Md. lawmakers consider measure to reverse state’s drug decision

Suboxone sublingual film. (Wikimedia Commons / Jr de Barbosa / Suboxone SL Tabs.jpg  / CC BY-SA 3.0  / cropped and resized)

ANNAPOLIS — A panel of lawmakers is threatening legislative action to challenge a decision by state Medicaid officials to limit access to a drug used to treat opioid addiction that has become a major contraband problem in Maryland prisons.

The decision to exclude Suboxone Film from a preferred list of drugs paid for by Medicaid comes as Maryland and the nation wrestle with an opioid addiction crisis. Corrections officials say the film is a growing problem; it is smuggled into prisons and local detention centers and is the cause of violence between inmates and assaults on corrections employees.

But advocates say the drug, when properly used, helps patients addicted to heroin and other opioid drugs stop using and that the tablet form of the drug doesn’t work as well with some patients.

“I think we’re listening, and we’re going to have to take some action,” said Sen. Kathy Klausmeier, D-Baltimore County and co-chair of the legislature’s Joint Behavioral Health and Opioid Use Disorders Committee.

“It’s not the end of the discussion, in my opinion,” she said.

“I think we’re listening, and we’re going to have to take some action,” said Sen. Kathy Klausmeier, D-Baltimore County and co-chair of the legislature’s Joint Behavioral Health and Opioid Use Disorders Committee. (File)

The decision earlier this year effectively moves most Medicaid patients to a tablet form of the drug that interrupts cravings for drugs such as heroin. Department of Health and Mental Hygiene Secretary Van T. Mitchell, in a letter to the Baltimore Sun, said that the decision was made in an effort to reduce smuggling into the state-run Baltimore City Detention Center and other prisons and detention centers around the state.

“The introduction of contraband into our correctional facilities is one of our top risks for our safety and security of our staff, our inmates and our facilities,” said Department of Public Safety and Correctional Services Stephen T. Moyer.

The department supervises approximately 21,000 inmates and another 45,000 on parole and probation.

“Suboxone Film is by far the most prevalent form of contraband found in Maryland state correctional facilities because it is easy to conceal and it is easy to transfer to other forms for consumption,” Moyer said.

In 2014, the department seized 2,875 strips of the drug. In 2015, that figure climbed to 3,689. The department is currently on pace to equal that amount this year.

The ease of access to the drug caused the department in July to propose a rule to restrict mail to inmates to postcards only. The department later dropped that proposal in the face of opposition from civil liberties and prison rights advocates.

The problem is not limited to state prison facilities.

Terry Kokolis, superintendent of the Anne Arundel County Detention Center and vice president of the Maryland Correctional Administrators Association, said the drug is frequently smuggled in under stamps or in envelopes or is liquified and sprayed on paper. Once inside, the contraband is sold or traded for other contraband items.

Erik Robey, legislative officer for the Harford County Sheriff’s Department, said the drug is smuggled into the jail for the sole purpose of selling to inmates who want to get high.

“They’re selling it for money so they can buy heroin and other illegal drugs,” Robey said.

Terry Cornell, a nurse practitioner at Health Care for the Homeless in Baltimore, said the Medicaid decision would limit the options available for treating patients who want to stop using heroin and other related drugs but are suffering from withdrawal.

“This is a really fragile time for our patients,” Cornell said, adding that she was glad that Suboxone was being smuggled into jails rather than opioids.

“We’re smuggling in treatment,” Cornell said.

Steve Daviss, a psychiatrist who specializes in addiction and who represents the Maryland Society of Addiction Medicine, said patients on Suboxone Film should be grandfathered in without having to jump through administrative hoops. Some patients who have been moved to the preferred tablet form are suffering from withdrawal issues, he said.

Daviss added that restricting one form of the drug is not going to solve the problem, saying all forms of the drug are “dissolvable … and therefore any of those can be painted onto a picture or otherwise made available.” He added that the tablet form of the drug will soon become the correctional system’s “No. 1 problem.”

Del. Dan Morhaim, D-Baltimore County and a physician, criticized the decision by Medicaid officials because it only applies to the state’s prescription program for the poor.

“The underlying assumption is that it’s Medicaid patients who are doing the smuggling,” Morhaim said.

Shannon McMahon, deputy secretary of health care financing for the department, said the state agency is the largest payer for the prescriptions in the state.

“We know we are part of the problem and are likely in the best position to be part of the solution,” McMahon said, adding that the agency has reached out to private insurance companies to discuss the issue.