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

A brand new examine has discovered that extending state Medicaid protection didn’t improve the chance of prescription opioid or benzodiazepine misuse amongst individuals who use medicine.

Individuals who inject medicine and expertise poverty are at an elevated threat of well being circumstances similar to HIV and tuberculosis, in addition to overdose. Whereas this inhabitants stands to profit from well being companies supplied by means of Medicaid growth, prior experiences have claimed that extending Medicaid protection to this group encourages misuse of opioids.

A brand new examine led by researchers at Boston College College of Public Well being (BUSPH) and Emory College Rollins College of Public Well being (Rollins SPH) vigorously refutes this declare.

Revealed within the Journal of Substance Use and Dependancy Therapy, the examine examined federal information on well being and drug use amongst almost 20,000 individuals who inject medicine and are low-income within the US, and located no affiliation between Medicaid growth and misuse of prescription opioids or benzodiazepines, medicine typically prescribed for anxiousness or insomnia.

Importantly, these findings current real-world information that disprove narratives claiming that Medicaid growth has fueled the longstanding opioid disaster in America by growing entry to low-cost prescription opioids diverted for non-prescribed use.

The brand new examine takes into consideration state-level opioid tendencies and individual-level traits—similar to race, well being standing, and insurance coverage protection—that may have an effect on how and to what extent folks might entry and make the most of opioids. The researchers noticed no improve in non-prescribed opioid use amongst low-income individuals who use medicine, a clinically and socially weak inhabitants for which expanded Medicaid protection might fulfill unmet and dear well being wants.

If Congress advances a finances blueprint that cuts funding to Medicaid—which serves greater than 1 in 5 folks within the US—these essential wants might stay unmet.

“Our findings present robust empirical information that point out there isn’t a hyperlink between Medicaid growth and non-prescribed use of opioids and benzodiazepines,” says examine lead and corresponding creator Dr. Danielle Haley, assistant professor of neighborhood well being sciences at BUSPH. “This perception permits us to deal with what we do know from the literature about Medicaid growth—that there are potential life-saving advantages for individuals who use medicine.”

Whereas the sooner phases of the opioid disaster have been pushed by an overprescribing of opioid ache treatment, the US has made concerted efforts to deal with this downside, Dr. Haley provides.

“The timing of the opioid overdose disaster far predates the growth of Medicaid, which started in 2014 beneath the Reasonably priced Care Act,” she says. “What has actually pushed overdose deaths over the past a number of years are artificial opioids, similar to fentanyl. We have to help insurance policies that guarantee people have entry to applicable ache treatment whereas advancing greatest practices for prescribing these medicine.”

For the examine, Dr. Haley and colleagues from Rollins SPH, Johns Hopkins Bloomberg College of Public Well being, and the Florida State College Faculty of Nursing utilized three waves of federal well being information in 2012, 2015, and 2018, amongst 19,728 individuals who inject medicine ages 18–64 who have been enrolled in Medicaid with an revenue of 138 p.c of the federal poverty line or under. The members resided in 13 states, together with 10 that expanded Medicaid and three that didn’t increase Medicaid.

After accounting for quite a few elements, similar to race/ethnicity, revenue, employment, well being circumstances, and entry to drug monitoring applications, they noticed no connection between Medicaid growth and non-prescribed use of opioids or benzodiazepines amongst all the members—nor any affiliation primarily based particularly on race/ethnicity or HIV standing.

The researchers hope the brand new findings assist cut back persistent stigmas and structural inequities related to opioid use amongst individuals who inject medicine.

“FDA-approved medicines for opioid use dysfunction are very efficient in treating opioid use dysfunction, and likewise decreasing overdose,” Dr. Haley says. “There are a number of points that also have to be addressed, however having medical health insurance is a essential gateway for folks to entry these life-saving companies. You will need to deal with the boundaries that Medicaid enrollees who inject medicine encounter in really receiving the therapy and companies their insurance coverage offers.”