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The use of methadone has increased in states with expanded Medicaid programs. Getty Images
  • Researchers say deaths from most opioids have decreased in states that expanded Medicaid programs.
  • However, those states also saw an increase in methadone overdoses.
  • Experts say regions with expanded Medicaid programs tend to see an increase in methadone prescriptions and a decrease in other opioid prescriptions.

States that expanded Medicaid programs between 2001 and 2017 have seen a drop in opioid-related deaths but a rise in methadone overdoses.

Researchers in California, New York, and Rhode Island looked at National Vital Statistics System data from the Centers for Disease Control and Prevention (CDC), involving 3,109 counties in 49 states and the District of Columbia.

The goal was to examine the importance of Affordable Care Act-related Medicaid expansions on opioid overdose deaths.

The 32 states plus the District of Columbia with expanded Medicaid services at the time of the study had 6 percent fewer opioid deaths after expansion than counties in states that didn’t expand the program.

The study was published online in JAMA Network Open.

Alaska was excluded from the study due to substantial differences in the size and shape of various counties during the period of the study.

Researchers found 383,091 opioid-related deaths within the study’s purview.

The overall death rate more than quadrupled from 2.49 deaths per 100,000 people in 2001 to 11.41 deaths per 100,000 in 2017.

Death rates did increase in states that expanded Medicaid but at a lower rate than non-expansion states.

Within those states, fatal heroin overdoses decreased by 11 percent. Overdose deaths involving synthetic opioids other than methadone, such as fentanyl, decreased by 10 percent.

“This alone indicates that these methods are effective, but additional education and implementation of these treatment options is needed,” Charley Melson, MS, LPCC, the executive director of Praxis, a Landmark Recovery facility in Louisville, Kentucky, told Healthline.

“I feel that any significant decrease in death rates is a positive outcome,” she said.

Opioids are a class of drugs derived from the opium poppy plant that produce a variety of effects in the brain, including relief of moderate to severe pain and a feeling of being high.

Opioids such as OxyContin and Vicodin are prescribed medications. Fentanyl is also a prescribed opioid, frequently made illegally, that’s 50 to 100 times more powerful than morphine (another opioid).

When some people run out of prescribed opioids, they sometimes turn to illegal street opioids, such as heroin.

“A person who became addicted to prescription opioid painkillers after an automobile accident could switch to illegal opioids if she suddenly couldn’t obtain her usual opioids or if illicit opioids became cheaper and easier to get,” Colin Planalp, MPA, a senior research fellow with the State Health Access Data Assistance Center (SHADAC) at the University of Minnesota, told Healthline.

Methadone is a prescribed drug that reduces withdrawal symptoms in people with opioid use disorder without the “high” associated with other narcotics. Dosage is gradually decreased as the user’s pain and withdrawal symptoms wane.

“Methadone is a synthetic opioid that has the interesting distinction of being utilized for both pain management and to help treat people who are experiencing opioid use disorder,” Crystal Riley, MHA, MBA, a lecturer of health administration at New York University’s Robert F. Wagner Graduate School of Public Service, told Healthline.

“Though it is used to help patients recover from addiction to other narcotics, it is still a potent drug that carries the same risk for possible overdose,” she added.

Methadone has a lower mortality rate than heroin and fentanyl in the study, but its use in Medicaid expansion states still increased 11 percent.

“Beginning around 2012, overdose deaths from natural and semi-synthetic opioids, (like) prescription opioid painkillers, largely plateaued — possibly due to efforts to intervene in the opioid crisis, such as reducing inappropriate prescribing of opioids and drug makers’ changes to certain medications to make them tamper resistant,” Planalp said.

“But that coincided with the beginning of a dramatic rise in deaths from heroin, followed by synthetic opioids such as fentanyl,” he said.

Melson pointed out “correlation is not causation.”

“The Medicaid expansion often used in rural areas is often not considered best practice with additional supportive factors,” Melson said.

“An increase in methadone deaths can be correlated, but not enough data is given to rule out other variables that may be linked to the deaths. Often methadone is used in these rural areas due to lack of access to other options or in cases of severe pain management,” she said.

Dr. Douglas P. Jeffrey, a family doctor in Oregon and a reviewer for the informational website eMediHealth, said there are “several” explanations for Medicaid expansion decreasing opioid-related deaths while increasing the number of methadone overdoses.

“Most of the states in the U.S. have had methadone on their preferred drug list,” he told Healthline. “Secondly, there has been some ignorance on the part of prescribers and the general public to the dangers of methadone. Thirdly, methadone is less expensive than many other narcotics and this has influenced the selection of methadone as a choice for pain control.”

Jeffrey said 36 states once considered methadone a “preferred drug.”

“In those states that took the medication off the preferred drug list, or required (prescriptions), the death rate from methadone has dropped in those states,” he noted.

Melson said the problem with methadone overdoses can be solved.

“Comprehensive treatment that includes psychotherapy, case management, occupational (and) life skills, and medical treatment greatly increases the chances of success,” she said.

Melson continued, “Combine this with well-educated providers regarding the risks and best practices of prescribing these medications, especially for the pain, would likely create an environment where you would see a steep decrease of overdose deaths.”