Opioid users 50 percent more likely to get treatment under Obamacare

August 10, 2017 by Frank Otto
Credit: Drexel University

Once the Affordable Care Act was fully implemented in 2014, people who struggled with misusing opioids were 50 percent more likely to get treatment and twice as likely to have that treatment paid for by insurance than before, according to a new Drexel University study.

Ryan McKenna, PhD, an assistant professor in Drexel's Dornsife School of Public Health, analyzed data from the National Survey on Drug Use and Health concerning more than 4,000 people diagnosed with opioid use disorder between 2008 and 2014, spanning the period before the ACA and after it was completely implemented.

"Since the national implementation of the ACA in 2014, those with opioid use disorder were less likely to be uninsured as well as less likely to report financial barriers as a reason they did not receive ," said McKenna, who published his findings in Drug and Alcohol Dependence. "Ultimately, a significant increase in access to treatment was observed for this population."

Opioid use disorder is a term that effectively replaces "opioid abuse" or "opioid dependency" due to the negative connotations associated with each. Symptoms of opioid use disorder, in accordance with the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), include withdrawal, tolerance to opioids, use of the drugs in dangerous situations, trouble with the law and interference with obligations such as school or work.

Looking at the population dealing with opioid use disorder, McKenna hoped to discover how the implementation process of the ACA affected their status, treatment status, and treatment payment method.

Once the law was fully implemented, the data on these points showed significant progress.

McKenna found that odds of insurance coverage increased by 72 percent for people with opioid use disorder between 2008 and 2014. The odds of not receiving substance use disorder treatment due to financial concerns dropped by 50 percent. And the odds of receiving treatment increased by 158 percent, with the odds of the respondent's insurance paying for treatment climbing by 213 percent.

"These gains are an important first step," McKenna said. "Prior to national implementation, only about 25 percent of those with opioid use disorder reported receiving treatment, with the lowest rates of treatment being among the uninsured."

Full implementation of the ACA really appeared to be the key, according to the data. McKenna looked at the years 2009 through 2013—when some measures such as the young adult mandate and early Medicaid expansion came online—to contrast the complete product from what he termed "Partial-ACA."

Going from the Partial-ACA to the full, final ACA, McKenna found that the odds for people with opioid use disorder not being insured declined by 89 percent, while the odds of not receiving treatment due to financial considerations dropped by 45 percent, both strong indications of progress. Additionally, respondents were 16 and 46 percent more likely, respectively, to get treatment and have it paid for by insurance.

"While some of the provisions of the ACA were implemented prior to 2014—like early Medicaid expansion and the young adult mandate—several policy measures went into effect in 2014," McKenna explained. "The inclusion of mental health services and addiction treatment into the ACA's 10 essential health benefits—along with the establishment of health insurance exchanges and the option for states to expand Medicaid coverage up to 138 percent of the Federal Poverty Line—all played key roles to extending coverage to those with opioid use disorder."

While it appears that the ACA had a strong, positive impact on people with opioid use disorder, McKenna's data showed that the majority of people with it still don't receive treatment (just 33 percent do) and have it paid for by their insurance provider (only 16 percent).

Moreover, 27 percent still don't have health insurance and 38 percent have chosen to forgo treatment because it would be too expensive.

"We should keep in mind that this will not be solved immediately and that there are several factors working against those with opioid use disorder," McKenna said.

One of those main factors is that people with opioid use disorder often don't recognize the need for treatment, according to McKenna, and the ability to successfully navigate insurance policies and markets is "typically low" for this population.

"Lastly, there are still social stigmas at play that deter treatment-seeking behavior," McKenna said.

Although plans to repeal the ACA are—for now—shelved, McKenna believes the concerns of this population can't be disregarded.

"This population accounts for approximately 29 percent of the Medicaid expansion population and a repeal threatens to leave many uninsured," McKenna said. "And while repeal efforts aim to cut spending, they would result in increased criminal justice costs, uncompensated emergency department care and productivity losses tied to the use disorder population."

Explore further: More access to opioid treatment programs needed in Southeast, says study

More information: Ryan M. McKenna, Treatment use, sources of payment, and financial barriers to treatment among individuals with opioid use disorder following the national implementation of the ACA, Drug and Alcohol Dependence (2017). DOI: 10.1016/j.drugalcdep.2017.06.028

Related Stories

More access to opioid treatment programs needed in Southeast, says study

March 30, 2017
In 2015, more than 30,000 Americans died from overdosing on opioids, and a new study led by the University of Georgia shows that one of the hardest hit populations-low-income Americans on Medicaid-isn't getting the help it ...

Medicaid expansion linked to increased prescribing of buprenorphine for opioid use disorder treatment

March 16, 2017
States where Medicaid coverage was expanded under the Affordable Care Act have had a significant increase in prescribing of buprenorphine—a medication that plays an important role in addressing the opioid epidemic, reports ...

Clinical trial looks at tramadol for opioid withdrawal

July 12, 2017
A randomized clinical trial published by JAMA Psychiatry compared tramadol extended-release with clonidine and buprenorphine for the management of opioid withdrawal symptoms in patients with opioid use disorder in a residential ...

Opioid abuse down in younger americans, but up among older adults

July 26, 2017
(HealthDay)—While opioid abuse has fallen among younger Americans, the same cannot be said for older adults, a new government report shows.

Why are doctors underusing a drug to treat opioid addiction?

August 3, 2017
A drug approved for private physicians to treat opioid addiction is being underprescribed, and a survey of addiction specialists suggests that many of them are not willing to increase their use of it, despite an expanding ...

Americans favor treatment, not enforcement, to address opioid crisis

May 23, 2017
Many Americans have been directly touched by the opioid crisis—more than a quarter of Americans and more than a third of millennials, report knowing someone who has been addicted to opioids or prescription painkillers. ...

Recommended for you

Fighting opioid addiction in primary care—new study shows it's possible

October 18, 2017
For many of the 2 million Americans addicted to opioids, getting good treatment and getting off prescription painkillers or heroin may seem like a far-off dream.

With no morphine, 25 million die in pain each year: report

October 13, 2017
Every year, some 25 million people—one in ten of them children—die in serious pain that could have been alleviated with morphine at just a few cents per dose, researchers said Friday.

Study finds few restrictions on Rx opioids through Medicare

October 9, 2017
Medicare plans place few restrictions on the coverage of prescription opioids, despite federal guidelines recommending such restrictions, a new Yale study finds. The research results highlight an untapped opportunity for ...

Nocebo effect: Does a drug's high price tag cause its own side effects?

October 5, 2017
Pricey drugs may make people more vulnerable to perceiving side effects, a new study suggests—and the phenomenon is not just "in their heads."

Pre-packaged brand version of compounded medication to prevent preterm births costs 5,000 percent more

October 2, 2017
Preventing a preterm birth could cost as little as $200 or as much as $20,000, depending on which one of two medications a doctor orders, according to a new analysis from Harvard Medical School.

Cancer drugs' high prices not justified by cost of development, study contends

September 12, 2017
(HealthDay)— Excusing the sky-high price tags of many new cancer treatments, pharmaceutical companies often blame high research and development (R&D) costs.


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.