A new study in the JAMA Open Network links the expansion of Medicaid under the Affordable Care Act (ACA) with an overall reduction in opioid deaths.

The study notes that drug overdose is a leading cause of injury-related death in the U.S., resulting in more than 200 deaths a day—and more than 700,000 per year. "Fatal drug overdoses have increased markedly during the past 2 decades in large part because of overdoses involving opioids, including prescription opioids and illegal opioids, such as heroin and illicitly manufactured fentanyl," the study said. "Between 2001 and 2017, the age-adjusted mortality rate for opioid-related overdoses more than quadrupled, from 3.3 to 14.9 per 100,000 standard population."

The study noted that some research has been done on the link between expanded Medicaid coverage and its effect on opioid abuse, but this was the first national study looking a data on a county-by-county basis.

Health reform and the opioid epidemic

The study sought to examine the impact of Medicaid expansion on the opioid overdose epidemic. With the passage of the ACA, states were allowed to expand their Medicaid eligibility to reach more low-income Americans. At the same time, the health reform law, also known as Obamacare, required insurance programs, including Medicaid, to provide mental health and substance use disorder (SUD) services on parity with other medical and surgical services.

After the ACA's passage, a Supreme Court ruling allowed states to opt out of the Medicaid expansion, and a number of states chose not to expand the program, leaving more state residents without coverage. At the time the study was conducted, 32 states had expanded Medicaid coverage under the ACA.

The question of which approach—Medicaid expansion or declining the expansion—is better for overall health remains a topic of debate for politicians. Health researchers are also looking at the medical outcomes via studies such as this one. Some in the policy arena have raised questions about the effectiveness of Medicaid expansion in addressing opioid abuse, and related issues such as whether Medicaid enrollees would use their access to prescription drugs to abuse opioids.

Fewer deaths in Medicaid expansion states

The study, which looked at data from 3,109 counties in 49 states and the District of Columbia, found a six percent lower rate of total opioid overdose deaths in states that expanded Medicaid.

"Medicaid expansion was associated with reductions in total opioid overdose deaths, particularly deaths involving heroin and synthetic opioids," the study reported.

However, the data also showed an increase in methadone abuse deaths in states that expanded Medicaid. The authors said this finding should prompt further study on methadone overdose deaths.

"The observed association between Medicaid expansion and decreased total opioid overdose deaths and deaths involving heroin and synthetic opioids other than methadone is likely in part attributable to the ACA's inclusion of mental health and SUD services as essential health benefits," the report concluded. "Expanded Medicaid eligibility has substantially increased access to these services among the low-income population."

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Medicaid expansion tied to 6 percent decrease in opioid deaths

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