Potential cuts to state Medicaid funding in recently proposed healthcare reform legislation in both the House and Senate could jeopardize access to naloxone for the populations that have benefited most from it, according to a study released this month by the Commonwealth Fund, a private foundation that aims to improve healthcare for vulnerable populations.
The report notes that more than half of those in the United States with an opioid use disorder have incomes below 200% of the federal poverty level, and that Medicaid has played a key role in making naloxone more accessible for low-income populations.
States with expanded Medicaid programs have in recent years used Medicaid funds to purchase large quantities of naloxone units. Per data from the Centers for Disease Control and Prevention, the number of laypeople who received naloxone kits doubled from June 2013 (the year prior to Medicaid expansion) to June 2014 (the first year of expansion). The Commonwealth Fund concludes through its research that there have been 11,500 overdose reversals with naloxone funded by Medicaid since 2014.
While overdose reversals in non-expansion states have increased, they have been significantly outpaced by the 31 states and Washington, D.C., with expanded Medicaid programs as of December 2016, according to the study. For example: opioid-related death rates in Massachusetts and Tennessee were relatively similar in 2015 at 20.9 and 21.5 per 100,000 population, respectively. In 2016, 868 overdose deaths were averted in Massachusetts, a rate of 13 per 100,000 population. Meanwhile, Tennessee, a non-expansion state, had just 11 opioid-related deaths averted (0.17 per 100,000).
The Commonwealth Fund concludes that while differences observed between expansion and non-expansion states could be the result of differences in policies on how to combat the opioid crisis, Medicaid expansion on the whole has increased the use of naloxone and the total number of opioid overdose reversals in the U.S.
The full study is available on the Commonwealth Fund’s website.