Total Opioid Overdose Deaths Down With Medicaid Expansion

Medicaid expansion is associated with a reduction in total opioid overdose deaths and with increases in methadone-related mortality, according to a study published online January in JAMA Network Open.

Nicole Kravitz-Wirtz, Ph.D., M.P.H., from the University of California Davis School of Medicine in Sacramento, and colleagues used cross-sectional data from 3,109 counties within 49 states and the District of Columbia to examine annual county-level mortality for overdoses involving any opioid, natural and semisynthetic opioids, methadone, heroin, and synthetic opioids other than methadone.

The researchers observed 383,091 opioid overdose fatalities across U.S. counties during the study period, with a mean of 7.25 deaths per county. The rate of total opioid overdose deaths was 6 percent lower with adoption of Medicaid expansion versus the rate in nonexpansion states (relative rate, 0.94). Compared with counties in nonexpansion states, counties in expansion states had reduced rates of death involving heroin and involving synthetic opioids other than methadone (relative rates, 0.89 and 0.90, respectively). Methadone-related overdose mortality was increased in expansion states (relative rate, 1.11). No significant association was seen between Medicaid expansion and deaths involving natural and semisynthetic opioids.

"These findings add to the emerging body of evidence that Medicaid expansion under the Affordable Care Act may be a critical component of state efforts to address the continuing opioid overdose epidemic in the United States," the authors write.

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