After expanding Medicaid, Oklahoma recorded a steep increase in access to a key opioid addiction medication, according to a study published in February.
The study suggests that broader health care coverage reduced barriers to buprenorphine, a gold-standard medicine for treating patients struggling with opioid use disorder that has been proven to reduce opioid-related deaths, especially when paired with long-term medical care and recovery support.
In Oklahoma and the seven other states that expanded Medicaid after 2018, buprenorphine prescriptions rose by more than 21% between 2019 and 2023, the study found.
States that expanded Medicaid before 2018 also saw an increase in buprenorphine prescriptions, but they were generally smaller, according to the study. That's because other federal changes, aside from Medicaid expansion, have made buprenorphine easier to get in recent years.
Nicole Siegal is a postdoc at Indiana University and the study's principal author. Her team analyzed pharmacy claims data from retailers across the country for more than 4.5 million unique patients to make their findings.
Siegal said even though increases in buprenorphine prescriptions were concentrated among Medicaid recipients, all patients, including people paying through private insurance, got more access to the medication.
"It's not just a shift of patients going from one source to another," Siegal said.
Instead, researchers said their study suggests that expanded health care coverage allowed a larger number of people to get prescriptions to buprenorphine. The study estimates that buprenorphine access averted up to 140 overdose deaths per year in the recent-expansion states.
Last year, deaths from drug overdoses declined by 43% in Oklahoma, according to data from the Centers for Disease Control and Prevention. It was one of the most significant drops in overdose deaths across the nation, which health experts attribute, in part, to increased access to treatment.
Changing attitudes about seeking help, harm reduction programs and other efforts have also contributed to a nationwide decline in deaths for the first time since the COVID-19 pandemic.
Funding threats endanger Oklahoma's 'success story'
Stephen Crystal, director of the Center for Health Services Research at Rutgers University and another author of the study, said Oklahoma's gains are threatened by federal and local attacks on Medicaid.
"I don't know how you would maintain the current level of buprenorphine treatment if you eliminated Medicaid expansion because the expansion population is where you find a lot of the people with opioid use disorder," he said.
Medicaid is the largest payer of opioid use disorder treatment. It covered medicine for nearly half of all non-elderly adults in the U.S. with opioid use disorder in 2023, according to the health policy research group KFF.
Medicaid expansion currently covers health care for 228,000 Oklahomans.
Crystal said Oklahoma is a "success story" and sustaining Medicaid expansion is critical to making sure more people don't die of overdose. Another study he published analyzing buprenorphine trends across the U.S. also showed a significant link between the medicine and Medicaid.
Congressional Republicans are expected to pursue deep Medicaid cuts, which could result in millions of Americans losing health care coverage unless states decide to play a larger role in its funding.
At least nine states have enacted trigger laws explicitly requiring them to stop Medicaid expansion or make significant changes if the federal share of spending drops.
Two measures moving through the Oklahoma legislature seek to do the same, but both require voter approval if they advance. Oklahoma was one of three states that enshrined expansion in its constitution, preventing lawmakers from taking normal measures to make changes on their own.
This report was produced by the Oklahoma Public Media Exchange, a collaboration of public media organizations. Help support collaborative journalism by donating at the link at the top of this webpage.
