Medicaid Coverage Expansion Leads to Less Opioid Deaths

There are Less Opioid Overdose Deaths with Medicaid Coverage

A study published by JAMA Network Open looked at 3,109 counties across America to determine if state Medicaid expansion was associated with opioid-involved overdose deaths. The study took place from 2001 to 2017 and examined counties in 49 states and the District of Columbia. The number of opioid related deaths has been increasing over the years, with a rate of 2.4 deaths per 100,000 people in 2011 to 11.4 deaths per 100,000 in 2017. Many people with an opioid use disorder (OUD) do not seek treatment because they believe they cannot afford it. However, the expansion of Medicaid has given people the opportunity to get help. In 2017, those with Medicaid coverage were more likely to get treatment. Coverage can provide access to treatment by covering inpatient and outpatient treatment services, therapy, and treatment medications.

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In the places that expanded Medicaid coverage, the JAMA study found that fewer people died from heroin or synthetic opioids. In the counties where Medicaid was expanded, there was an 11% lower death rate from heroin, and a 10% lower death rate from synthetic opioids. Synthetic opioids are man-made opiates like oxycodone, hydrocodone, fentanyl, and methadone. Between 2014 and 2016, up to 8,100 lives were saved as the Affordable Care Act (ACA) took full effect.

Throughout the study, there were 383,091 opioid overdose deaths. The largest number of deaths were because of natural opioids and semisynthetic opioids at 40%. Heroin had the second highest number of deaths at about 25%, followed by synthetic opioids other than methadone at 24% and methadone deaths last at 17%. These numbers changed over time, with almost 60% of deaths being caused by synthetic opioids, especially fentanyl. The authors stated, “given the 82,228 opioid-related deaths from 2015 to 2017 in the 32 states that expanded Medicaid between 2014 and 2016, our findings suggest these would have had between 83,906 and 90,360 deaths in the absence of expansion, implying that expansion may have prevented between 1678 and 8132 deaths in these states during those years.”

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Methadone Clinics

Counties that saw Medicaid expansion had fewer opioid death rates from heroin and synthetic opioids, but they did have an 11% increase of methadone-related overdose deaths. Overall, the death rates still declined with a net decline of 6%. Methadone was originally used as a pain relief medication but is now often used as a medication to treat an addiction to heroin or narcotic pain killers. During treatment it is prescribed to help with withdrawal symptoms. It is safer than other opioids but can still lead to an addiction and be abused.

Methadone clinics are medically staffed clinics where a patient can go to take a dose a methadone, instead of relapsing or seeking out heroin. This is safer than taking heroin or other street drugs, as the purity of the drug on the street cannot be determined. Methadone maintenance treatment reduces drug injecting, which also leads to less transmission of HIV. This practice also reduces criminal activity by opioid users, as well as reducing the death rate associated with opioid dependence. Even though methadone can be helpful in treating an opioid addiction, it is still an addictive drug that can lead users to develop a physical dependence. According to the Center for Substance Abuse Research, street names for methadone include Dollies, Dolls, Mud, Phyamps, Red Rock, Tootsie Roll, Amidone, Fizzies, Balloons, Breaze, Burdock, Buzz Bomb, Cartridges, Jungle Juice, and Junk.

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