More Americans are in treatment for opioids, but crisis keeps growing

Proposed GOP cuts to Medicaid have divided senators in Washington. Sen. Pat Toomey (R., Pa.), who helped draft the proposal, was the target of protests outside his Philadelphia offices on Friday, June 23. (DON SAPATKIN / Staff)

More and more people are being treated for opioid addiction, according to two new reports, but not nearly enough to slow the epidemic.

Medicaid spending on several prescription medicines used to treat opioid addiction more than doubled nationwide in the last five years, accelerating between 2015 and 2016, an Urban Institute analysis of federal data found. The vast majority of that money was spent in states such as Pennsylvania and New Jersey that opted into the Affordable Care Act’s Medicaid expansion. Republican proposals in both the Senate and House would roll back the expansion, but drug treatment spending has emerged as a possible area of compromise, especially for senators in states  devastated by addiction.

A separate report, from the Blue Cross Blue Shield Association, found a nearly 400 percent increase in diagnoses of opioid use disorders in the last five years. Both analyses were released last week.

Blues companies across the nation collectively cover 106 million people, the single largest chunk of commercial health insurance. But addiction hits the poor especially hard, and the federal government has turned out to be a critical source of funding for treatment, much of it covered by the Affordable Care Act’s Medicaid expansion.

The Blues report also looked at links between opioid prescriptions and use disorders. It found that people who received high dosages of prescription pain medicines — the equivalent of more than about 65 milligrams of oxycodone or 100 milligrams of hydrocodone a day — were  more likely to end up addicted, even when the prescription was for less than 90 days.

Only 7 percent of the prescription regimens in the report were for high dosages. But those patients were up to 43 times more likely to be diagnosed with an addiction disorder than patients filling scripts for lower doses.

The Blues data also showed that women of all ages were more likely to be prescribed opioids than men, with the biggest gap among middle-aged patients. But men were more likely to be diagnosed with an opioid use disorder through their mid-40s. Among people older than that, however, women were more likely to run into trouble.

Blues subscribers in New Jersey and Pennsylvania were below the national average on three measures of opioid use and diagnosed use disorder. Yet members in both states who got treatment were more likely to receive medications that have been shown to reduce the chances of relapsing.

Rates of opioid use disorders were highest in the Southeast and in Appalachia, the Blues report found, while use of the medicines that help people stay off drugs was lowest in those regions.

The Urban Institute report focused on Medicaid coverage of medications used to treat opioid use disorder or reverse overdoses. But it contained no data at all on methadone maintenance, which is regulated separately from all other drugs.

Medicaid spending on buprenorphine, which is often sold as Suboxone, doubled over five years. Buprenorphine, like methadone, is a substitute opioid, but treatment is more accessible and accounted for the bulk of the $930 million spent by Medicaid on addiction treatment medications in 2016. Spending on the opioid-blocking medication naltrexone, especially the pricey monthly injection sold as Vivitrol, increased tenfold.

The report included spending on the emergency overdose-reversal medication naloxone, including the brand-name spray Narcan, which New Jersey, Pennsylvania, and many other states have made widely available as a lifesaver over the last few years. Medicaid spending on that was up 900 times nationwide.

Democrats, moderate Republicans, and a united front of medical organizations have grown increasingly alarmed about the potential impact on addiction treatment and overdose deaths if the Medicaid expansion is rolled back, as outlined in both the Senate and House health care plans. The Wolf administration has estimated that one-fifth of the more than 700,000 Pennsylvanians who have gained coverage through the expansion have used it for substance-abuse treatment.

According to the Congressional Budget Office, spending on Medicaid in two decades would be about one-third lower than it is now if the Senate GOP plan were to take effect. That proposal, from Majority Leader Mitch McConnell, had included $2 billion over 10 years specifically for the opioid crisis. By the time senators left for a 10-day holiday break, he reportedly had agreed to moderates’ demands for $45 billion.

But estimates of the cost of treating Medicaid patients with opioid addiction and diseases that it can help spread, such as hepatitis C, go as high as $183 billion over the next decade.

“The trajectory is unknown,” said Lisa Clemans-Cope, a health economist and co-author of the Urban Institute report. “Clearly, treatment is not keeping up [with need] even given these big increases.” Cutting Medicaid, she said, “could have really devastating effects for families and communities and states.”