ACA's Medicaid expansion associated with increase in prescriptions for opioid use disorder treatment

Bottom Line: Medicaid expansion under the Affordable Care Act (ACA) was associated with an overall increase in people filling prescriptions for buprenorphine with naloxone, which is a treatment for opioid use disorder, as well as an increase in people filling prescriptions for opioid pain relievers (OPRs) paid for by Medicaid in a data analysis from five states.

Why The Research Is Interesting: Opponents of the ACA have suggested Medicaid expansion worsened the opioid crisis because insurance let people access cheap opioid pain relievers. However, the insurance expansion under the ACA also could help to lessen the opioid crisis by increasing access to medication to treat opioid use disorder. This study used pharmacy claims data for five states (three that expanded Medicaid and two that didn't) to examine changes in prescriptions filled for buprenorphine with naloxone and for opioid pain relievers after the ACA's Medicaid expansion.

Who and When: 11.9 million individuals who filled two or more prescriptions for opioids during at least one year between 2010 and 2015 from California, Maryland, and Washington (Medicaid expansion states) and Florida and Georgia (nonexpansion states)

What (Study Measures and Outcomes): Medicaid expansion (exposure); rates per 100,000 county residents were calculated for buprenorphine with naloxone and for opioid pain reliever prescriptions overall and by different payment sources (outcomes)

How (Study Design): This was an observational study. Researchers were not intervening for purposes of the study and cannot control all the natural differences that could explain the study findings.

Authors: Brendan Saloner, Ph.D., of the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, and co-authors

Study Limitations: Data included from only five states; unobserved differences between states may be associated with the outcomes; and alternative explanations independent of the ACA could be driving prescription rates​