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Colorado doctors say Medicaid coverage falls short of escalating fentanyl use

Posted at 11:20 AM, Jan 23, 2024
and last updated 2024-01-23 13:20:01-05

Those who are closest to the Fentanyl crisis in Southern Colorado said they’re seeing users' tolerance increase and practitioners who are working with drug addicts said Medicaid is limiting how much they can help in their recovery.

Fentanyl could kill you, but there is a new trend among some users in Colorado Springs who have built up a tolerance. They are chasing a new high – taking up to 50 pills of Fentanyl a day.

"This drug has somehow managed to induce tolerance is higher than we've ever seen," Dr. Kevin Snyder said.

Snyder opened Achieve Whole Recovery clinic with his business partner in 2017 to offer testing, support services and outpatient treatment for Medicaid patients.

"We were seeing people at one milligram and two milligrams was like, 'Whoa, that's a lot.' We were now having people come in and report using four to five milligrams of heroin. And we were like, ‘How are you surviving? How are you still breathing,'” Snyder recalled.

84 people died from taking Fentanyl out of the total 146 drug-related deaths in 2023, according to data from the El Paso County Coroner's Office. That’s up from the 79 people killed by Fentanyl in 2022.

As Fentanyl is produced illegally and is uncontrolled, there’s no telling how much is mixed into any drug or compound. The potency can vary and that’s why one pill can kill.

But an increase in Fentanyl tolerance among Snyder’s patients means they’re taking more and need a higher dose of medication to help them ween off the drug.

"But we've kind of have a limit. Medicaid will only pay for 24 milligrams of buprenorphine per day. But we're afraid that the tolerance that fentanyl has produced is leading us to believe that maybe some of these people actually need more like 32 milligrams a day," Snyder said.

Buprenorphine is taken as a replacement in the treatment of heroin and other opioid dependence, according to the Alcohol and Drug Foundation.

Health First Colorado within Colorado’s Department of Health Care, which oversees the state’s Medicaid program, said it covers 24 milligrams of Buprenorphine for patients daily and will cover 32 milligrams for patients on a case-by-case basis with prior authorization.

But Snyder said he's seeing more patients who need a higher dosage as part of their treatment plan. Medicaid isn’t keeping up with the higher usage, he said, so his clinic has had to change how it treats patients.

"The way we would treat it with the Buprenorphine in the office wasn't working anymore," Snyder said.

Instead of one shot in the office, clinicians now instruct patients how to self-medicate to continue treatment at home. Snyder said it’s necessary to ward off withdrawal symptoms that could push them to relapse.

"We went from in-office inductions to primarily home inductions, which is basically, 'Here's your medication, here's your education. Let's hope that you can do it correctly and make it through,' so much more complicated," Snyder said.

Meanwhile, Colorado’s Justice System is also seeing the effect of higher Fentanyl use.

"They're seeking now specifically Fentanyl out on the street. And they might use 40 or 50 pills in a day," El Paso County District Attorney Michael Allen said.

Investigators are starting to bring in cases that reflect the marked increase in the amount of Fentanyl exchanged in drug deals, he said.

"So we're probably going to see a lag when that starts to hit our doorstep with cases. But the number of cases that we've been filing from last year to this year has grown exponentially," Allen said.

Allen's team is implementing state legislation as a tool to fight back against drug dealers by raising penalties they face if convicted.

Under Colorado’s Fentanyl Accountability and Prevention Act passed in 2022, if someone is found in possession of more than 4 grams of Fentanyl, the case is bumped up to a Level Two Felony, which means they could face a max of eight years in prison and fines up to $750,000.

New figures from the Drug Enforcement Administration show in controlled testing last year, seven out of ten Fentanyl pills tested in a lab contained 2 milligrams – a lethal dose. That’s up from four out of ten "street Fentanyl" tested in 2021. According to the DEA, more than 112,000 people in our country lost their lives after taking Fentanyl last year.

Doctors say Medicaid coverage falls short of escalating fentanyl use