Consensus is growing around the idea that for some patients higher doses of a gold-standard opioid addiction treatment drug may be better than lower doses at keeping patients healthy and in treatment, especially for those who use fentanyl. But whether someone can access higher doses of buprenorphine — which works by curbing cravings and withdrawal from opioids — depends on where they live. In most states, Medicaid — the largest payer of substance use disorder treatment in the U.
S. — caps the doses it will pay for at arbitrary levels, typically at no more than 24 milligrams. In some states, like Tennessee, that level is as low as 16 milligrams.
With “underdosing,” patients may experience symptoms that could push a person back toward the drugs they’re trying to quit, risking overdose or even death. Providers say higher doses, sometimes up to 32 milligrams, are necessary in the face of a drug supply dominated by highly potent fentanyl. “It’s probably the most significant challenge that we’re facing in our community because so many patients are needing higher doses to have the desired outcome the medicine is designed to achieve,” said Ryan Alexander, addiction medicine physician and medical director for substance use programming at McNabb Center in Knoxville, Tenn.
TennCare, Tennessee’s Medicaid program, won’t pay for doses higher than 16 milligrams except in limited circumstances. “If you’re on a limit of 16 milligrams and cravings aren’t being co.