A new study has found that Medicaid waivers, designed to expand addiction treatment services in large residential facilities, have had little effect on increasing treatment or reducing nonfatal overdoses. The study, conducted by researchers at Oregon Health & Science University (OHSU), compared the outcomes in 17 states that received these waivers from 2017 to 2019 with 18 states that did not.
Historically, the federal government has avoided funding mental health and substance use treatment in large institutions, but in 2015, this policy changed. Faced with rising overdose deaths from illicit drugs, the government allowed states to use Medicaid funding for services in these facilities, provided they increased the use of medication-assisted treatments for addiction.
Despite the change, the OHSU study, published in Health Affairs, found no significant improvements in treatment access or reductions in overdoses among the states with waivers. The study underscores that while waivers may be necessary, they are not enough to combat the growing overdose crisis in the U.S.
“These waivers began nearly 10 years ago, when about 50,000 people died of drug overdoses annually. Now, that number has more than doubled, with over 100,000 deaths each year,” said lead researcher Lindner. “While we’ve made some progress in tackling the opioid crisis, more comprehensive action is needed at the federal level to ensure all individuals with opioid use disorder receive the treatment they need.”
Lindner and his team highlight several key strategies that could more effectively address the overdose epidemic:
Comprehensive Treatment Access
A 2018 federal law mandates that states cover all three FDA-approved medications for opioid use disorder: methadone, buprenorphine, and naltrexone. However, Lindner suggests enforcement of this law may be insufficient.
Easier Access to Methadone
Research shows that increasing access to methadone, which has traditionally been available only in specialized clinics, could significantly improve treatment outcomes. A recent OHSU study found that 87% of opioid users in France had access to methadone, compared to less than 20% in the U.S.
Wider Distribution of Naloxone
Naloxone, a life-saving medication that reverses opioid overdoses, has been shown to save lives. OHSU has recently promoted widespread naloxone distribution, particularly to younger populations, as a key preventive measure.
Expanding Access to Buprenorphine
Previous studies by Lindner have found that access to buprenorphine, another critical medication for opioid use disorder, varies significantly by state. Stigma in healthcare settings, including pharmacies, remains a major barrier to broader access.
The study was co-authored by OHSU researchers Kyle Hart, Brynna Manibusan, and Kirbee Johnston, as well as Dennis McCarty, Ph.D., a professor emeritus at OHSU, and K. John McConnell, Ph.D., director of the OHSU Center for Health Systems Effectiveness.
The findings stress the need for stronger, more coordinated federal and state efforts to address the opioid crisis and ensure that those with addiction have reliable access to effective treatments.
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