Opioid Overdose Mortality Decreased 6% in Medicaid Expansion States

Medicaid expansion states saw a six percent decreased rate in total opioid overdose deaths compared to states that did not expand Medicaid eligibility, according to researchers from the University of California Davis School of Medicine.

Drug overdose is responsible for more than 70,000 fatalities in the US, equaling nearly 200 deaths per day. Between 2001 and 2017, the mortality rate for opioid related overdoses increased from 3.3 to 14.9 per 100,000 standard population. And in 2017, more than two thirds of all drug overdose fatalities involved an opioid. 

Nearly 41 percent of overdoses across all of the US involved natural and semisynthetic opioids, followed by heroin at 25.3 percent, synthetic opioids other than methadone at 24 percent, and 17 percent of deaths were due to methadone. And by 2017, more than half of all opioid overdose deaths (59.9 percent) involved synthetic opioids other than methadone. 

But Medicaid expansion could help alleviate that problem, the UCSD researchers reported in JAMA Network Open.

In a cross-sectional analysis looking at 3,109 counties within 49 states and the District of Columbia, the researchers reported a total of 383,091 opioid overdose fatalities between 2001 and 2017. Deaths from opioid overdose increased from 2.49 deaths per 100,000 people in 2001 to 11.41 deaths per 100,000 in 2017, the study highlighted.

These numbers may have been higher had fewer states expanded Medicaid, the study showed. Between 2014 and 2017, 32 states and DC expanded Medicaid eligibility. Using data analysis, Medicaid expansion prevented between 1678 and 8132 deaths by opioid overdose during those years.

Specifically, counties within states that expanded Medicaid had a six percent decrease in rates of opioid overdose deaths after expansion compared to counties with states that did not expand Medicaid eligibility. 

In addition, counties within states that expanded Medicaid had an 11 percent decreased rate of fatal heroin overdoses and a 10 percent decreased rate of overdose deaths involving synthetic opioids other than methadone. 

Opioid overdose deaths likely went down in expansion states because of increased coverage for substance use disorder treatment. Medicaid reimbursement for prescriptions for medication assisted treatment (MAT) also increased significantly more in expansion states, the researchers reported.

Opioid abuse has been a nationwide epidemic for years, and rates are reported to be higher in urban areas compared to rural areas. Specifically, individuals living in rural areas had an 87 percent higher chance of receiving an opioid prescription compared to those in metropolitan areas, according to a November study from the American Academy of Family Physicians.  

Rural communities are faced with challenges that aren’t seen in urban communities. They have a smaller clinical workforce, fewer specialists, and very limited transportation to health services. The stigma associated with opioid use disorder hinders individuals from stepping forward and seeking help. 

Numerous programs are currently working in rural areas to combat opioid misuse. Vermont recently held a statewide intervention to develop the Hub-and-Spoke intervention model which improves treatment accessibility and promotes care coordination. The Hub-and-Spoke mimics previous models seen in chronic disease management by focusing on maximizing small budgets, gaining political will, and working with local communities to improve patient care.

After Vermont voted to expand Medicaid and implement the Hub-and-Spoke model, the state overdose death rates have decreased nearly 50 percent in several counties. 

With political buy in from the highest funding sources, the Hub-and-Spoke model successfully became a self-sufficient care model. Other communities are currently able to replicate the model, as ACA funding sources currently exist.