Medicaid expansion does not lead to increase in non-prescribed drug use

A new study has found that extending state Medicaid coverage did not increase the likelihood of prescription opioid or benzodiazepine misuse among people who use drugs.

People who inject drugs and experience poverty are at an increased risk of health conditions such as HIV and tuberculosis, as well as overdose. While this population stands to benefit from health services provided through Medicaid expansion, prior reports have claimed that extending Medicaid coverage to this group encourages misuse of opioids.

A new study led by researchers at Boston University School of Public Health (BUSPH) and Emory University Rollins School of Public Health (Rollins SPH) vigorously refutes this claim.

Published in the Journal of Substance Use and Addiction Treatment, the study examined federal data on health and drug use among nearly 20,000 people who inject drugs and are low-income in the US, and found no association between Medicaid expansion and misuse of prescription opioids or benzodiazepines, drugs often prescribed for anxiety or insomnia.

Importantly, these findings present real-world data that disprove narratives claiming that Medicaid expansion has fueled the longstanding opioid crisis in America by increasing access to low-cost prescription opioids diverted for non-prescribed use.

The new study takes into account state-level opioid trends and individual-level characteristics—such as race, health status, and insurance coverage—that can affect how and to what extent people may access and utilize opioids. The researchers observed no increase in non-prescribed opioid use among low-income people who use drugs, a clinically and socially vulnerable population for which expanded Medicaid coverage could fulfill unmet and costly health needs.

If Congress advances a budget blueprint that cuts funding to Medicaid—which serves more than 1 in 5 people in the US—these critical needs could remain unmet.

“Our findings provide strong empirical data that indicate there is no link between Medicaid expansion and non-prescribed use of opioids and benzodiazepines,” says study lead and corresponding author Dr. Danielle Haley, assistant professor of community health sciences at BUSPH. “This insight allows us to focus on what we do know from the literature about Medicaid expansion—that there are potential life-saving benefits for people who use drugs.”

While the earlier stages of the opioid crisis were driven by an overprescribing of opioid pain medication, the US has made concerted efforts to address this problem, Dr. Haley adds.

“The timing of the opioid overdose crisis far predates the expansion of Medicaid, which began in 2014 under the Affordable Care Act,” she says. “What has really driven overdose deaths over the last several years are synthetic opioids, such as fentanyl. We need to support policies that ensure individuals have access to appropriate pain medication while advancing best practices for prescribing these drugs.”

For the study, Dr. Haley and colleagues from Rollins SPH, Johns Hopkins Bloomberg School of Public Health, and the Florida State University College of Nursing utilized three waves of federal health data in 2012, 2015, and 2018, among 19,728 people who inject drugs ages 18–64 who were enrolled in Medicaid with an income of 138 percent of the federal poverty line or below. The participants resided in 13 states, including 10 that expanded Medicaid and 3 that did not expand Medicaid.

After accounting for numerous factors, such as race/ethnicity, income, employment, health conditions, and access to drug monitoring programs, they observed no connection between Medicaid expansion and non-prescribed use of opioids or benzodiazepines among all of the participants—nor any association based specifically on race/ethnicity or HIV status.

The researchers hope the new findings help reduce persistent stigmas and structural inequities associated with opioid use among people who inject drugs.

“FDA-approved medications for opioid use disorder are very effective in treating opioid use disorder, and also reducing overdose,” Dr. Haley says. “There are multiple issues that still need to be addressed, but having health insurance is a critical gateway for people to access these life-saving services. It is important to address the barriers that Medicaid enrollees who inject drugs encounter in actually receiving the treatment and services their insurance provides.”

A new study has found that extending state Medicaid coverage did not increase the likelihood of prescription opioid or benzodiazepine misuse among people who use drugs.

People who inject drugs and experience poverty are at an increased risk of health conditions such as HIV and tuberculosis, as well as overdose. While this population stands to benefit from health services provided through Medicaid expansion, prior reports have claimed that extending Medicaid coverage to this group encourages misuse of opioids.

A new study led by researchers at Boston University School of Public Health (BUSPH) and Emory University Rollins School of Public Health (Rollins SPH) vigorously refutes this claim.

Published in the Journal of Substance Use and Addiction Treatment, the study examined federal data on health and drug use among nearly 20,000 people who inject drugs and are low-income in the US, and found no association between Medicaid expansion and misuse of prescription opioids or benzodiazepines, drugs often prescribed for anxiety or insomnia.

Importantly, these findings present real-world data that disprove narratives claiming that Medicaid expansion has fueled the longstanding opioid crisis in America by increasing access to low-cost prescription opioids diverted for non-prescribed use.

The new study takes into account state-level opioid trends and individual-level characteristics—such as race, health status, and insurance coverage—that can affect how and to what extent people may access and utilize opioids. The researchers observed no increase in non-prescribed opioid use among low-income people who use drugs, a clinically and socially vulnerable population for which expanded Medicaid coverage could fulfill unmet and costly health needs.

If Congress advances a budget blueprint that cuts funding to Medicaid—which serves more than 1 in 5 people in the US—these critical needs could remain unmet.

“Our findings provide strong empirical data that indicate there is no link between Medicaid expansion and non-prescribed use of opioids and benzodiazepines,” says study lead and corresponding author Dr. Danielle Haley, assistant professor of community health sciences at BUSPH. “This insight allows us to focus on what we do know from the literature about Medicaid expansion—that there are potential life-saving benefits for people who use drugs.”

While the earlier stages of the opioid crisis were driven by an overprescribing of opioid pain medication, the US has made concerted efforts to address this problem, Dr. Haley adds.

“The timing of the opioid overdose crisis far predates the expansion of Medicaid, which began in 2014 under the Affordable Care Act,” she says. “What has really driven overdose deaths over the last several years are synthetic opioids, such as fentanyl. We need to support policies that ensure individuals have access to appropriate pain medication while advancing best practices for prescribing these drugs.”

For the study, Dr. Haley and colleagues from Rollins SPH, Johns Hopkins Bloomberg School of Public Health, and the Florida State University College of Nursing utilized three waves of federal health data in 2012, 2015, and 2018, among 19,728 people who inject drugs ages 18–64 who were enrolled in Medicaid with an income of 138 percent of the federal poverty line or below. The participants resided in 13 states, including 10 that expanded Medicaid and 3 that did not expand Medicaid.

After accounting for numerous factors, such as race/ethnicity, income, employment, health conditions, and access to drug monitoring programs, they observed no connection between Medicaid expansion and non-prescribed use of opioids or benzodiazepines among all of the participants—nor any association based specifically on race/ethnicity or HIV status.

The researchers hope the new findings help reduce persistent stigmas and structural inequities associated with opioid use among people who inject drugs.

“FDA-approved medications for opioid use disorder are very effective in treating opioid use disorder, and also reducing overdose,” Dr. Haley says. “There are multiple issues that still need to be addressed, but having health insurance is a critical gateway for people to access these life-saving services. It is important to address the barriers that Medicaid enrollees who inject drugs encounter in actually receiving the treatment and services their insurance provides.”