Medicaid expansion and opioid supply policies to address the opioid overdose crisis

Abstract

Background: The opioid overdose crisis remains of critical concern after historic increases in overdose mortality in the United States between 2020 and 2021. Improving access to buprenorphine -a partial opioid agonist and one of three FDA-approved medications for opioid use disorder (OUD) treatment- and reducing inappropriate opioid prescriptions may help curb mortality. Here, we examined the impact of Medicaid expansion and pain management clinic laws on opioid prescription rates and buprenorphine availability. Methods: We examined both retail opioid prescriptions per 100 persons in the state population using data from the Centers for Disease Control and Prevention and data on buprenorphine distributions in kilograms per 100,000 persons in the state population from the Automated Reports and Consolidated Ordering System database. We employed difference-in-difference frameworks to estimate the impact of Medicaid expansion on buprenorphine access and retail opioid prescription rates. Models considered three separate treatment variables: Medicaid expansion, pain management clinic ("pill mill") laws, and the interaction of Medicaid expansion and pain management clinic laws. Results: Findings showed that Medicaid expansion was associated with increased access to buprenorphine in expansion states that also employed more stringent supply-side policies, including pain management clinic laws, relative to states that did not implement policies targeting the over-supply of prescription opioids over the same time period. Conclusions. Together, Medicaid expansion and policies limiting inappropriate opioid prescriptions show promise for improving the accessibility of buprenorphine treatment for OUD.

Keywords: Buprenorphine; Medicaid; Opioid use disorder; Pain management clinic.

Fig. 1

Retail opioid prescriptions dispensed per 100 persons, 2006–2017. Notes: The analysis of retail opioid prescriptions dispensed per 100 personsfrom 2006 to 2017 is based on publicly available data from the Centers for Disease Control and Prevention.

Fig. 2

Trends of buprenorphine distributions in kilograms per 100,000 population, 2006–2017. Notes: The analysis of buprenorphine distributions in kilograms per 100,000 in the population from 2006 to 2017 is based on publicly available data from the Automated Reports and Consolidated Ordering System (ARCOS).

Fig. 3

Medicaid expansion. Notes: The analysis of Medicaid expansion effective dates is based on publicly available data from Kaiser Family Foundation. The color codes show the effective dates of coverage following Medicaid expansion.

Fig. 4

Pain management clinic (“pill mill”) laws. Notes: The analysis of state oversight of pain management clinics is based on publicly available data from Rutkow et al. (2017). State law defines what constitutes a pain management clinic, with definitions falling into one or more of three categories: (1) providing pain management services with prescription controlled substances; (2) advertising pain management services; and (3) prescribing controlled substances forpain to a majority of patients Rutkow et al. (2017). The color codes show the effective dates.