Buprenorphine with naloxone (Suboxone), an established treatment for opioid use disorder, has been increasingly used in states that chose to expand Medicaid eligibility under the Affordable Care Act (ACA), according to the results of a recent study.

Following the 2014 ACA-mandated Medicaid expansion, 26 states and the District of Columbia allowed individuals with household incomes up to 138% of the federal poverty level to be eligible for health coverage under Medicaid, according to the study results published in JAMA Network Open. To assess the effect of this expansion on buprenorphine-naloxone use, a research team evaluated 2010-2015 data on 11.9 million patients who filled 2 or more opioid prescriptions across 3 expansion states (California, Maryland, and Washington) and 2 nonexpansion states (Florida and Georgia).

Based on their analysis, the researchers determined that, between 2010 and 2015, the rate per 100,000 residents of patients filling buprenorphine-naloxone prescriptions increased from 68.8 to 77.1 in expansion counties. Comparatively, this rate among patients in nonexpansion counties only increased from 98.8 to 99.2 during this period.

The researchers also found that Medicaid expansion was not associated with a significant increase in overall rate per 100,000 residents of patients filling opioid pain relievers (OPRs) between 2010 and 2015. However, expansion states did see a notable increase in the rate of individuals filling OPRs paid for by Medicaid, which the study authors pointed to as an indication of Medicaid’s growing importance in pain management and addiction prevention.

Notably, previous research has also shown that states that expanded Medicaid saw a greater decrease in uninsured rates among low-income patients with substance use disorders than nonexpansion states.

“The increasing role of Medicaid in covering populations seeking these treatments suggests the need for comprehensive efforts by state programs to track patients receiving OPRs, expand nonopioid options for pain care, screen for opioid use disorder, and link high-risk patients to evidence-based addiction treatments, such as treatment with buprenorphine with naloxone,” the study authors concluded. “The potential implications of these changes in prescription use on rates of addiction and overdose are an important area for future research.”


Saloner B, Levin J, Chang H, Jones C, Alexander G. Changes in buprenorphine-naloxone and opioid pain reliever prescriptions after the Affordable Care Act Medicaid expansion. JAMA Network Open. Published August 17, 2018. doi:10.1001/jamanetworkopen.2018.1588.