Millions of Opioid Addicts Not Getting Home Treatment: For Journalists

  • First study to fully compare residential care use among Medicaid participants across several states
  • 14.9 million people live in 9 states (20% of all Medicaid enrollees).

CHICAGO — Approximately 7 million adults in the United States have an opioid use disorder (OUD). But a new Northwestern Medicine study that measured the use of residential care among Medicaid participants in nine states found that only 7% of her OUD enrollees received residential care.

“Given the worsening opioid crisis, that number seems low,” said corresponding author Lindsey Allen, a health economist and assistant professor of emergency medicine at Northwestern University Feinberg School of Medicine. “We are probably leaving millions of people with effective treatments.”

Additionally, the study found that usage rates varied widely across the nine states, with some states providing residential care to only 0.3% of Medicaid participants, while others provided up to 14.6%. was offering Differences in utilization rates can be attributed to differences in insurance coverage, facility supply, and state population characteristics by state, Allen said.

“It’s disconcerting that these rates fluctuate so dramatically,” Allen said. “We don’t know the ‘exact’ number of people who need home care, but it is clearly higher than the actual number.”

The findings were published April 12 in the Journal of Substance Use and Addiction Treatment. The results of this large nine-state study add context to the ongoing national debate on OUD treatment and policy and provide a baseline for future research.

“One of the Best Treatments for Heavy Substance Use”

Residential treatment centers are 24-hour residential facilities (sometimes called “rehabilitation”) that provide structured support. This includes individual and/or group therapy and pharmacotherapy for opioid use disorders such as methadone and buprenorphine.

“Home treatment is one of the best treatments for severe drug users, as long as it is evidence-based,” Allen said. It helps, saves lives in the long run, and reduces the need for costly medical care.”

Prior to this paper, researchers had difficulty making side-by-side comparisons of treatment use across states due to differences in residential treatment definitions and reimbursement among state Medicaid programs. This is the first study to fully compare the number of OUD Medicaid participants receiving home care in several states. Scientists used a decentralized research network that standardizes Medicaid data for nine states.

Why State Medicaid Data Matters in OUD Care

Medicaid provides health insurance to low-income individuals and is one of the largest health care payers in the United States. As more Medicaid agencies begin to cover residential OUD treatments, it is important to capture the use of residential OUD treatments across state Medicaid populations for benchmarking purposes. It helps guide policy decisions, Allen said.

Since Medicaid is a state-run program, plans to increase residential care rates are up to the states themselves. However, there are some federal mechanisms (such as Section 1115 waivers) that states can use to reimburse treatment costs (and in some cases receive federal funding), Allen said.

The nine states that participated in the study—Delaware, Kentucky, Maryland, Michigan, North Carolina, Ohio, Pennsylvania, Virginia, and West Virginia—represented 14.9 million people (20% of all Medicaid enrollees). Results from each state were anonymized due to confidentiality agreements with state partners.

Funding for this study was provided by the National Institutes of Health’s National Institute on Substance Abuse (Grant 5R01DA048029).

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