Addressing the Opioid Crisis
Learn more about our response to the opioid epidemic. Read Opioid Crisis: Protecting Medicaid Members (PDF). 
Deaths from drug overdoses in the United States continue to rise, with more than half a million people succumbing in the last decade. In 2017 alone, the Centers for Disease Control and Prevention (CDC) estimated that more than 70,000 Americans died of a drug overdose. Nearly 48,000 of those deaths were due to the use of prescription opioids, heroin, or synthetic opioids that were illegally obtained.1
With opioid addiction and overdose deaths continuing to rise, our health plans are combating the opioid epidemic through:
- Providing care management and utilization training and outreach.
- Working with our providers to address responsible opioid prescribing.
- Partnering with local behavioral health managed care organizations and collaborating on information, such as prior authorization requirements for medication-assisted treatment medications.
- Urging change in public policy, including promoting training for opioid treatment and collaborating on the development of waivers to allow matching dollars for inpatient behavioral health admits greater than 15 days.
- Studying pharmacy, professional, and facility data to identify trends and opportunities to intervene with our provider community.
What is opioid use disorder (OUD)?
OUD is a combination of opioid dependence and opioid abuse. It is a medical condition that causes clinically significant patient impairment and distress.
OUD is classified as a chronic brain disease. It requires treatment and management like any other long-term chronic condition. Individuals with OUD benefit from a comprehensive public health approach that incorporates evidence-based treatments that include medication, behavioral therapy, and community and recovery support.
The Center on Budget and Policy Priorities (CBPP), a non-partisan research and policy institute, reports that the uninsured rate from 2013 to 2015 dropped for opioid-related hospitalizations by2:
79% in Medicaid-expansion states, from 13.6% in 2013 to just 2.9% in 2015.
Only 5% in non-expansion states, from 17.3% in 2013 to 16.4% in 2015.
Based on 2016 data, Kaiser analysis revealed the following for adults who received outpatient rehabilitation services3:
30%
were covered by Medicaid.13%
had no insurance.8%
were covered by private insurance.That’s what Medicaid managed care can offer.
For more on the cost of OUD care and managed care’s role in treatment, download The Opioid Crisis: Protecting Medicaid Members (PDF).
How managed care is helping to overcome the opioid epidemic
Medicaid managed care providers like us are at the forefront of the opioid epidemic. Our work with vulnerable populations puts us in a unique and critical position to address opioid addiction.
Consider the important role that Medicaid coverage plays:
- Medicaid provides health care coverage and numerous opioid treatment services to those who otherwise might not have it.3
- Medicaid covers a disproportionate share of individuals with opioid addiction.5 According to the Kaiser Family Foundation, Medicaid covers nearly four in 10 nonelderly adults with opioid addiction.3
- According to the CBPP, the expansion of Medicaid has provided treatment to 99,000 people and helped reduce the “unmet need for treatment of substance use disorders by 18 percent.4
Seventeen percent of Americans (approximately one in six) with opioid addiction are still uninsured.5 To effectively treat opioid addiction, patients need personalized, coordinated care with a strong support system.
Learn more about our opioid outreach and treatment efforts and programs.
What kinds of drugs are opioids?
Opioids are a class of drugs that includes legally prescribed pain relievers, synthetic drugs, and illegal drugs. These drugs interact with opioid receptors in the body and brain.6 When opioid drugs bind to these receptors, they can drive up dopamine levels in the brain's reward areas, producing a state of euphoria and relaxation.7 This feeling of euphoria can lead to misuse and addiction.7
Synthetic and illegal street drugs include:
- Fentanyl.
- Heroin.
Prescription opioids include painkillers such as:
- Morphine.
- Methadone.
- Buprenorphine.
- Hydrocodone.
- Oxycodone.
These painkillers often are referred to under their brand names:
- OxyContin®.
- Percocet®.
- Palladone®.
- Vicodin®.
- Percodan®.
- Tylox®.
- Demerol®.
For more information on opioids, visit the CDC website.
- https://www.cdc.gov/drugoverdose/data/statedeaths.html.
- “Chart Book: The Far-Reaching Benefits of the Affordable Care Act’s Medicaid Expansion,” Center on Budget and Policy Priorities, October 2, 2018, https://www.cbpp.org/research/health/chart-book-the-far-reaching-benefits-of-the-affordable-care-acts-medicaid.
- “Medicaid’s Role in Addressing the Opioid Epidemic,” Henry J. Kaiser Family Foundation, February 27, 2018. https://www.kff.org/infographic/medicaids-role-in-addressing-opioid-epidemic/.
- Kyle Hayes, “Medicaid Expansion Essential to Address Opioid Epidemic,” Center on Budget and Policy Priorities, October 5, 2017, https://www.cbpp.org/blog/medicaid-expansion-essential-to-address-opioid-epidemic.
- “The Opioid Epidemic and Medicaid's Role in Facilitating Access to Treatment,” Henry J. Kaiser Family Foundation, April 11, 2017. https://www.kff.org/medicaid/issue-brief/the-opioid-epidemic-and-medicaids-role-in-facilitating-access-to-treatment/.
- National Institute on Drug Abuse, “Opioids,” https://www.drugabuse.gov/drugs-abuse/opioids#summary-of-the-issue.
- National Institute on Drug Abuse, “Fentanyl,” February 2019, https://www.drugabuse.gov/publications/drugfacts/fentanyl.
