Researchers find Medicaid is crucial to access treatment for opioid addiction
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Medicaid plays a key role for giving people with opioid-use disorder access to treatment, according to a Rutgers Health study.
Progress in life-saving treatment for opioid-use disorder with the medication has stalled in the past several years, according to a Rutgers Health study. However, researchers added that while some states were able to achieve substantial improvement, others lost ground.
Specifically, states that have expanded access to Medicaid insurance coverage since 2018 saw increases in prescriptions for opioid-use disorder treatment, according to the study, while states that haven’t expanded Medicaid experienced declining treatment rates after 2022.
Researchers found that state Medicaid policies were key drivers of population-level treatment rates.
The study, published in Health Affairs, examined trends in national retail pharmacy claims by Medicaid, Medicare and private insurance across states between 2018 and 2024, a period of rising fatal overdose rates and national policy changes aimed at increasing treatment. Researchers compared the claims with state populations and overdose rates to assess the impact of Medicaid eligibility on treatment uptake.
“We were impressed by the success stories in some states, such as those with recent eligibility expansions,” said Stephen Crystal, director of the Rutgers Center for Health Services Research at the Institute for Health, Health Care Policy and Aging Research. “Several of these states, like Virginia, Utah and Missouri, doubled or tripled Medicaid-paid prescribing, driving strong population-level improvement. These successes point to opportunities for improvement even when the overall national rate of progress is disappointing. Nevertheless, wide disparities between states remained, as shown in maps and state comparison tables in the paper and its appendix.”
Despite the availability of effective treatments for opioid-use disorder, more than 80,000 died in 2024from opioid-use overdoses. In addition to the disease of addiction, there are a number of policy and financial barriers preventing people from accessing medication, the researchers said. The federal government declared an opioid public health emergency in 2017 and again in 2025.
Because people with opioid-use disorder tend to be low-income single adults, Medicaid is the most important payer for buprenorphine, a highly effective medication used to treat opioid-use disorder. However, Medicaid policies covering opioid-use disorder treatment vary state to state, resulting in vastly different uptake of treatments that can dramatically lower the risk of overdose and support recovery. New Jersey is among the states that have implemented important initiatives that have aided access to Medicaid-paid treatment, including Medicaid expansion, elimination of buprenorphine prior authorization, and increased reimbursement for treatment, with improvements in Medicaid and all-payer buprenorphine prescribing during the study period.
The national analysis led by Crystal, who is a Distinguished Research Professor at the Rutgers School of Social Work, showed diverse state-level trends that often pointed to the importance of Medicaid.
States that recently expanded the eligibility criteria to qualify for Medicaid insurance experienced a 27.3% increase in buprenorphine prescribing rates. But in states that didn’t expand Medicaid, overall prescribing lagged, with declines after 2022.
Researchers said expanding Medicaid eligibility and minimizing disenrollment from Medicaid during eligibility redeterminations are critical steps in increasing access to opioid-use disorder treatment across the country.
“Translating evidence into consistent practice has been uneven across the country for multiple reasons, including the stigma surrounding people with addiction,” said Crystal. “But progress is possible when states take action to help residents access and afford effective medication. Maintaining the progress that has been made in opioid-use disorder treatment through state Medicaid policies will be challenging under the financial pressures created by recent federal legislation, but it is vital in maintaining progress on preventing overdoses and supporting recovery.”
Coauthors of the study include Fangzhou Xie, Hillary Samples, Elizabeth Stone and Jennifer Miles of Rutgers; Allen Campbell of the IQVIA Institute, Peter Treitler of Boston University; and Sumedha Gupta and Kosali I. Simon of Indiana University.
Crystal will discuss the research during the Health Affairs Health Policy Briefing focused on the opioid crisis on Sept. 3 and in an upcoming Health Affairs Health Podyssey podcast episode.
Journal
Health Affairs
Method of Research
Data/statistical analysis
Subject of Research
Not applicable
Article Title
States With Substantial Increases In Buprenorphine Uptake Did So With Increased Medicaid Prescribing, 2018–24
Article Publication Date
2-Sep-2025
Despite relaxed prescribing rules, opioid addiction treatment still hard to find at pharmacies
Only 4 in 10 U.S. retail pharmacies carry buprenorphine, with access even more limited in Black and Latino communities
University of Southern California
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Trends in buprenorphine availability at U.S. retail pharmacies, overall and by neighborhood majority race and ethnicity
view moreCredit: USC Schaeffer Center for Health Policy & Economics
Faced with a worsening drug crisis, policymakers in recent years have made it much easier for doctors to prescribe the highly effective opioid addiction treatment buprenorphine. However, many patients may still struggle to find pharmacies carrying the treatment, finds new research led by the USC Schaeffer Center for Health Policy & Economics.
Buprenorphine was available at just 39% of U.S. retail pharmacies in 2023, a modest increase from 33% in 2017, according to the study published Sept. 2 in Health Affairs. But disparities in who can access the treatment have persisted. Pharmacies in predominantly Black neighborhoods (18%) and Latino neighborhoods (17%) remain significantly less likely to carry buprenorphine as those in white neighborhoods (46%).
Buprenorphine is one of several medications that can ease opioid cravings and withdrawal, and it is the only one that can be prescribed in primary care settings and dispensed at retail pharmacies. Because these treatments are milder opioids and considered controlled substances, they historically have been subject to tight prescribing and dispensing rules.
Recent efforts to ease prescribing rules include the 2023 elimination of the so-called “X-waiver” that required doctors to receive specialized training and registration to prescribe the treatment. However, dispensing rates have changed little, suggesting that pharmacy regulations aimed at preventing opioid (and buprenorphine) diversion, abuse and misuse continue to discourage pharmacies from carrying the treatment, particularly in minority neighborhoods and some areas hit hardest by the opioid epidemic.
“Relaxing buprenorphine prescribing rules was an important step in making this critical treatment more accessible, but too many patients lack a nearby pharmacy that carries it,” said Dima Mazen Qato, senior scholar at the Schaeffer Center and the Hygeia Centennial Chair at the USC Mann School of Pharmacy and Pharmaceutical Sciences. “Federal and state policymakers must reduce barriers that make it difficult for pharmacies to stock buprenorphine, especially in some of the more vulnerable communities.”
Limited access in some hard-hit areas
Researchers analyzed buprenorphine claims from 2017 to 2023 from an IQVIA pharmacy database from covering 93% of U.S. retail prescription claims. Among their key findings:
- Although buprenorphine availability increased in most states, there were significant declines in five states (Florida, Ohio, Tennessee, Washington, Virginia) and Washington, DC.
- In nearly every state, buprenorphine availability was lowest in Black or Latino neighborhoods. In some states (California, Illinois and Pennsylvania), availability in these neighborhoods was about four to five times lower than in white neighborhoods.
- Independent pharmacies in Black and Latino neighborhoods were significantly less likely to stock buprenorphine and were also more likely to stop carrying it over time. But when these pharmacies did stock the treatment, they persistently filled about twice as many prescriptions per month compared with other types of pharmacies.
- Pharmacies in rural counties and those with high rates of opioid-related overdose deaths were persistently more likely to carry buprenorphine. Yet in 73 hard-hit rural counties, less than 25% of pharmacies carried the medication, and another 25 counties lacked a pharmacy.
Areas with fewer dispensing barriers had better access
Researchers said states should consider easing tight controls on buprenorphine dispensing, which can restrict access to the treatment in several ways.
When buprenorphine demand rises, suppliers may delay or pause shipments to pharmacies to avoid scrutiny from the Drug Enforcement Agency (DEA), and pharmacies often refuse to stock buprenorphine out of concern the orders will be flagged to the DEA. Some pharmacies carry the medication but refuse to dispense it for fear of running afoul of the federal Controlled Substances Act and similar state pharmacy regulations and laws, which require pharmacists to ensure that prescriptions for controlled substances are valid.
The researchers found buprenorphine availability was greatest in states with the least restrictive prescription drug monitoring programs, including those that limited how law enforcement could access the electronic databases to investigate suspicious prescribing.
The researchers said state and local governments should consider requiring pharmacies to maintain buprenorphine stock, noting that some have issued similar orders for the overdose reversal treatment naloxone and emergency contraception in an effort to improve access.
“If policymakers fail to introduce policies that increase equitable access to buprenorphine at local pharmacies, existing racial and ethnic disparities in opioid use disorder treatment and recovery will likely worsen,” said first author Jenny S. Guadamuz, an assistant professor at the University of California, Berkeley School of Public Health.
About the Study
Sarah Axeen of the USC Schaeffer Center and the Keck School of Medicine of USC is also an author. This study was supported by a grant from the Foundation for Opioid Response Efforts.
Journal
Health Affairs
Article Publication Date
2-Sep-2025
California program successfully scales emergency department addiction treatment statewide
CA Bridge initiative demonstrates emergency rooms can effectively treat opioid use disorder
University of California - Los Angeles Health Sciences
A comprehensive study shows that California's CA Bridge program has successfully implemented opioid use disorder treatment services across more than 80% of the state's emergency departments, reaching over 165,000 patients and providing nearly 45,000 instances of buprenorphine treatment from July 2022 through December 2023 alone. The initiative proves that emergency departments can serve as a critical entry point for addiction care when provided with proper funding, training, and patient navigation support.
Why it matters
The opioid crisis continues to devastate communities across America, with emergency departments treating large numbers of people with opioid use disorder but most health systems failing to provide evidence-based addiction care. Nationally, only 5.7% to 11.5% of emergency department patients with opioid use disorder receive medications for opioid use disorder, life-saving medications that reduce overdose deaths and improve treatment outcomes. CA Bridge represents the largest state-based emergency department addiction treatment initiative in the United States, offering a potential roadmap for nationwide implementation.
What the study did
Researchers analyzed data from 252 California hospitals participating in CA Bridge from July 2022 through December 2023. The program provided hospitals with $120,000 in funding, technical assistance, and training to hire patient navigators, support clinical champions, and establish addiction treatment pathways. Using grant reporting data and California's controlled substances prescribing database, researchers tracked patient navigator encounters, buprenorphine treatments, and subsequent care engagement across rural, urban, public, and private hospitals.
What they found
The program achieved remarkable reach and effectiveness:
- From June 2022 through December 2023 at CA Bridge participating hospitals:
- Patient navigators engaged patients with opioid use disorders in over 165,671 emergency department visits.
- Patient engagement at public hospitals was about 80% higher than public hospitals.
- Provision of buprenorphine treatment at public hospitals was about 50% higher than private hospitals.
- In 2022, across all California EDs:
- 119,271 people received a prescription for buprenorphine for treatment of opioid use disorder, of whom 5,150 people (4.3 percent) received that prescription from an emergency medicine clinician.
- Among the 58,399 people receiving a first-time buprenorphine prescription, 5.3% were started by emergency clinicians.
- There were 1,737 unique emergency clinician prescribers, with nearly 22% new to prescribing buprenorphine.
- About 36% of patients who received an buprenorphine prescription in the emergency department had a follow-up prescription within 40 days.
- Patients received a median 58 days of uninterrupted treatment within one month of receiving a buprenorphine in the emergency department.
What's next
The success of CA Bridge demonstrates that emergency departments can be transformed into effective sites for initiation of addiction treatment and linkage to maintenance care, but researchers emphasize the need for sustainable financing and quality measures to support nationwide dissemination. Future work should focus on understanding implementation strategies used by high-performing sites, developing standardized quality metrics for emergency addiction care, and exploring similar initiatives for other substance use disorders including methamphetamine and alcohol. The program's model could inform national policy discussions about expanding emergency department addiction services.
From the experts
"CA Bridge has helped transform emergency care throughout California to include low-barrier buprenorphine for opioid use disorder. The program has developed a successful model for scaling ED addiction care across diverse practice settings, with high adoption and services provision," said Dr. Elizabeth Samuels, lead author of the study and researcher at UCLA. "EDs are a strategic point of entry into the addiction care system, and our findings demonstrate that with technical assistance, training, and funding, adoption and services provision are high."
About the study
"Increasing Emergency Department Patient Navigation and Buprenorphine Use: A Model for Low-Barrier Treatment." The study appears in the Health Affairs September 2025 issue on "Insights About the Opioid Crisis,” which includes the latest empirical research and policy perspectives, available at https://www.healthaffairs.org/opioids.
About the Research Team
Elizabeth A. Samuels (UCLA), Allison D. Rosen (UCLA), Sarah Abusaa (Public Health Institute), Annette M. Dekker (UCLA), David L. Schriger (UCLA), Steven J. Shoptaw (UCLA), Mariah M. Kalmin (RAND Corporation), Chunqing Lin (UCLA), Serena Clayton (Public Health Institute), Sarah Windels (Public Health Institute), Elizabeth Keating (Public Health Institute), Sherrie Cisneros (Public Health Institute), Arianna Campbell (Public Health Institute), Aimee Moulin (Public Health Institute), Andrew A. Herring (Public Health Institute)
Funding and Disclosures
The authors acknowledge grant support from the California Department of Health Care Services, the California Health Care Foundation, the Public Health Institute, and the National Association of County and City Health Officials. The program cost $40 million from the state general budget, with $36 million distributed to hospitals and $4 million for program administration, training, and monitoring. Authors assume full responsibility for the accuracy of ideas presented, which do not represent the views of supporting institutions.
Journal
Health Affairs
Method of Research
Experimental study
Subject of Research
Not applicable
Article Title
Increasing Emergency Department Patient Navigation and Buprenorphine Use: A Model for Low-Barrier Treatment
Article Publication Date
2-Sep-2025
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