Study: Medicaid Expansion Associated with Reductions in Total Opioid Overdose Deaths

Counties in Medicaid expansion states saw an 11% lower rate of heroin deaths and a 10% lower rate of deaths involving synthetic opioids compared with counties in non-expansion states.

A new study published in JAMA Network Open suggests that expanding eligibility for Medicaid may help mitigate the opioid overdose epidemic, though expansion was associated with increased mortality-involved methadone.

States are permitted to expand Medicaid coverage to include most low-income adults up to 138% of the federal poverty level, according to the 2010 Patient Protection and Affordable Care Act (ACA). Notably, the researchers said it also requires mental health and substance use disorder services to be provided on par with other medical and surgical services.

According to the authors, the ACA was signed into law in the midst of that increase in overdose deaths, and was designed to increase access to and improve the quality of health insurance coverage. From 2014 to the end of the study observation in 2017, 32 states and the District of Columbia expanded Medicaid eligibility.

Drug overdose is a major issue in the United States, resulting in more than 70,000 fatalities in 2017, according to the study authors. Overdoses involving opioids, including prescription and illegal opioids, have resulted in large increases in overdoses over the past 2 decades.

The researchers noted that uptake of substance use disorder services with medications for opioid use disorder has increased in Medicaid expansion states compared with non-expansion states, but the effects of ACA-related Medicaid expansion ha dnot been previously examined.

The researchers performed a serial cross-sectional study using data from 3109 counties across 49 states and the District of Columbia, between January 1, 2001, and December 31, 2017. The outcomes of interest were annual county-level mortality from overdoses involving any opioids, natural and semisynthetic opioids, methadone, heroin, and synthetic opioids other than methadone. A secondary analysis examined fatal overdoses involving all drugs.

They found 383,091 opioid overdose fatalities across all observed counties during the study period, with a mean of 7.25 deaths per county, ranging from 0 to 1145 deaths per county. Adoption of Medicaid expansion was associated with a 6% lower rate of total opioid overdose deaths, compared with the rate in non-expansion states.

Specifically, counties in expansion states saw an 11% lower rate of heroin deaths and a 10% lower rate of deaths involving synthetic opioids compared with counties in non-expansion states. An 11% increase was seen in methadone-related overdose mortality in expansion states. Any association between Medicaid expansion and deaths involving natural and semisynthetic opioids was not well supported by the evidence.


Kravitz-Wirtz N, Davis C, Ponicki W, et al. Association of Medicaid Expansion With Opioid Overdose Mortality in the United States. JAMA Network, Jan 10, 2020. Accessed Jan 15, 2020.

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