March 3, 2022

Study shows little variance in overdose deaths when sorting by Medicaid expansion status

A study by researchers from Vanderbilt and Boston University found that the increase in drug or opioid overdose deaths experienced during the first year of the COVID-19 pandemic was similar in states with and without Medicaid expansion.


by Jill Clendening

The COVID-19 pandemic caused significant disruptions in the delivery of health services, and researchers from Boston University (BU) and Vanderbilt University Medical Center looked at the pandemic’s impact on access to substance use disorder (SUD) treatment services.

Medicaid expansion has been previously associated with increased access to SUD services for low-income adults. This study, published in the March issue of the journal Drug and Alcohol Dependence, examined trends in overdose mortality nationally and by state Medicaid expansion status from 2013 to 2020.

They found that the increase in drug or opioid overdose deaths experienced during the first year of the COVID-19 pandemic was similar in states with and without Medicaid expansion.

Kevin Griffith, PhD

“Few of us remain unscathed after living through two years of the COVID-19 pandemic,” said Kevin Griffith, PhD, an assistant professor in the VUMC Department of Health Policy. “We not only have to worry about the virus, but we’ve seen reports that rates of alcohol consumption, depression, suicidal ideation and drug abuse all spiked in 2020. However, we didn’t have good data on the true extent of overdose deaths during COVID-19 until recently. We also know that Medicaid is an important tool to increase both rates of diagnoses and access to substance use treatment.”

It was particularly important to examine this possible correlation due to the big-picture impact of the pandemic that increased reliance on the United States’ public health insurance program.

“The COVID-19 pandemic caused record job losses, and Medicaid insurance coverage can serve as an important safety-net after loss of employer-sponsored insurance coverage,” said lead author Samantha Auty, a PhD candidate at BU’s School of Public Health. “Medicaid expansion had reduced the burden of the overdose epidemic prior to the COVID-19 pandemic. Before this study, it was unknown if Medicaid expansion reduced overdose and opioid overdose deaths during the pandemic, which introduced significant new barriers to care.”

For the study, state-level data on overdose mortality were obtained from the Centers for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research

(WONDER) database for 2013–2020. The primary outcomes were drug and opioid overdose deaths per 100,000 residents. Data was sorted according to Medicaid expansion status as of Jan. 1, 2020. Then, changes in outcomes between expansion and non-expansion states after the onset of the COVID-19 pandemic were compared.

The United States experienced 91,799 drug overdose deaths in 2020, a 29.9% relative increase from 2019, the largest annual increase ever recorded since the CDC began data collection in 1999. Expansion states experienced an adjusted increase of 7.0 drug overdose deaths per 100,000 residents, compared to an increase of 4.3 deaths in non-expansion states from 2019 to 2020. Similar trends were observed in opioid overdose deaths.

“These results tell us that Medicaid expansion and non-expansion states experienced similar increases in drug and opioid overdose deaths during the first year of the COVID-19 pandemic, but trends might change in 2021 and 2022,” Auty said. “Moreover, individual states made other Medicaid policy changes that might impact these outcomes but that this study doesn’t examine. There is still a lot we don’t know and more research to be done.”

The group is planning another analysis of data from the pandemic’s second year as soon as that information becomes available.

“Future monitoring of these worrisome trends is critical, and we cautiously hope that overdose rates dipped in 2021 as people adjusted to this new normal of pandemic life,” Griffith said. “In the short term, we are focused on disseminating these results and encouraging policymakers to remove as many barriers to substance use disorder treatment and harm reduction services as possible.”

“The U.S. has been experiencing a drug and opioid overdose epidemic for decades, and the COVID-19 pandemic exposed substantial flaws in the delivery of services that reduce the risk of overdose death,” Auty said. “It’s no secret that policies in the U.S. make it difficult for people to access substance use and harm-reduction services. For example, there are restrictions on who can prescribe medications for opioid use disorder and regulations that limit the number of take-home doses of these medications.

“Identifying which policy solutions do and do not reduce overdose deaths is a key first step; getting states to implement these solutions is another. Asking questions about why rates of overdose deaths are continuing to grow hopefully provides evidence for policymakers that enables them to make evidence-based policy changes.”