Changes in Buprenorphine-Naloxone and Opioid Pain Reliever Prescriptions After the Affordable Care Act Medicaid Expansion

Saloner, Brendan; Levin, Jonathan; Chang, Hsien Yen; Jones, Christopher M.; Alexander, G. Caleb

doi:10.1001/jamanetworkopen.2018.1588

Cited by 94 publications

(71 citation statements)

References 24 publications

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“…Our results are robust to a number of specifications and a falsification test. This finding is similar to Sharp et al () and Saloner et al () whose analyses of Medicaid prescribing data indicate that there was no effect of Medicaid expansion on prescription opioid use. One possible explanation for these findings is that the two opposing effects (increased access and increased treatment) wash each other out.…”

Section: Resultssupporting

confidence: 89%

Medicaid expansion and opioid deaths

2019

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The United States is in the midst of an opioid epidemic, and drug overdose deaths are becoming a leading cause of death. Meanwhile, in 2010, the United States passed comprehensive health care reform providing access to care for millions of individuals who previously lacked care. Part of the new access came from expanding Medicaid, the insurance program for low‐income individuals. Expanding Medicaid was optional for states. Those individuals living in expansion states gained prescription drug coverage and hence more access to opioid pain‐relievers that are known to be addictive. However, they also gained access to medication‐assisted treatment for addiction. This paper uses a difference‐in‐differences approach and state‐level data from 2010 to 2017 to compare opioid death rates in expansion and non‐expansion states to determine if Medicaid expansion was a potential cause of rising opioid deaths. We find no evidence that Medicaid expansion is related to opioid deaths.

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Section: Resultssupporting

confidence: 89%

Medicaid expansion and opioid deaths

2019

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“…10,29 Recent evidence demonstrates that compared with nonexpansion states, Medicaid expansion states experienced increases in overall prescriptions for, Medicaidcovered prescriptions for, and Medicaid spending on both MOUDs, particularly buprenorphine and naltrexone, and the opioid overdose reversal medication naloxone. [6][7][8]11,14,30,31,35 Two prior studies 12,16 have found associations between income eligibility expansions for…”

Section: Discussionmentioning

confidence: 99%

“…Previous research suggests that uptake of medications for opioid use disorder (MOUDs), including methadone, buprenorphine, and extended-release naltrexone, has increased more in expansion states compared with nonexpansion states. [6][7][8][9][10][11] These medications (often in combination with counseling and behavioral therapies) have been linked to improvements in treatment retention and OUD remission as well as reductions, in some cases as high as 50%, in all-cause and overdose-related mortality. 12,13 Medicaid-reimbursed prescriptions for the opioid overdose reversal medication naloxone have also increased significantly more in expansion states compared with nonexpansion states.…”

Section: Introductionmentioning

confidence: 99%

Association of Medicaid Expansion With Opioid Overdose Mortality in the United States

et al. 2020

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IMPORTANCE The Patient Protection and Affordable Care Act (ACA) permits states to expand Medicaid coverage for most low-income adults to 138% of the federal poverty level and requires the provision of mental health and substance use disorder services on parity with other medical and surgical services. Uptake of substance use disorder services with medications for opioid use disorder has increased more in Medicaid expansion states than in nonexpansion states, but whether ACA-related Medicaid expansion is associated with county-level opioid overdose mortality has not been examined. OBJECTIVE To examine whether Medicaid expansion is associated with county × year counts of opioid overdose deaths overall and by class of opioid.

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“…Recent evidence demonstrates that compared to non-expansion states, Medicaid expansion states experienced increases in overall prescriptions for, Medicaid-covered prescriptions for, and Medicaid spending on evidence-based OUD pharmacotherapies, particularly buprenorphine and naltrexone. [33][34][35][36] Some limitations and future directions are noteworthy. First, although buprenorphine distribution was increasing overall, examination of individual 3-digit zip codes indicates that the opposite pattern may be occurring in some rural areas.…”

Section: Discussionmentioning

confidence: 99%

Rise and Regional Disparities in Buprenorphine Utilization in the United States

Pashmineh

Cruz-Mullane

Podd

et al. 2019

Preprint

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Aims: Buprenorphine is an opioid partial-agonist used to treat Opioid Use Disorders (OUD). While several state and federal policy changes have attempted to increase buprenorphine availability, access remains well below optimal levels. This study characterized how buprenorphine utilization in the United States has changed over time and whether there are regional disparities in distribution. Measurements: Buprenorphine weights distributed from 2007 to 2017 were obtained from the Drug Enforcement Administration. Data was expressed as the percent change and as the mg per person in each state. Separately, the formulations for prescriptions covered by Medicaid (2008 to 2018) were examined. Findings: Buprenorphine distributed to pharmacies increased about seven-fold (476.8 to 3,179.9 kg) while the quantities distributed to hospitals grew five-fold (18.6 to 97.6 kg) nationally from 2007 to 2017. Buprenorphine distribution per person was almost 20-fold higher in Vermont (40.4 mg/person) relative to South Dakota (2.1 mg/person). There was a strong association between the number of waivered physicians per 100K population and distribution per state (r(49) = +0.76, p < .0005). The buprenorphine/naloxone sublingual film (Suboxone) was the predominant formulation (92.6% of 0.31 million Medicaid prescriptions) in 2008 but this accounted for less than three-fifths (57.3% of 6.56 million prescriptions) in 2018. Conclusions: Although buprenorphine availability has substantially increased over the last decade, distribution was very non-homogenous across the US.

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Changes in Buprenorphine-Naloxone and Opioid Pain Reliever Prescriptions After the Affordable Care Act Medicaid Expansion

Cited by 94 publications

References 24 publications

Medicaid expansion and opioid deaths

Medicaid expansion and opioid deaths

Association of Medicaid Expansion With Opioid Overdose Mortality in the United States

Rise and Regional Disparities in Buprenorphine Utilization in the United States

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