• Posted October 2, 2023

Third of Medicaid Patients With Opioid Use Disorder Don't Get Treatment

Medications that cut cravings have been shown to help with opioid use disorder, yet nearly a third of Medicaid recipients dealing with opioid addiction aren't getting them, a new report shows.

There were significant disparities in who gets these medications by age, race and states, according to the report released Friday by the U.S. Department of Health and Human Services, and Medicaid needs to improve access to the treatments.

“Medicaid is uniquely positioned to achieve these goals, given that the program is estimated to cover almost 40% of non-elderly adults with opioid use disorder,” the report said.

The analysis draws from 2021 enrollment, eligibility and claims data. Findings showed that more than a half million people who were covered by Medicaid and had opioid use disorder did not receive medication.

Dr. Bradley Stein, director of the RAND Opioid Policy Center and a senior physician policy researcher at the RAND Corp., told the New York Times that he thought the numbers not receiving treatment would be even higher, but said for certain groups “things are not where they need to be, and I'm asking: Are the successes things we're going to be able to sustain or not?”

Medications for addiction include methadone, buprenorphine and naltrexone.

Among the findings were that -- in the 15 states that included data on race and ethnicity -- only 53% of Black patients received a medication compared to 70% of white people with opioid use disorders. Black people have had more significant increases in overdose deaths.

Disparities by age include that only 11% of those under age 19 received the medication, compared to 70% of those aged 19 to 44. Numbers were also low for those 65 and up, with less than half getting these medications.

States with strong coverage include Rhode Island and Vermont with nearly 90% covered, while those with weak coverage were Illinois and Mississippi with less than 40% covered. State policies about medication vary widely, Stein noted.

More than half of those with opioid use disorder who are covered by Medicaid did not receive medication in 10 states, which included significant populations in Texas and New York.

Meanwhile, in 2021 more than 80,000 people died from opioid overdoses, a 17% increase.

Among the barriers to treatment are stigma, finding providers willing to describe these medications and a lack of awareness by patients.

In the report, the inspector general's office outlined steps for U.S. Centers for Medicare and Medicaid Services (CMS) to take, including the creation of a social media campaign and fact sheets.

Those recommendations are “infuriating,” Dr. Ayana Jordan, an associate professor of psychiatry at NYU Grossman School of Medicine who studies race and addiction, told the Times.

Jordan would have liked to have seen solutions to medication shortages in pharmacies serving communities of color and incentives for health care providers to collaborate with churches and other community organizations to increase prescribing.

“They 'encourage, encourage, encourage' action -- what does that mean? Nothing. It is not enough,” she said. “How can the federal government be involved in actually holding states accountable?”

Jordan “is tired of seeing so many” patients die.

“I'm over it,” she said. “There is intense sorrow in trying to address a crisis when you are very much handicapped by a lack of legislation.”

More information

The National Institute on Drug Abuse has more on medications to treat opioid use disorder.

SOURCE: New York Times