Milken Institute School of Public Health Poster Presentations (Marvin Center & Video)
Poster Number
94
Document Type
Poster
Status
Graduate Student - Doctoral
Abstract Category
Health Policy and Management
Keywords
Medicaid, Opioids, Affordable Care Act, Expansion, Drug Abuse
Publication Date
Spring 2018
Abstract
Background
Between 2012 and 2016, the opioid overdose mortality rate in the U.S. almost doubled from 7.4 to 13.3 per 100,000 population, leading to calls for a national opioid crisis. This crisis has generated interest in Medicaid’s dual role as a health insurance system that provides reimbursement for both prescription opioid analgesics like Oxycodone used to treat chronic pain, which could inadvertently fuel addiction, and prescription opioids used as treatment medication to help people survive and recover from drug abuse, such as Naloxone.
Methods
In this study, we conduct a multi-variate analysis of Medicaid prescription drug utilization data for the years 2012 through 2016 to examine overall and per-enrollee changes in the number of prescriptions for opioid analgesics and opioid treatment medications and examine the impact expansion, opioid mortality, unemployment, and the availability of drug abuse treatment facilities that accept Medicaid have on the number of prescriptions.
Results
Overall, we find that Medicaid expansion did not have a significant impact on the use of opioid analgesics or treatment medications per adult Medicaid enrollee. Based on our analyses, these changes in the use of opioid analgesics and treatment medications are driven largely by changes in opioid mortality rates, and somewhat by changes in unemployment rates. However, by significantly increasing Medicaid enrollment levels, the expansion did increase the total volume of both opioid analgesics and opioid treatment medications being covered by Medicaid.
Upon conducting a simple analysis to evaluate gross changes in opioid prescriptions between states that expanded and did not expand Medicaid, we find that the average opioid analgesic prescriptions per adult enrollee have gone down by almost a fourth in both expansion (24.1% decrease) and non-expansion states (28.4% decrease) from 2012 to 2016, signaling a nation-wide effort to curb the opioid crisis. We also find that the average opioid treatment medication prescriptions per adult enrollee have increased sharply in expansion states (55.9% increase) as compared to non-expansion states (9.9% increase).
Conclusions
Our findings suggest that, contrary to arguments that suggest that expanding Medicaid worsened the opioid crisis, the expansion has had no significant impact on prescription opioid use. In fact, the expansion has greatly increased the scope of treatment for drug abuse by providing states that were already hard-hit by the crisis with the funding they needed to expand treatment to cover a greater number of low-income and at-risk adults.
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Open Access
1
A Multivariate Analysis of Nationwide Changes in Opioid Prescriptions from 2012-2016
Background
Between 2012 and 2016, the opioid overdose mortality rate in the U.S. almost doubled from 7.4 to 13.3 per 100,000 population, leading to calls for a national opioid crisis. This crisis has generated interest in Medicaid’s dual role as a health insurance system that provides reimbursement for both prescription opioid analgesics like Oxycodone used to treat chronic pain, which could inadvertently fuel addiction, and prescription opioids used as treatment medication to help people survive and recover from drug abuse, such as Naloxone.
Methods
In this study, we conduct a multi-variate analysis of Medicaid prescription drug utilization data for the years 2012 through 2016 to examine overall and per-enrollee changes in the number of prescriptions for opioid analgesics and opioid treatment medications and examine the impact expansion, opioid mortality, unemployment, and the availability of drug abuse treatment facilities that accept Medicaid have on the number of prescriptions.
Results
Overall, we find that Medicaid expansion did not have a significant impact on the use of opioid analgesics or treatment medications per adult Medicaid enrollee. Based on our analyses, these changes in the use of opioid analgesics and treatment medications are driven largely by changes in opioid mortality rates, and somewhat by changes in unemployment rates. However, by significantly increasing Medicaid enrollment levels, the expansion did increase the total volume of both opioid analgesics and opioid treatment medications being covered by Medicaid.
Upon conducting a simple analysis to evaluate gross changes in opioid prescriptions between states that expanded and did not expand Medicaid, we find that the average opioid analgesic prescriptions per adult enrollee have gone down by almost a fourth in both expansion (24.1% decrease) and non-expansion states (28.4% decrease) from 2012 to 2016, signaling a nation-wide effort to curb the opioid crisis. We also find that the average opioid treatment medication prescriptions per adult enrollee have increased sharply in expansion states (55.9% increase) as compared to non-expansion states (9.9% increase).
Conclusions
Our findings suggest that, contrary to arguments that suggest that expanding Medicaid worsened the opioid crisis, the expansion has had no significant impact on prescription opioid use. In fact, the expansion has greatly increased the scope of treatment for drug abuse by providing states that were already hard-hit by the crisis with the funding they needed to expand treatment to cover a greater number of low-income and at-risk adults.
Comments
Presented at GW Annual Research Days 2018.