Between 2011 and 2018, Medicaid-covered prescriptions for buprenorphine increased from 40 to 138 per 1,000 enrollees in states that expanded the program, the study estimated using data from the federal Centers for Medicare and Medicaid Services. In comparison, such prescriptions increased from 16 to 41 per 1,000 enrollees in states that did not expand Medicaid.
States that have chosen not to expand Medicaid have depended on several billion dollars in grants that Congress has doled out since 2017 for treatment, prevention and recovery services, but the money is scheduled to run out next year. The Trump administration is also supporting a Republican-led court case seeking to overturn the Affordable Care Act, including the expansion of the Medicaid program.
Even among the states with large increases in buprenorphine prescribing, there was wide variation. Vermont had by far the highest rate: 1,210 buprenorphine prescriptions for every 1,000 Medicaid enrollees in 2018. The next highest rate, in West Virginia, was 827 prescriptions per 1,000 enrollees.
Vermont has had one of the most ambitious expansions of opioid addiction treatment in the country, including in prisons and hospital emergency rooms. The researchers said its high prescribing rate could also reflect higher dosing — patients taking two eight-milligram tablets of buprenorphine at a time, for example.
The study did not look at prescribing data for naltrexone, another medication approved to treat opioid addiction. A third medication, methadone, is dispensed at highly regulated clinics rather than prescribed. It is possible that in some regions with low buprenorphine prescribing rates, naltrexone or methadone are more commonly used.
Dr. G. Caleb Alexander, co-director of the Johns Hopkins Center for Drug Safety and Effectiveness, said that the findings were useful but that researchers should also study the quality of care that people on buprenorphine are getting from state to state.
“Expanding the use of these evidence based, F.D.A.-approved treatments is an important first step in improving care for opioid-use disorder,” he said. “But all too often, treatment courses are short, and care for opioid addiction is fragmented from all of the other health care needs that people have.”