A review of state responses to the opioid epidemic shows that those who expanded their public health insurance to low-income adults are leading the way in expanding comprehensive treatment for substance use disorder.

The American Medical Association and consultants from Manatt Health analyzed what laws and efforts Colorado, Mississippi, North Carolina and Pennsylvania have implemented in recent years to increase access to evidence-based treatment for people with substance use disorder or chronic pain as well as to prevent overdose and end the epidemic. From this analysis, published Tuesday, they created a national "road map" for how states and communities can better tackle the public health emergency.

"There is no one solution; there are many solutions, and even solutions need to be nuanced because there are no one-size-fits-all solutions," Dr. Patrice Harris, president of the American Medical Association, said at a roundtable discussion in Washington on the report. "But we do know that despite this continued epidemic, there is progress, and there are best practices happening in states."

Among the progress, the report noted that the "growing practice among Medicaid agencies of reducing prior authorization requirements for (medication-assisted treatment)," as observed in Colorado, North Carolina and Pennsylvania, enabled more patients to enter substance use disorder treatment without delay. This initiative is now being pursued by state insurance commissioners and other state leaders, notably in Pennsylvania, to "remove administrative barriers to MAT."

"States that have expanded Medicaid coverage to low-income adults are, at baseline level, far ahead of those that have not expanded in terms of addressing this epidemic," the report said. "We urge all states to expand their Medicaid programs as allowed under the Affordable Care Act as a key step in addressing the epidemic."

Of the states analyzed in the AMA report, Colorado and Pennsylvania have expanded their Medicaid programs while North Carolina and Mississippi have not. So far, 36 states and the District of Columbia have passed or enacted laws for Medicaid expansion while 14 states, primarily located in the Southeastern and Midwest U.S., have not, according to the Kaiser Family Foundation.

Jocelyn Guyer, managing director of Manatt Health, said at the roundtable discussion that "without expansion, you're missing a fundamental tool that could help address the epidemic."

"We are seeing states to some extent – in some jurisdictions in Pennsylvania, in Missouri – that are saying, 'We are unable to reimburse you and pay you with Medicaid funds if you are not practicing the gold-standard expectation of providing medication-assisted treatment, or at least connecting people with medication-assisted treatment,'" she said. In addition, "Medicaid has been leading the way in some of the states by making sure that they're doing a comprehensive review of their benefit package to ensure coverage of the full array of options that may be helpful to physicians in addressing pain in the absence of opioids."

Two out of three drug overdose deaths involve an opioid, according to the Centers for Disease Control and Prevention.

The report also laid out areas in which state regulators, policymakers and stakeholders could take action:

