ANNAPOLIS (Nov. 4, 2016)—Since Suboxone film strips were removed from the Medicaid Preferred Drug List in July, the amount of the drug recovered in Maryland correctional facilities as contraband has decreased by 41 percent, according to Maryland's Department of Public Safety and Correctional Services.
Suboxone—a drug used to treat opiate addiction—has a high risk of addiction and dependence, and can even lead to death when paired with other drugs or alcohol, according to the Food and Drug Administration.
The medication is easily smuggled into state prisons and jails when it is in the form of a strip, designed to be placed under a user's tongue, said Gary McLhinney, the director of professional standards at the Maryland Department of Public Safety and Corrections.
"It is an epidemic, the amount of Suboxone that comes in," said Terry Kokolis, the director of corrections for Anne Arundel County, Maryland, at Wednesday's meeting of the legislature's Joint Committee on Behavioral Health and Opioid Use disorders. "Strips come in, they're sold, they're bartered, they're cut into four pieces and the inmate population is always looking for Suboxone. It's the preferred drug."
In May, the Maryland Medicaid Pharmacy and Therapeutics Committee made recommendations for the Medicaid Preferred Drug List.
The Department of Health and Mental Hygiene removed Suboxone from the preferred list and instead made comparable Zubsolv tablets preferred on July 1, making Maryland the first state to do so.
The tablets are more difficult to smuggle into prison than the film strips, which can be easily concealed.
If a drug is on the Medicaid Preferred Drug List, a person covered by Medicaid can obtain that drug for a small co-pay. If a drug is denoted as non-preferred, a person must get prior authorization for the medication through a doctor or prescriber in order for it to be covered or partially covered by Medicaid, according to the Maryland Medicaid Pharmacy Program.
On Sept. 23, 35 states—including Maryland—and Washington, D.C., filed a class action lawsuit against Indivior, the company that produces Suboxone. The states allege Indivior impeded the sale of generic versions of Suboxone in tablet form until it forced other generic alternatives out of the market, driving up the price of the film strips, according to a Sept. 27 release from Indivior.
The release is the only comment the company has on the lawsuit or on the Medicaid restrictions at this time, said a representative from Indivior.
Between July 1, when the film strips were removed from the Medicaid Preferred Drug List, and Oct. 31, the Department of Public Safety and Corrections has recovered 940 pieces of Suboxone film strips, compared to 1,603 recovered from July 1 to Oct. 31 in 2015.
"We've also had our teams monitor inmate calls and they're overhearing some frustration about not being able to obtain the strips behind the walls as easily as it was prior to July 1," said McLhinney.
The disparity between the asking price of contraband Suboxone strips has also sharply increased since July 1. The street price for a film strip is only $5, while the price behind bars can be up to $500, said McLhinney.
Typically, the film strips are cut into four pieces and sold separately within prisons to increase an inmate's profit margin, Kokolis said.
"We've done numerous cases where Suboxone has been smuggled in the jail behind stamps or in envelopes or where the paper was colored with Suboxone and then the inmate would get the paper and eat it," said Dan Alioto, the commander of the vice/narcotics division at the St. Mary's County Sheriff's Office.
Though the amount of the drug recovered in St. Mary's County has declined slightly since July, Suboxone strips are still being abused and traded for other drugs within jails and prisons, he told the University of Maryland's Capital News Service.
"I think it has slowed down, but it's still an old trick, so it takes a little while for the next thing to emerge," he said.
Local jails have become the "biggest detox facilities in the state of Maryland," Kokolis said. However, 85 percent of the prison and jail population who reported using drugs prior to being sentenced also reported using heroin within 24 hours of imprisonment, while they were incarcerated, he said.
"All of the good that we try to do is very easily compromised by the easy intake of Suboxone," he said.
Maryland officials are also working to collect more data on heroin and opioid use statewide, said Glenn Fueston, the executive director of the Governor's Office on Crime Control and Prevention.
"We need to make sure that we're getting more access to that data as a whole so we can make better decisions and better understand the current threat that we have," he said. "Understanding the threat is a very important part of this problem."