Medicaid Expansion Associated with Fewer Fatal Opioid Overdoses

Medicaid expansion could be credited with saving the lives of thousands from opioid overdoses, researchers assert in a new study.

In fact, states that adopted Medicaid expansion between 2014 and 2016 recorded fewer opioid-related deaths than states that did not, according to results published by JAMA Network Open.

Medicaid expansion was born out of the Affordable Care Act. It allows states to expand Medicaid eligibility to uninsured people with incomes up to 138% of the federal poverty level. Additionally, it guarantees mental health and substance abuse coverage to those individuals.


To reach their findings, researchers looked at population statistics initially gathered by demographic data company GeoLytics. Specifically, they examined socio-demographic data of individuals living in 3,109 counties across 49 states and the District of Columbia from 2001 to 2017. (Alaska was not included in the study.)

Authors of the study then cross-referenced those findings with state Medicaid expansion data obtained from the Kaiser Family Foundation.

In doing so, they found that opioid death rates were 6% lower in states that had adopted Medicaid expansion.


Counties in Medicaid-expanded states had an 11% lower death rate by heroin overdoses than counties in non-expanded states. Additionally, overdose deaths from synthetic opioids such as fentanyl were 10% lower in counties within Medicaid-expanded states. However, those same counties saw 11% more methadone-related overdose fatalities than counties in states that had not expanded Medicaid.

A total of 383,091 opioid-related deaths occurred during the study’s time period.

When taking all drugs into account — not just opioids — counties in Medicaid-expanded states recorded a 2% lower rate of total overdose fatalities than counties in non-expansion states.

Researchers concluded that the expansion of Medicaid in 32 states and D.C. between 2014 and 2016 may have saved anywhere between 1,678 and 8,132 lives between 2015 to 2017.

However, the authors qualified their findings, noting several limitations.

For example, they acknowledged the study only focused on associations (rather than perhaps an obvious, cause-and-effect relationship) between Medicaid expansion and overdose deaths. They went on to encourage future research that might establish a clear-cut link between Medicaid expansion and the risk of opioid overdose.

“These findings add to the emerging body of evidence that Medicaid expansion under the ACA may be a critical component of state efforts to address the continuing opioid overdose epidemic in the United States,” the authors noted in the study. “As states invest more resources in such efforts, attention should be paid to the role that health coverage expansions can play in reducing opioid overdose mortality, potentially through greater access to [medications for opioid use disorders].”

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