The Role of Medicaid Expansion in Treating Opioid Misuse

A recently published Urban Institute study about the role of Medicaid expansion under the Affordable Care Act (ACA) in treating people affected by the opioid crisis shows the demand for such services has dramatically grown in recent years.1 In particular, the study found significant increases in prescriptions for drugs commonly used to treat patients experiencing opioid misuse disorder. The growth has been greatest in Medicaid expansion states, though prescriptions have also increased in non-expansion states. Increased access to treatment is a positive development. But it also has implications for state health care funding. Now that Medicaid expansion has been approved in Virginia, should the Commonwealth expect to experience similar trends in prescription growth? To examine this question, VHHA’s Analytics Team reviewed Virginia’s All-Payer Claims Database to analyze buprenorphine, naltrexone, and naloxone prescribing patterns. Those three drugs were chosen because they are commonly used in treating opioid use disorder. Buprenorphine is used in medication-assisted treatment (MAT) to help patients reduce, or discontinue, their dependence on heroin or other opiates such as pain relievers like morphine. Naltrexone is an opiate antagonist. It blocks the euphoric and sedative effects of drugs such as heroin, morphine, and codeine. It also decreases the desire to take opiates. Naloxone is a so-called “rescue” drug that blocks the effects of opioids and reverses an overdose. The chart below shows Virginia’s experience regarding prescribing trends for those drugs from 2011-2016. The data shows the pattern in Virginia is similar to the national trend documented in the Urban Institute study. The Y-axis reflects the amount of drug for each prescription, not the volume of prescriptions. The amount of drug prescribed is used rather than the number of prescriptions because the amount prescribed can change from one prescription to the next. Over a five-year period, the amount of buprenorphine prescribed increased by 17.8 percent. The amount of Naltrexone prescribed remained consistent. And the amount of naloxone increase by 600 percent. As a rescue drug, this increase illustrates the importance of continued access to treatment for opioid use disorder. Because Medicaid expansion is expected to increase access to treatment options for people with substance addiction, Virginia can expect to continue to see a rise in the amounts of buprenorphine and naloxone prescribed while the opioid epidemic remains a challenge. – Analytics Team