Prescription opioid availability and opioid overdose‐related mortality rates in Medicaid expansion and non‐expansion states

Swartz, James A.; Beltran, Susanny J.

doi:10.1111/add.14741

Cited by 6 publications

(10 citation statements)

References 30 publications

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“…Medicaid and reductions in SUD-related deaths, and a recent study 17 been rigorously studied and found to be equally and, in some cases, more effective than other MOUDs in suppressing illicit opioid use, particularly heroin use, and retaining persons in treatment. 31,32 On the basis of this evidence, in combination with our findings for heroin and synthetic opioids other than methadone, increased access to MOUDs likely not did not contribute to the observed increase in methadone mortality associated with Medicaid expansion.…”

Section: Discussionmentioning

confidence: 99%

“…Association of Medicaid Expansion With Opioid Overdose Mortality in the United States Previous studies 12,16,17 of the association of Medicaid expansion with fatal overdoses have been conducted at the state level. Although the most appropriate spatial scale for this association remains unclear, state-level analyses may not adequately reflect local (within-state) variation in the level and rate of growth of overdose deaths or differences in policy implementation, such as local disparities in the capacity for or accessibility of SUD treatment.…”

Section: Jama Network Open | Health Policymentioning

confidence: 99%

“…However, to our knowledge, with only 1 recent exception, 17 no study has examined the association of ACA-related Medicaid expansion with opioid-related overdose mortality more specifically.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Jama Network Open | Health Policymentioning

confidence: 99%

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

et al. 2020

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“…Finally, there have been several national and state policy changes which has resulted in reductions in prescription opioid use since the national peak in 2011 [2,3]. Naturalistic studies like this are extremely challenging to interpret as there are multiple demographic and socioeconomic factors which contribute to both prescription opioid and marijuana use [6,7,9]. There may be no single state, or states, that perfectly matches the characteristics of Colorado (Table 2).…”

Section: Discussionmentioning

confidence: 99%

“…Analysis of the National Health and Nutrition Examination Survey estimated that one-seventh of prescription opioid use was attributable to obesity and associated conditions [6]. States with fewer uninsured people as a result of Medicaid expansion had greater prescription opioid use [7,8]. Use of the OUD pharmacotherapy buprenorphine differed over twenty-fold between the highest (Rhode Island = 2158 morphine mg equivalents (MME)/person) and lowest (North Dakota = 99 MME/person) states [3].…”

Section: Introductionmentioning

confidence: 99%

Prescription Opioid Distribution after the Legalization of Recreational Marijuana in Colorado

Lopez

Nichols

Chung

et al. 2020

IJERPH

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There have been dynamic changes in prescription opioid use in the US but the state level policy factors contributing to these are incompletely understood. We examined the association between the legalization of recreational marijuana and prescription opioid distribution in Colorado. Utah and Maryland, two states that had not legalized recreational marijuana, were selected for comparison. Prescription data reported to the Drug Enforcement Administration for nine opioids used for pain (e.g., fentanyl, morphine, hydrocodone, hydromorphone, oxycodone, oxymorphone) and two primarily for opioid use disorder (OUD, methadone and buprenorphine) from 2007 to 2017 were evaluated. Analysis of the interval pre (2007–2012) versus post (2013–2017) marijuana legalization revealed statistically significant decreases for Colorado (P < 0.05) and Maryland (P < 0.01), but not Utah, for pain medications. There was a larger reduction from 2012 to 2017 in Colorado (–31.5%) than the other states (–14.2% to –23.5%). Colorado had a significantly greater decrease in codeine and oxymorphone than the comparison states. The most prevalent opioids by morphine equivalents were oxycodone and methadone. Due to rapid and pronounced changes in prescription opioid distribution over the past decade, additional study with more states is needed to determine whether cannabis policy was associated with reductions in opioids used for chronic pain.

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Systematic Evaluation of State Policy Interventions Targeting the US Opioid Epidemic, 2007-2018

et al. 2021

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IMPORTANCE In response to the increase in opioid overdose deaths in the United States, many states recently have implemented supply-controlling and harm-reduction policy measures. To date, an updated policy evaluation that considers the full policy landscape has not been conducted. OBJECTIVE To evaluate 6 US state-level drug policies to ascertain whether they are associated with a reduction in indicators of prescription opioid abuse, the prevalence of opioid use disorder and overdose, the prescription of medication-assisted treatment (MAT), and drug overdose deaths. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used drug overdose mortality data from 50 states obtained from the National Vital Statistics System and claims data from 23 million commercially insured patients in the US between 2007 and 2018. Difference-indifferences analysis using panel matching was conducted to evaluate the prevalence of indicators of prescription opioid abuse, opioid use disorder and overdose diagnosis, the prescription of MAT, and drug overdose deaths before and after implementation of 6 state-level policies targeting the opioid epidemic. A random-effects meta-analysis model was used to summarize associations over time for each policy and outcome pair. The data analysis was conducted July 12, 2020. EXPOSURES State-level drug policy changes to address the increase of opioid-related overdose deaths included prescription drug monitoring program (PDMP) access, mandatory PDMPs, pain clinic laws, prescription limit laws, naloxone access laws, and Good Samaritan laws. MAIN OUTCOMES AND MEASURES The outcomes of interests were quarterly state-level mortality from drug overdoses, known indicators for prescription opioid abuse and doctor shopping, MAT, and prevalence of drug overdose and opioid use disorder. RESULTS This cross-sectional study of drug overdose mortality data and insurance claims data from 23 million commercially insured patients (12 582 378 female patients [55.1%]; mean [SD] age, 45.9 [19.9] years) in the US between 2007 and 2018 found that mandatory PDMPs were associated with decreases in the proportion of patients taking opioids (−0.729%; 95% CI, −1.011% to −0.447%), with overlapping opioid claims (−0.027%; 95% CI, −0.038% to −0.017%), with daily morphine milligram equivalent greater than 90 (−0.095%; 95% CI, −0.150% to −0.041%), and who engaged in drug seeking (−0.002%; 95% CI, −0.003% to −0.001%). The proportion of patients receiving MAT increased after the enactment of mandatory PDMPs (0.015%; 95% CI, 0.002% to 0.028%), pain clinic laws (0.013%, 95% CI, 0.005%-0.021%), and prescription limit laws (0.034%, 95% CI, 0.020% to 0.049%). Mandatory PDMPs were associated with a decrease in the number of overdose deaths due to natural opioids (−518.5 [95% CI, −728.5 to −308.5] per 300 million people) and methadone (−122.7 [95% CI, −207.5 to −37.8] per 300 million people). Prescription drug monitoring program access policies showed similar results, although these policies were also associated with increases in overdos...

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Prescription opioid availability and opioid overdose‐related mortality rates in Medicaid expansion and non‐expansion states

Cited by 6 publications

References 30 publications

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

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

Prescription Opioid Distribution after the Legalization of Recreational Marijuana in Colorado

Systematic Evaluation of State Policy Interventions Targeting the US Opioid Epidemic, 2007-2018

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