Medicaid expansion increases access to opioid-treatment drug Suboxone: Study

States that expanded Medicaid coverage under the Affordable Care Act improved access to buprenorphine with naloxone, medication used to treat opioid dependence, compared to states that didn’t expand insurance options for low-income individuals, according to a new study published Thursday.

Buprenorphine was approved in 2002 by the Food and Drug Administration for the treatment of opioid-use disorder. The medication blocks opioid receptors in the brain to reduce cravings and even if a person takes opioids, they don’t feel the euphoric effects.

Naloxone is the opioid-overdose reversal medication. The two drugs together go by the brand name Suboxone.

Federal health officials have highlighted increased access to buprenorphine as a key pillar in preventing overdose deaths and treating addiction.

In 2017, an estimated 72,000 people died of a drug overdose, with 42,000 of those from opioids. At least 30,000 died from opioids mixed with illicit, synthetic fentanyl — which can be fatal at doses as low as a few milligrams.

The latest study, led by researchers from Johns Hopkins Bloomberg School of Public Health sought to answer the question of whether Medicaid expansion helped fuel the opioid epidemic, by making powerful pain relievers more affordable.

“Concerns have been raised by [Affordable Care Act] opponents that the Medicaid expansion has made the opioid crisis worse, contending that new enrollees could use their insurance to gain access to low-cost [Opioid Pain Reliever’s], increasing rates of abuse and diversion,” the authors wrote in the study, published in the Journal of the American Medical Association.

Since the ACA was enacted in 2008, the number of uninsured dropped from 16 percent to nine percent, the authors noted.

In the study, they looked at insurance claims by 11.9 million individuals in three states that expanded Medicaid — California, Maryland and Washington — and two states that didn’t — Florida and Georgia. The data is from 2010 to 2015.

The researchers sought to understand changes over time of prescription fills for both opioid pain relievers and buprenorphine.

They found that while Medicaid expansion increased coverage of prescriptions for opioid pain relievers, there was not a statistically significant increase in the number of prescriptions filled, for both expansion states and non expansion states.

For buprenorphine, however, in states that expanded Medicaid coverage, prescription rates increased, from 68.8 per 100,000 people to 71.1.

This wasn’t observed in non-expansion states.

“Our findings underscore the important role that Medicaid programs play in the opioid epidemic, especially in expansion states,” the authors wrote.

Changes in Medicaid programs have resulted in less barriers for people to access buprenorphine, the authors wrote, and that monitoring programs for opioid prescription fills are also an important factor in curbing rates of abuse.