Research published recently in Health Affairs finds that use of medications for opioid use disorder (MOUD) dramatically increased among Medicaid enrollees in Louisiana after lawmakers enacted a host of policy changes designed to better address the opioid crisis and help people access evidence-based treatment.
The study, conducted by researchers from Johns Hopkins Bloomberg School of Public Health, examined 2018-21 claims data for Medicaid enrollees diagnosed with OUD who were receiving treatment in both residential and outpatient facilities. Medicaid is the public health care program financed jointly by the state and federal governments.
Researchers sought to understand how MOUD—which include methadone, buprenorphine, and naltrexone and are considered the gold standard of care for opioid addiction—increased after Louisiana policymakers implemented Medicaid and legislative reforms, including Act 425. The law, enacted in 2019, requires residential treatment facilities to offer buprenorphine and naltrexone on-site as a condition of licensure. Notably, Louisiana was the first state to propose connecting the use of medication to a facility’s operating license.
Louisiana adopted these policies after an extensive engagement with Pew’s substance use prevention and treatment initiative that began in 2018. For several months, Pew staff members worked closely with lawmakers to assess the strengths and weaknesses of the state’s substance use treatment system and offer recommendations for ensuring that people in need have access to effective, comprehensive addiction care amid a growing overdose crisis.
The research findings are significant, with the authors noting that in 2021, 42% of patients in residential treatment facilities received MOUD, up from 8% in 2018. This increase was driven largely by buprenorphine prescribing, which increased 29 percentage points in residential facilities across the four-year study period.
This marked increase is a direct result of Louisiana’s requirement that residential treatment facilities offer medications on-site to maintain their operating licenses, a reform that the study authors called “one of the most expansive uses of state licensure authority in the US regarding MOUD.” Historically, residential treatment programs in Louisiana have supported abstinence-only treatment, which had made access to MOUD challenging.
Notable gains were also found in outpatient facilities. Total MOUD use in nonresidential treatment facilities jumped, with 50% of patients receiving medication in 2021 versus 21% in 2018, again driven primarily by increased buprenorphine prescribing.
Despite these gains, researchers discovered that many disparities remain in access to care. For example, study authors reported that younger patients, specifically those under age 20, were much less likely to receive MOUD than were older populations. White patients, meanwhile, were more likely to receive MOUD than non-White patients. And individuals living in urban areas had greater access to MOUD than those living in rural areas.
Medicaid coverage of methadone was another notable policy change that occurred during the study period, but methadone use remained lower than buprenorphine use. Distance to an opioid treatment program (OTP)—the only place where patients can receive methadone for OUD—is also a factor in accessing these medications; patients who lived farther from OTPs had less access to MOUD than did patients who lived closer. Researchers found that methadone use in residential treatment programs was scarce, with less than 1% of Medicaid enrollees taking this medication. Uptake in residential programs remains low, given restrictions on the drug’s use—specifically that patients must go to an OTP to receive a dose, or that the medication must be brought to them at their treatment facility.
Even with these disparities, Louisiana lawmakers’ efforts to connect state residents to lifesaving treatment for OUD is commendable and has surely helped to save lives. The promising results can offer lessons to other states looking for effective strategies to address the overdose crisis.
Andrew Whitacre, Chris Lipson, and Alaina McBournie work on The Pew Charitable Trusts’ substance use prevention and treatment initiative.
Note: The Health Affairs research article is behind a paywall.