OBJECTIVES : Since 2014, several US states have undergone expansion of eligibility for their Medicaid programs under the Affordable Care Act. During this time, opioid misuse has escalated to a public health crisis, and the Food and Drug Administration (FDA) have recommended opioid replacement therapy (ORT) to prevent overdose and treat addiction. This research aimed to compare the number of ORT prescriptions between states that maintained or expanded their Medicaid program.

METHODS : Prescription numbers of FDA-recommended methadone-, buprenorphine- and naltrexone-based therapies were compared between 2013 and 2014 in New York, Ohio, New Jersey, Illinois and California (expansion), and Texas, Florida, Pennsylvania, Georgia and North Carolina (no expansion) using the Medicaid State Drug Utilization Database. The largest states by population were selected from all Medicaid expanded or maintained states. A comparison between 2013 to 2014 was chosen as January 1 2014 is the date that most states expanded eligibility.

RESULTS : Among the states that expanded eligibility, a 26.6% relative increase in the prescription of ORT was observed between 2013 and 2014, compared to a 12.3% relative increase in the states that maintained eligibility. This difference was not statistically significant (p=0.29). The greatest increase in prescription numbers was observed in Ohio (45.9%), with the lowest in Texas (−1.9%). In states with increased prescriptions, this was predominantly driven by increases in prescription of buprenorphine-based therapies (5/7 states).

CONCLUSIONS : The research suggests that expansion of Medicaid eligibility may have led to increased prescriptions of ORT compared to states that maintained eligibility. Improved patient access to ORT is likely to play an important part in counteracting the US opioid crisis. Further research is warranted to account for limitations of the research, which included analysis of a subset of states/a short time period, lack of indication-specificity in the prescription data and not accounting for confounding factors.