By Joseph P. Kahn at the Boston Globe
BRAINTREE — In the space of a few hours, on bomb-clearing patrol near Balad, Iraq, US Army Corporal Eric Small and his unit were rocked by three separate roadside explosions. He sustained serious injuries to his head, back, neck, and hip. Small’s combat days were over.
It was the summer of 2008, and Small spent 10 months convalescing in military hospitals. He came home to Massachusetts with two lasting wartime souvenirs: a Purple Heart medal and a painkiller addiction.
But in a bitter irony for Small and his family, the same government that sent him to war balked for months before agreeing to pay for the treatment his doctors feel best addresses his drug addiction. Small’s frustration is shared by some medical specialists who say it’s shameful to deny him, and others like him, coverage for a condition he acquired doing his patriotic duty. The issue has been federal regulations that restrict coverage for treatment of drug addiction for military personnel.
“I never dreamed when I joined the military that I’d be put in this situation,’’ Small, 29, said at his Braintree apartment, with his wife, Shannon, and baby daughter, Isabella, nearby. “I wasn’t a drug addict. I didn’t do drugs. Suddenly I’m going through withdrawals, wanting my body to stop being the way it is.’’
Percocet, the painkiller Small had been taking, is potent and can become highly addictive. Small no longer takes the drug, having been put on buprenorphine, a cutting-edge medication used to treat opiate dependency. Addiction specialists consider it the gold standard for treating drug dependencies like his, safer and more effective in many cases than older-generation drugs like methadone. Buprenorphine is also approved by the Federal Drug Administration for treatment of chronic pain.
Paying for buprenorphine, which costs $250 a week, has left the Smalls more than $3,500 in debt and scrambling to make ends meet.
Tricare, the military’s health care provider, did recently agree to cover the cost of Small’s buprenorphine, sold under the brand name Suboxone. But that approval did not come easily; it took months of negotiation between Small’s physician and Tricare, which will not approve the drug for “maintenance therapy of opioid dependency,’’ but will for detoxification and supervised drug withdrawal. In Small’s case, Tricare is covering the drug for pain management as well.
To many addiction specialists, all that amounts to a distinction without a real difference — and a conundrum for doctors wanting to provide optimal care for patients like Small. (Small’s physician declined to be interviewed.)
See Joseph P. Kahn at the Boston Globe.
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