Medicaid expansion and opioid supply policies
Publication id: shakya-2022-medicaid-expansion-opioid-supply
Status: verified
Citation: Shakya, S., & Harrish, S. (2022). Medicaid expansion and opioid supply policies to address the opioid crisis. Drug and Alcohol Dependence Reports. Download PDF
Facts¶
Policy hook¶
The opioid crisis has a demand side (addiction, treatment access) and a supply side (overprescribing, drug availability). Policymakers use both: Medicaid expansion increases treatment access, while pain management clinic laws restrict oversupply. The question is whether these demand-side and supply-side policies work together, and which combination most effectively addresses opioid mortality.
Main finding¶
Mix of Medicaid expansion and pain management clinic laws could balance limiting opioid prescription oversupply while improving access to opioid use disorder (OUD) treatment. States with both policies (Kentucky, Ohio, West Virginia, Louisiana) show potential for coordinated impact. Must-access PDMPs and pain management clinic laws are associated with reduced opioid prescribing and overdose deaths; Medicaid expansion increases buprenorphine availability for treatment.
Data and setting¶
CDC data on retail opioid prescriptions dispensed per 100 persons (2006–2017) and buprenorphine distributions per 100,000 persons. Multiple states with varying pain management clinic law implementations (Louisiana 2006, Texas/Wisconsin 2009, Ohio/Mississippi/Kentucky/Florida 2011, Tennessee 2012, Georgia/Alabama 2013, West Virginia 2014). Four states enacted both Medicaid expansion and pain management clinic laws after 2014.
Research design (plain language)¶
Difference-in-differences framework examining impacts of three treatment variables: (1) Medicaid expansion, (2) pain management clinic laws, (3) interaction of both. Dependent variables: retail opioid prescriptions per 100 persons and buprenorphine distributions per 100,000 persons. Controls for other opioid policies (must-access PDMPs, Good Samaritan laws, naloxone access) and socioeconomic variables (poverty, unemployment).
One caveat¶
Complex interaction between demand-side and supply-side policies requires careful timing; confounding by multiple concurrent opioid-related policies makes isolating specific policy effects difficult. Buprenorphine distributions may not fully capture treatment access. Different implementation dates across states complicate causal attribution.
PDF or DOI¶
Why it matters¶
The opioid crisis requires both supply and demand solutions. This paper suggests they work best together. Pain management clinic laws alone restrict supply but may worsen inequality if they deny medication to patients with legitimate pain. Medicaid expansion alone increases treatment but doesn’t address overprescribing. The synergy—restricting inappropriate supply while expanding access to evidence-based treatment—offers a more balanced approach. For policymakers in high-overdose states, the finding supports comprehensive policy packages rather than betting on a single lever. For Southern and Appalachian states where both opioid prescribing and treatment gaps are severe, the paper provides evidence that coordinated demand-and-supply policies can address both sides of the crisis. The emphasis on policy complementarities also suggests that state-level variation in outcomes may reflect not which policies exist but how well they’re coordinated—a valuable insight for policy evaluation and state learning.