Importance: Medicaid programs have expanded coverage of substance use disorder treatment and undertaken many other initiatives to reduce drug overdoses among beneficiaries. However, to date, no information has been published that tracks overdose deaths among the Medicaid population.
Objective: To determine the rate of drug overdose among Medicaid beneficiaries.
Design, setting, and participants: In this cross-sectional study, US Centers for Medicare & Medicaid Services data from 2016 to 2020 that linked enrollment and demographic data from all Medicaid beneficiaries in the US with the US Centers for Disease Control and Prevention National Death Index were used to determine the rate of drug overdose death among Medicaid beneficiaries. The Medicaid population rates were compared with those of the total US population, overall and by age and sex.
Exposure: Participation in the Medicaid program.
Main outcome: Death of a drug overdose.
Results: In 2020, the drug overdose death rate among Medicaid beneficiaries was 54.6 per 100 000, a rate that was twice as high as the drug overdose rate among all US residents (27.9 per 100 000). In 2020, Medicaid beneficiaries comprised 25.0% of the US population but 48% of all overdose deaths (44 277 of 91 783). For each age and sex group older than 15 years, overdose deaths were higher for the Medicaid population than for the US population, with the greatest difference occurring among adults ages 45 to 64 years. From 2016 to 2020, Medicaid overdose deaths increased by 54%.
Conclusions and relevance: The results of this study suggest that more research is needed to understand why Medicaid beneficiaries have higher rates of drug overdoses than all US residents. Additionally, research is needed to understand how best to prevent overdoses among Medicaid beneficiaries. The federal government should support these efforts by routinely linking Medicaid claims and enrollment data to death records.
Importance: Concerns around excessive opioid prescribing have been used to argue against the expansion of the scope of practice of nurse practitioners (NPs), but the association of NP practice independence with high-risk opioid prescribing is not well understood.
Objective: To assess whether the rates of high-risk opioid prescribing changed in association with NP independence legislation.
Design, setting, and participants: This difference-in-differences analysis compared rates of high-risk opioid prescribing in 6 states over 2 years following the adoption of NP independence compared with 10 neighboring nonadopting states from January 2012 to December 2021. Prescription insurance claims for 2 874 213 continuously enrolled individuals (members) aged 18 to 64 years from Blue Cross Blue Shield Axis were analyzed. Data analysis was carried out from 2021 to 2024.
Exposure: Timing of the legislative effective date of NP independence in a state.
Main outcomes and measures: The primary outcome was the rate of opioid prescriptions that overlapped with a prescription for a central nervous system (CNS) depressant. Secondary outcomes included the number of days of opioid-CNS depressant overlap, as well as the dosage and days supplied of opioids among all members and among opioid-naive members.
Results: Six states that adopted NP independence legislation and 10 nonadopting neighboring states were similar in terms of demographic characteristics and had comparable pretrends in prescribing. The estimated change in the rate of opioid prescriptions that overlapped with a CNS depressant was -0.03 per 100 members per month (95% CI, -0.11 to 0.05). Changes in the number of days of opioid-CNS depressant overlap and in the dosage and days supplied of opioids among all members and among opioid-naive members were also small and statistically insignificant.
Conclusions and relevance: The results of this difference-in-differences analysis suggest that there was no relative increase in rates of high-risk opioid prescribing during the 2 years following the adoption of independence for NPs.
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