Impact of Medicaid Expansion on Access to Opioid Analgesic Medications and Medication-Assisted Treatment

Sharp, Alana; Jones, Austin; Sherwood, Jennifer; Kutsa, Oksana; Honermann, Brian; Millett, Gregorio A.

doi:10.2105/ajph.2018.304338

Cited by 78 publications

(59 citation statements)

References 4 publications

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“…Our results are robust to a number of specifications and a falsification test. This finding is similar to Sharp et al () and Saloner et al () whose analyses of Medicaid prescribing data indicate that there was no effect of Medicaid expansion on prescription opioid use. One possible explanation for these findings is that the two opposing effects (increased access and increased treatment) wash each other out.…”

Section: Resultssupporting

confidence: 89%

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Medicaid expansion and opioid deaths

2019

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The United States is in the midst of an opioid epidemic, and drug overdose deaths are becoming a leading cause of death. Meanwhile, in 2010, the United States passed comprehensive health care reform providing access to care for millions of individuals who previously lacked care. Part of the new access came from expanding Medicaid, the insurance program for low‐income individuals. Expanding Medicaid was optional for states. Those individuals living in expansion states gained prescription drug coverage and hence more access to opioid pain‐relievers that are known to be addictive. However, they also gained access to medication‐assisted treatment for addiction. This paper uses a difference‐in‐differences approach and state‐level data from 2010 to 2017 to compare opioid death rates in expansion and non‐expansion states to determine if Medicaid expansion was a potential cause of rising opioid deaths. We find no evidence that Medicaid expansion is related to opioid deaths.

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Section: Resultssupporting

confidence: 89%

“… 7Expanded after 2014 (in treatment group for those years): PA, IN and AK 2015; LA and MT, 2016. Both of these columns represent the definition of expansion used by Sharp et al ().…”

Section: Methodsmentioning

confidence: 99%

Medicaid expansion and opioid deaths

2019

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“…Our data analyses confirm the important role Medicaid plays in reimbursing for opioid poisoning hospitalizations: 43% of the opioid overdose hospitalizations in our sample had Medicaid as the primary payer, a percentage by far larger than the percentage of Medicaid enrollees in the South Carolina population (25%) (The Center for Medicaid and CHIP Services, 2016). This reflects the excess burden of the opioid epidemic on Medicaid financing as well as illustrates the potential role Medicaid has in controlling the opioid epidemic (Sharp et al, 2018). Similar interpretation can be drawn for the "other payers," which consisted of a large proportion of public funding as explained earlier.…”

Section: Discussionsupporting

confidence: 64%

Burden of non-fatal opioid overdose hospitalizations on Medicaid

Shi

Truong

Chen

et al. 2019

Journal of Substance Use

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Background: The Medicaid population experienced an elevated risk of opioid overdose death. Higher risks of a health condition or worse health outcomes could mean high costs imposed on public sources of insurance. In this study, we compared the length of stay and total charge of hospitalized opioid overdose patients across insurance types to shed light on the financial burden of opioid epidemic across different types of payers. Method: Our sample includes all opioid overdose hospitalizations in the 2012-2013 South Carolina Patient Encounter database. Length of stay and total hospital charge are the two dependent variables. The key independent variable is the insurance status, categorized as: selfpay, commercial insurance, Medicare, Medicaid, and other payers (other government plan and charitable plans). Multilevel models were applied to account for the clustering effect of each hospital. The patients' age, gender, race/ethnicity, and Charlson Comorbidity Index were used as covariates. Results: A total of 1,262 hospitalizations were included. Medicaid patients stayed longer in hospital (β = 1.815, 95% confidence interval = [0.406-3.224]) and had higher total charge (β = $6,695.2, 95% CI = [215.1-13,175.3) compared with patients with commercial insurance. Conclusion: Medicaid patients' longer hospitalization and higher hospital charge suggest disparity at the hospital treatment stage.

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“…17 The five-fold increase over the past decade in hospital buprenorphine use may reflect greater use within the emergency-room after overdoses as part of a broader effort to improve the transition to outpatient treatment for opioid addiction. 32 Under the Affordable Care Act, all Medicaid Alternative Benefit Plans, including those offered to members of the expansion category, must provide coverage for mental health and Substance Use Disorder treatment, including buprenorphine, on parity with other medical and surgical services in compliance with the Mental Health Parity and Addiction Equity Act. Recent evidence demonstrates that compared to non-expansion states, Medicaid expansion states experienced increases in overall prescriptions for, Medicaid-covered prescriptions for, and Medicaid spending on evidence-based OUD pharmacotherapies, particularly buprenorphine and naltrexone.…”

Section: Discussionmentioning

confidence: 99%

Rise and Regional Disparities in Buprenorphine Utilization in the United States

Pashmineh

Cruz-Mullane

Podd

et al. 2019

Preprint

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Aims: Buprenorphine is an opioid partial-agonist used to treat Opioid Use Disorders (OUD). While several state and federal policy changes have attempted to increase buprenorphine availability, access remains well below optimal levels. This study characterized how buprenorphine utilization in the United States has changed over time and whether there are regional disparities in distribution. Measurements: Buprenorphine weights distributed from 2007 to 2017 were obtained from the Drug Enforcement Administration. Data was expressed as the percent change and as the mg per person in each state. Separately, the formulations for prescriptions covered by Medicaid (2008 to 2018) were examined. Findings: Buprenorphine distributed to pharmacies increased about seven-fold (476.8 to 3,179.9 kg) while the quantities distributed to hospitals grew five-fold (18.6 to 97.6 kg) nationally from 2007 to 2017. Buprenorphine distribution per person was almost 20-fold higher in Vermont (40.4 mg/person) relative to South Dakota (2.1 mg/person). There was a strong association between the number of waivered physicians per 100K population and distribution per state (r(49) = +0.76, p < .0005). The buprenorphine/naloxone sublingual film (Suboxone) was the predominant formulation (92.6% of 0.31 million Medicaid prescriptions) in 2008 but this accounted for less than three-fifths (57.3% of 6.56 million prescriptions) in 2018. Conclusions: Although buprenorphine availability has substantially increased over the last decade, distribution was very non-homogenous across the US.

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Impact of Medicaid Expansion on Access to Opioid Analgesic Medications and Medication-Assisted Treatment

Abstract: The Medicaid expansion enrolled a population no more likely to be prescribed opioids than the base Medicaid population while significantly increasing uptake of 2 drugs used in medication-assisted treatment.

Cited by 78 publications

References 4 publications

Medicaid expansion and opioid deaths

Medicaid expansion and opioid deaths

Burden of non-fatal opioid overdose hospitalizations on Medicaid

Rise and Regional Disparities in Buprenorphine Utilization in the United States

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