In the past year, my colleagues at Georgetown University CCF have blogged about increases in funding to fight the opioid epidemic, Medicaid’s critical role in caring for infants exposed to opioids in utero, as well as Medicaid doubling the likelihood that Americans with opioid addiction will get the treatment they need. A new research report supported by NIH/NIA funding continues to build on this body of work with results suggesting that Medicaid expansion increases access to treatment for opioid use disorder through addiction therapies and prescription medications.

Medical Care’s Medicaid Expansion and Prescription Trends: Opioids, Addiction therapies, and other drugs

The authors analyze the 2010-2016 Medicaid State Drug Utilization Data to test the association between Medicaid expansion and Medicaid-paid prescriptions for opioid pain relievers and opioid addiction therapies. Before 2014, drug overdose deaths were common in states that chose to expand Medicaid, so researchers were interested in examining any trends in access to treatments based on state expansion status. The authors found that access to opioid addiction treatments grew in expansion states with higher pre-2014 opioid overdose death rates. The authors of the study also found that substantial prescriptions used in the treatment of chronic conditions increased as well — suggesting that Medicaid expansion may be addressing prior gaps in responding to overall health needs.

If you look at 2018 data from NIH on Opioid Summaries by State you will see that bright red states indicate the highest incidence rate of >15 deaths per 100,000 people. States that still have not expanded Medicaid (status post 2018 election) have some of the highest death rates including: Wisconsin, Missouri, Tennessee and North Carolina. You will also see the bright pink states with the next highest incidence rate of 10-14.9 deaths per 100,000 people; non-expansion states falling in the next category include Oklahoma, South Carolina, and Florida.

What the report finds

• Expanding Medicaid coverage to low-income adults was not associated with a meaningful increase in opioid pain reliever use, despite presupposition and claims to the contrary.
• Medicaid expansion was associated with a substantial increase in opioid addiction therapies, particularly in states with high opioid overdose rates.

Why it matters

• In comparing Medicaid expansion and non-expansion states, the study authors found that expansion was associated with increases in the use of opioid addiction therapies, antihypertensives, diabetes therapies, and cholesterol-lowering medications.

The study results suggest Medicaid expansion did increase access to effective, evidence-based therapies and medications for opioid addiction and counter the notion that Medicaid expansion contributed to the opioid use epidemic by fueling use of opioid pain relievers. As our nation continues to struggle with this deadly epidemic, Medicaid expansion is an obvious and vital tool that many states with high death rates have yet to embrace.