Friday, September 01, 2017 1:00 am
Medicaid-opioid abuse theory doubted
Researchers say they see no link, puzzled by claim
Also: Petition seeks FDA ban on high doses
CHICAGO – Safety advocates and state health officials are formally calling on the Food and Drug Administration to ban high-dose opioid painkillers to prevent accidental overdose deaths among patients and people who abuse drugs.
A petition filed Thursday asks the FDA to ban opioid pills that, when taken as directed, would add up to a daily dose of more than 90 milligrams of morphine. The Centers for Disease Control and Prevention has said that level is dangerous for most patients and doesn't improve pain control or the ability to function.
The petition was signed by leaders of the Association of State and Territorial Health Officials, Physicians for Responsible Opioid Prescribing, the National Safety Council and the American College of Medical Toxicology.
FDA officials declined to comment on the petition, but FDA Commissioner Dr. Scott Gottlieb has called the opioid epidemic his “highest immediate priority” and has been willing to consider abuse of opioids in evaluating their safety.
WASHINGTON – An intriguing new theory is gaining traction among conservative foes of the Obama-era health law: Its Medicaid expansion to low-income adults may be fueling the opioid epidemic.
If true, that would represent a shocking outcome for the Affordable Care Act. But there's no evidence to suggest that's happening, say university researchers who study the drug problem and are puzzled by such claims. Some even say Medicaid may be helping mitigate the consequences of the epidemic.
Circulating in conservative media, the Medicaid theory is bolstered by a private analysis produced by the Health and Human Services Department for Sen. Ron Johnson, R-Wis. The analysis says the overdose death rate rose nearly twice as much in states that expanded Medicaid compared with states that didn't.
Independent experts say the analysis misses some crucial facts and skips standard steps that researchers use to rule out coincidences.
Johnson has asked the agency's internal watchdog to investigate, suggesting that unscrupulous individuals may be using their new Medicaid cards to obtain large quantities of prescription painkillers and diverting the pills to street sales for profit. Diversion of pharmacy drugs has been a long-standing concern of law enforcement.
“These data appear to point to a larger problem,” Johnson wrote. “Medicaid expansion may be fueling the opioid epidemic in communities across the country.” He stopped just short of fingering Medicaid, saying more research is needed.
But if anything, university researchers say Medicaid might be doing the opposite.
“Medicaid is doing its job” by increasing treatment for opioid addiction, said Temple University economist Catherine Maclean, who recently published a paper on Medicaid expansion and drug treatment. “As more time passes, we may see a decline in overdoses in expansion states relative to nonexpansion states.”
Prescriptions for medications used to treat opioid addiction in outpatient settings increased by 43 percent in Medicaid expansion states compared with states that didn't expand, according to Maclean's research with Brendan Saloner of Johns Hopkins Bloomberg School of Public Health. That indicates Medicaid is paying for treatment.
But Maclean and Saloner also found another piece of the puzzle: Overdose death rates were higher to begin with in states that expanded Medicaid. They looked at deaths from overdoses and fatal alcohol poisoning from 2010-2015, starting well before the Medicaid expansion. The HHS analysis for Sen. Johnson missed that underlying trend because it started with 2013 data.
Still another problem with the Medicaid theory is that it lumps all drug overdoses together. But illicit drugs Medicaid doesn't provide – heroin and fentanyl – have been driving surges in deaths since 2010.
“It's worrisome because this is the type of numerical evidence that's used to propose bad policy,” Garthwaite said.Some researchers see hints that Medicaid expansion may be helping to mitigate the overdose epidemic.
Vanderbilt economist Andrew Goodman-Bacon and Harvard's Emma Sandoe found that from 2010 through 2015, counties with the largest insurance coverage gains experienced smaller increases in drug-related deaths.
More research is needed to provide conclusive evidence.
Relying on faulty research is “dangerous,” said Maclean. “It can lead to bad policies, and people's lives are at stake here.”