News & Commentary

States Use Medicaid To Battle Drug Crisis


More and more states are jumping onto the front lines of the opioid addiction epidemic by adjusting their Medicaid plans to limit the number of prescriptions beneficiaries can fill, according to STAT. It seems to make sense. Medicaid beneficiaries are at three to six times greater risk of a fatal overdose than the general population because, in part, they’re prescribed opioids at twice the rate.

For every action there’s a reaction and then, often, there’s a reaction to the reaction. The opioid crisis was born in part because nearly 20 years ago, patient advocacy groups complained that providers were not focused enough on treating pain. The effort spurred by such complaints seems to have gone too far.

According to the CDC, overdose deaths from prescription opioids nearly quadrupled since 1999, as have sales of the drugs. In 2014, the epidemic caused more than 14,000 deaths, but that’s not the entire story. Some people switch from prescription opioids to heroin and fentanyl. Nonpharmaceutical fentanyl, which is made illegally, is often mixed with heroin or cocaine to increase the drug’s effect.

New York, Rhode Island, and Maine have placed restrictions on the number of opioid prescriptions doctors can give to Medicaid beneficiaries, and other states have similar controls in the works. Some commercial health plans are also using these sorts of strategies.

There are problems with this approach, say experts who are wary of what one calls a “blunt instrument” to control a crisis. One, there’s scant evidence that such moves will actually lessen the problem. Two, there are people in pain, such as cancer patients, who genuinely need the painkillers.