To Improve Addiction Treatment, States Should Measure More Than Deaths

During the first 12 months of the COVID-19 pandemic, more than 70,000 people died in the U.S. from an opioid overdose.

Although that staggering number does not fully quantify the toll of opioid use disorder (OUD), states often do not look deeper than lives lost to assess the effectiveness of their OUD treatment systems.

However, state officials can use quality measures—which provide data to assess and compare the quality of health care delivery against recognized standards—to determine how well their opioid policies are working, how effectively states are spending money, how equitable their care is, and what they need to do to improve. These metrics help insurers set reimbursement rates for value-based care to reward providers for the quality of their performance rather than the quantity of their procedures. Doctors, nurses, and other practitioners use quality measures to improve care, and even patients rely on them to find effective and reliable providers.

In OUD care, access to and use of medication are especially important quality measures. Food and Drug Administration-approved treatments such as methadone and buprenorphine significantly reduce the risk of overdose, but only 11% of people with OUD receive them. And although research indicates that a longer duration of treatment leads to better outcomes, people often leave treatment for a variety of reasons. If states consistently measured the extent to which people are connected to and remain in care, they could use the data to inform strategies that increase access and adherence to medications for OUD.

Kentucky is one state using OUD-related measures beyond overdose deaths. The state collects medication utilization data, which supported the legislature’s decision in 2022 to remove Medicaid’s prior authorization requirements for all forms of OUD medication, enabling more people to access treatment.

States can also use quality measures to improve health equity, but only if the data is broken down by race, ethnicity, age, gender, ZIP code, income, insurance status, and other characteristics. This is important because research has found that Black individuals and other people of color are less likely than White people to be referred to treatment for OUD and receive medication. By examining demographic data in the quality measures, states can uncover inequities like these and develop solutions to ensure that everyone can access care based on their unique needs rather than their race, address, or other factors.

Overdose deaths illustrate the severity of the opioid crisis, but they do not tell policymakers what kinds of action to take to get more people lifesaving treatment. States must track and report more data that provides a deeper understanding of their OUD treatment systems, from diagnosis to medication initiation and retention to recovery. That’s the only way to improve the quality of care, ensure that people have equitable access to it, and ultimately reduce the number of individuals dying from OUD.

Frances McGaffey is an associate manager and Sheri Doyle is a senior manager with Pew’s substance use prevention and treatment initiative. Josh Wenderoff is an officer with Pew’s health programs.