Posted by & filed under Noah's Notes.

During the debates about healthcare in the last 2 years one argument that was made by Senator Ron Johnson of Wisconsin against Medicaid expansion was that more people with access to health care resulted in more opioid prescriptions and made the crisis of addiction worse.

Most people working in healthcare argued that the origins of the opioid crisis were far earlier than Medicaid expansion (which only began in 2010), but with expansion of MaineCare now imminent it would be helpful to have information which would help us to anticipate its impact.

In August of this year Saloner et. al. published an article in the Journal of the American Medical Association Open Network outlining the results of a study they conducted on prescribing patterns in 3 Medicaid expansion states (California, Maryland and Washington) and two non-expansion states (Florida and Georgia). This study included 11.9 million people who filled 2 or more prescriptions for opioids over the course of a year and analyzed on a county by county basis. Here is what they found:

  • Prior to expansion nearly 70 people per 100,000 filled prescriptions for Suboxone across all counties, meaning that they were being treated for opioid addiction, or Opioid Use Disorder (the medical term).
  • After expansion, the counties where Medicaid was expanded showed and increase in Suboxone prescribing by nearly 13% compared to non-expansion counties.
  • Conversely, the rate of prescribing for opioid pain relievers did not increase after expansion, relative to non-expansion counties. In fact across all sectors, opioid pain reliever prescribing decreased steadily.

These data suggest that when Medicaid is expanded access to treatment for Opioid Use Disorder improved and expansion did not increase the prescribing rates of opioid pain relievers, in fact there is a trend of steadily decreasing rates of those prescriptions. Given that we know from very strong clinical evidence that treatment of people with Opioid Use Disorder with medication like Suboxone decreases deaths from overdose, decreases transmission of diseases like Hepatitis C and improves retention in treatment programs this is good news for Maine as we move toward MaineCare expansion and allowing more people to access healthcare.


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