The Affordable Care Act In The Heart Of The Opioid Crisis: Evidence From West Virginia

Abstract

West Virginia is the epicenter of a national opioid crisis. We examine trends in treatment for opioid use disorder (OUD) among individuals enrolled in the West Virginia Medicaid expansion program under the Affordable Care Act using 2014–2016 claims data. Expanding Medicaid could provide services to populations that may previously have had limited access to OUD treatment. We thus sought to understand trends over time in OUD diagnosis and treatment, especially with medications. About 5.5% of all enrollees were diagnosed with OUD per year, and the monthly prevalence of OUD diagnoses nearly tripled during this three-year period. The ratio of individuals filling buprenorphine to the number diagnosed with OUD was around one-third in early 2014, increasing to more than 75% by late 2016. Mean annual duration of filled buprenorphine increased from 161 days in 2014 to 185 days in 2016, and most individuals filling buprenorphine also received counseling and drug testing during the study period. The growing use of medication treatment for OUD in the West Virginia Medicaid expansion provides an opportunity to reduce overdose deaths.