The following Letter to the Editor by Robert Newman Appeared in The Detroit News
U.S. Sen. Carl Levin, chairman of the Senate Armed Services Committee and a Michigan Democrat, has been a leader in expanding the availability of treatment for Americans suffering from heroin addiction. In 2000, he co-sponsored with Sen. Orrin Hatch, R-Utah, the Drug Addiction Treatment Act -- groundbreaking legislation that allows community-based physicians to treat opioid-dependent patients with buprenorphine. Buprenorphine is similar to methadone, which has more than 40 years of proven effectiveness, but which may only be used by comprehensive treatment programs; both medications have a high degree of success in treating dependency on heroin and prescription painkillers such as OxyContin, Percocet and Vicodin.
In 2006, Levin sponsored another bill that substantially increased the number of patients for whom physicians can prescribe buprenorphine. At that time, he noted "the great success of buprenorphine treatment" and continued, "It is tragic if the personal and community benefits of this new anti-addiction medication ... are limited because of artificial limits on its use."
Unfortunately, precisely such "artificial limits" persist, and one of the greatest barriers to care is our Department of Defense. In clear defiance of congressional intent and ignoring decades of proven efficacy of medication-assisted treatment, the Department's TRICARE insurance plan refuses to pay for any maintenance treatment for addiction. And who are the people desperately seeking and needing help, but being denied coverage? American military, veterans and their families, including survivors of those who have made the ultimate sacrifice in defense of their country and been killed in action.
TRICARE is a well-deserved health care benefit for almost 10 million Americans. Its refusal to pay for what has been aptly described as "the gold standard" of care for opioid dependence is outrageous, and the outrage is underscored by the fact that treatment denied to our nation's heroes and their loved ones at home is being offered at U.S. taxpayer expense to opiate-dependent citizens of other countries -- for example, Vietnam.
Meanwhile, tens of thousands of veterans are known to be dependent on opioids, and the numbers keep rising. In May, former Drug Czar Barry McCaffrey told a conference of addiction-treatment providers that serious drug use among U.S. troops in Afghanistan has doubled in the last four years. Furthermore, according to a new report on veterans and addiction released by the Drug Policy Alliance, nearly a third of Iraq and Afghanistan veterans report symptoms of post-traumatic stress disorder. Of these, as many as three-quarters show signs of substance abuse or dependence.
To grasp the impact of the TRICARE tragedy, consider the case of Amanda Dressler of Georgia . In 2006 Amanda, then 23-years-old, married Sgt. Shawn Dressler; two weeks later he was deployed on his second tour to Iraq . In anticipation of Shawn's return, Amanda bought a house and began renovating it when, on June 2, 2007, shortly before their first wedding anniversary, she got word that Shawn had been killed in action.
In her grief, the young widow turned to opiate analgesics and quickly became dependent. With the strong support of her mother, Teresa Bridges, she sought and received in-patient care followed by buprenorphine prescribed by a duly certified community-based physician. Amanda responded extremely well to the treatment, but her recovery was thrown into jeopardy when she received notice that TRICARE would not cover her ongoing "maintenance" treatment.
Amanda's options were bleak. There was no way she could afford to pay out of pocket for continued buprenorphine treatment, but cutting short her care would result in an extremely high likelihood of relapse. Committed to her recovery, Amanda and her mom appealed to TRICARE and reached out to local political leaders, but they just said no!
Fortunately for Amanda, she caught a break; she recently learned that she had been accepted into a pharmaceutical company's "patient assistance program." This aid, however, will only provide treatment for one year, so the fundamental problem will persist for Amanda just as it does for thousands of others in need of opiate maintenance therapy.
Clearly, our leaders must again show compassion and common sense and demand that the TRICARE exclusion of "maintenance treatment" as a covered service be rescinded immediately. (The story online