Medicaid funding for addiction treatment has not reduced overdose deaths, research shows

For generations, the federal government has largely refrained from paying for mental health and substance abuse treatment in large residential facilities.

That changed in 2015, when the federal government, in response to rising overdose deaths nationwide from illicit drugs, allowed states to waive a longstanding ban on using federal Medicaid funding for services in so-called mental illness institutions. In turn, states had to improve their addiction care, with an emphasis on intensifying drug treatment.

Yet a new study from researchers at Oregon Health & Science University finds no overall benefit in terms of increased treatment or decrease in non-fatal overdoses among the 17 states that received these waivers between 2017 and 2019, compared to 18 that did not. Medicaid is a joint federal-state health insurance program that covers approximately 90 million Americans, although not every state extends Medicaid coverage to all low-income adults.

The work is published in the news Health matters.

“The waivers have been important in updating the Medicaid program for the treatment of opioid use disorder, but they do not on their own appear to have meaningfully improved the situation in terms of uptake of medications for the treatment of opioid use disorder or reducing overdoses” , said lead author Stephan Lindner. , Ph.D., associate professor at the OHSU Center for Health Systems Effectiveness and faculty member of the OHSU-Portland State University School of Public Health.

Lindner noted that the null result highlights the fact that the waivers may be necessary but are clearly insufficient to control the nation's overdose epidemic.

“These waivers started about a decade ago,” he said. “At the time, about 50,000 people died from drug overdoses every year. Ten years later, more than 100,000 people die from drug overdoses every year in the United States.

“We have made some progress in addressing the opioid crisis, but we need more substantive action at the federal level to ensure that all people with opioid use disorder get the treatment they need.”

Waivers aren't enough, but Lindner pointed to several initiatives, backed by research and legislation, that could better address the country's overdose crisis:

• Treatment across the entire spectrum of care. A federal law sponsored by former U.S. Rep. Greg Walden, R-Hood River, in 2018 already required states to cover the three FDA-approved medications for treating opioid use disorder (methadone, buprenorphine and naltrexone). lax.

• Improve access to methadone. Research, including a series of evidence studies conducted at OHSU, recommends facilitating access to methadone, which has traditionally only been provided in specialty clinics. A recent study by OHSU physician Honora Englander, MD, found that 87% of people with opioid use disorder in France accessed methadone, compared to less than 20% in the United States.

• Expand distribution of lifesaving naloxone. OHSU recently hosted a series of events promoting the widespread distribution of naloxone to combat overdoses, especially among youth.

• Increase access to buprenorphine. Lindner's previous research found that access to buprenorphine varied widely across US states. Stigma remains a hurdle in medical settings, including pharmacies.