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MONDAY, April 1, 2019 (Pharmacist's Briefing) -- New research suggests that the Medicaid expansion the Affordable Care Act set into motion has played a key role in fighting America's opioid epidemic.
Ever since West Virginia expanded its Medicaid program under "Obamacare," many more people with opioid addiction have been getting treatment, the new study shows.
Experts said the findings -- from a state that is at the center of the opioid epidemic -- point to a key benefit of Medicaid expansion.
West Virginia was one of 25 states that chose to expand its Medicaid program under Obamacare in 2014. Those expanded programs were required to pay for substance abuse treatment, though states have leeway on precisely what's covered.
The study found that among West Virginians who became newly eligible for Medicaid, treatment for opioid abuse rose over time. By 2016, three-quarters of patients with opioid dependence had been prescribed buprenorphine; that compared with less than one-third in early 2014.
Buprenorphine is one of three medications approved for treating opioid dependence -- the others being methadone and naltrexone.
So, the increase in buprenorphine prescriptions is good to see, said lead researcher Brendan Saloner, an assistant professor of health policy at Johns Hopkins University in Baltimore.
Still, he described the findings as "glass half-full and half-empty."
"We can pretty confidently say that Medicaid expansion increased the number of people going into treatment," Saloner said.
But, he added, the increase in buprenorphine prescriptions was unevenly distributed. Certain groups were more likely than others to receive counseling only -- with no medication.
That's despite the fact that medication with therapy is considered the gold standard treatment for opioid dependence.
Hispanic patients and those younger than 25 were more likely to receive counseling without medication compared with white patients and older patients, respectively. The same was true of people with depression, anxiety or alcohol abuse problems.
"It's not clear what's keeping them away from medication," Saloner said. "Is it an informed choice? Is it misinformation about medication?"
There is a "lot of misinformation out there," he noted -- including the myth that using medication is simply trading one addictive drug for another.
The findings, published April 1 in the journal Health Affairs, come at a time of renewed efforts by the Trump administration to repeal the Affordable Care Act (ACA).
And they point to one potential consequence if that should happen, according to Lisa Clemans-Cope, a researcher with the Urban Institute's Health Policy Center, in Washington, D.C.
"This is an important study, documenting improved access to care in a state that's at the heart of the opioid epidemic," said Clemans-Cope, who was not involved in the study.
"A repeal of the ACA would be devastating for these people," she said.
Every day in the United States, an average of 130 people die of an opioid overdose, according to the U.S. National Institute on Drug Abuse. In 2017 alone, close to 1.8 million Americans were dependent on prescription opioids or heroin.
West Virginia has been especially hard-hit. People there die of opioid overdoses at a rate that's more than triple the U.S. average, Saloner's team pointed out. Most overdose on heroin or illicitly manufactured fentanyl.
Shortly before Medicaid expansion, 29% of the state's residents younger than 65 had no health insurance. After the expansion, that dropped to 9% in 2015, according to the U.S. Centers for Disease Control and Prevention.
Saloner said Medicaid expansion has done a "good job" of getting people into treatment for opioid dependence. But there's more to be done.
"There's been a debate about whether Medicaid expansion has been helpful," he said. "I'd like to see us move beyond that, and start talking about how the program can better deliver needed services."
In West Virginia, for example, the program initially decided not to pay for methadone -- though it added coverage in 2017. And it required people to receive counseling to get buprenorphine or naltrexone prescriptions.
But, Saloner said, that requirement can keep some patients from getting needed medication -- either because they don't want counseling or because it's not readily available where they live.
"Counseling can be great for some people," Saloner said. "But for others, the requirement is a barrier."
According to Clemans-Cope, it's also important for people to have access to all the medication options for opioid dependence -- and not only what a state program decides to cover.
"If you're choosing your treatment, you may be more likely to stick with it," she explained.
The U.S. National Institute on Drug Abuse has more on opioid dependence treatment.
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