Policy Implications

State efforts to counter the surge in drug overdose deaths include improving access to life-saving opioid overdose reversal medications such as Naloxone, passing legislation that sets guidelines or limits for opioid prescriptions, and implementing Medicaid health home models that offer integrated services to treat and address the needs of patients with opioid use disorder. But there is still much more work to do in both preventing and treating addictions, and in responding more effectively to overdoses.

This will require better access to addiction services. In 2016, only about 10.6 percent of adolescents and adults who needed substance use treatment received it that year at a specialty facility such as hospital or drug or alcohol rehabilitation center, where staff are prepared to provide ongoing addiction treatment. (Most primary care practices are not currently equipped to treat addiction.) The increase in rates of deaths from suicides highlight the need for greater access to mental health services for severely depressed and suicidal patients. As the 2018 Scorecard reported, fewer than half of U.S. adults with symptoms of a mental illness — some of whom may not have been diagnosed — received treatment in the past 12 months, based on combined 2013 and 2015 National Survey of Drug Use and Health data.

The situation would be worse without the Affordable Care Act, which made mental health and substance use treatment an essential health benefit that most insurance plans must cover. In states that choose to expand Medicaid, the program covers these benefits for newly eligible enrollees. For example, in Kentucky, which expanded Medicaid in January 2014, the number of treatment services for substance use for Medicaid expansion enrollees climbed from about 1,500 in the first quarter of 2014 to more than 11,000 by the second quarter of 2016. And in Kentucky, as well as several other expansion states including West Virginia and Ohio, Medicaid pays for between a third and half of prescriptions for medication-assisted therapies that combat opioid use disorders.3

One state that has developed a successful strategy for expanding access to opioid addiction treatment is Vermont. To reduce long waiting lists for treatment at specialty facilities, Vermont launched the “Hub-and-Spoke” model in 2013. In Vermont’s approach, nine specialized drug treatment centers (the “hubs”) serve the most clinically complex patients, while more than 75 local primary care offices (the “spokes”) provide medication-assisted treatment to less complex patients.4 From the program’s inception through March 2017, the number of providers in the state willing to offer medication-assisted treatment for addiction nearly doubled, from 114 to 196. The model has shown sufficient enough promise that California and Pennsylvania are replicating it.

The recently passed House bill aims to further help states by freeing up Medicaid funds to cover opioid addiction treatment at more in-patient facilities, expanding access to medication-assisted therapies, and promoting the use of nonopioid painkillers. Yet reversing the upward trend in deaths of despair will likely require even greater cooperation and engagement, not only among policymakers but across sectors, including the health system, social service sector, and the criminal justice system.