Medicaid funding for addiction treatment hasn’t curbed overdose deaths, study finds

For generations, the federal authorities has largely shunned paying for psychological well being and substance use remedy in giant residential amenities.

That modified in 2015, when in response to rising overdose deaths nationwide from illicit medication, the federal authorities allowed states to waive a longstanding prohibition towards utilizing federal Medicaid funding for providers in so-called establishments of psychological ailments. In flip, states had been required to enhance their dependancy care with an emphasis on rising remedy with drugs.

But a brand new examine by researchers at Oregon Well being & Science College finds no general profit when it comes to elevated remedy or lower in nonfatal overdoses among the many 17 states that obtained these waivers between 2017 and 2019, in contrast with 18 that didn’t. Medicaid is a joint federal-state medical insurance program that covers about 90 million Individuals, though not each state extends Medicaid protection to all low-income adults.

The work is printed within the journal Well being Affairs.

“The waivers have been necessary to replace Medicaid’s program to deal with opioid use dysfunction, nevertheless they alone don’t seem to have meaningfully improved the state of affairs when it comes to uptake of medicine to deal with opioid use problems or in decreasing overdoses,” mentioned lead creator Stephan Lindner, Ph.D., affiliate professor within the OHSU Middle for Well being Techniques Effectiveness and a college member of the OHSU-Portland State College College of Public Well being.

Lindner famous that the null consequence highlights the truth that the waivers could also be mandatory however are clearly inadequate to carry the nation’s overdose epidemic underneath management.

“These waivers began about 10 years in the past,” he mentioned. “Again then, about 50,000 folks died of drug overdoses per 12 months. Quick ahead 10 years, and greater than 100,000 folks die of drug overdoses in the USA per 12 months.

“We’ve made some progress in addressing the opioid disaster, however we want extra substantial motion on the federal stage to ensure all folks with opioid use dysfunction get the remedy they want.”

Waivers aren’t sufficient, however Lindner pointed to a number of initiatives backed by analysis and regulation that might higher deal with the nation’s illicit drug overdose disaster:

Remedy throughout the complete spectrum of care. A federal regulation sponsored by former U.S. Rep. Greg Walden, R-Hood River, in 2018 already requires states to cowl the three FDA-approved drugs to deal with opioid use dysfunction (methadone, buprenorphine and naltrexone), nevertheless Lindner mentioned enforcement could have been lax.

Enhance entry to methadone. Analysis, together with a sequence of proof evaluations performed at OHSU, recommends easing entry to methadone, which has traditionally been disbursed solely in specialised clinics. A latest examine by OHSU doctor Honora Englander, M.D., discovered that 87% of individuals with opioid use dysfunction in France obtained entry to methadone in contrast with lower than 20% in the USA.

Step up distribution of life-saving naloxone. OHSU just lately hosted a sequence of occasions selling the widespread distribution of naloxone to reverse overdoses, particularly to younger folks.

Improve entry to buprenorphine. Earlier analysis by Lindner discovered that entry to buprenorphine assorted broadly between U.S. states. Stigma stays a hurdle in medical settings, together with pharmacies.