we were concerned about artificially high drug prices costing us all more money."

Trombley says the suit doesn't make sense to him. He wonders why state regulators put up approval hurdles for treatment, but not for opioids themselves.

"The medication that can actually create the problem goes straight through, but the medication to actually cure and help these patients requires prior authorization?"

Trombley doesn't want one drug maker dominating treatment because one size doesn't fit all his patients.

"It's kind of like the average shoe size for a man is a 10 and a half, and I have to get a prior authorization because you have a size 12," he said.