Managed Healthcare Executive: Deep Medicaid cuts could make opioid epidemic worse, UMass Medical School expert warns

May 12, 2017

States could wind up dealing with “massive” damage if there are deep cuts in federal health funding that helps pay for opioid addiction treatment, UMass Medical School’s Tyson Thompson, PharmD, tells Managed Healthcare Executive.

Thompson and Kimberly Lenz, PharmD, clinical pharmacy manager in UMass Medical School's Office of Clinical Affairs, discussed the most pressing issues surrounding opioid use and misuse with Managed Healthcare Executive for the story, “14 things Trump needs to know about opioids.”

Major health care reform now being debated in Washington could force states to reduce the number of residents enrolled in their federally-subsidized Medicaid programs.

And those dropped from Medicaid programs would in turn lose access to a range of services, including addiction treatment, warns Thompson, a clinical consultant pharmacist in UMass Medical School’s Clinical Pharmacy Services.

The American Health Care Act, passed by the House and now being reviewed in the Senate, would put an end to Medicaid expansion starting in 2020, potentially ending health coverage for millions of people around the country.

Those cuts would have a devastating impact on efforts to battle opioid addiction, with Medicaid enrollees including a “disproportionate share of individuals affected by SUD (substance abuse disorder),” Thompson tells the magazine.

While addiction programs can be costly, cutting off access to treatment for those struggling with opioid abuse would trigger a far greater drain on public resources over the long-term, he says.

The “loss of coverage or funding for treatment of these individuals is likely to worsen the opioid abuse epidemic,” Thompson notes. “It is worth the cost to keep Medicaid patients in treatment for SUD from both a humanistic and pragmatic point of view.”

In addition to considering the impact of Medicaid cuts, consideration needs to be given to increasing access to state prescription drug monitoring programs (PDMP), Lenz says. This can help insurers, including Medicaid, monitor for fraud, waste and abuse as well as ensure coordination of care.

“Very few states have granted insurers access to the PDMP,” Lenz notes. “Washington State gave their Medicaid program access and noted several benefits, including, better treatment outcomes, better coordination of care, and reduction in costs by a reduction in medically unnecessary prescription drug use and diversion.” 

Thompson also points out the importance of expanding treatment in correctional facilities for substance abuse disorders. This should include both medication assisted treatment (MAT) and behavioral health programs, such as various forms of counseling, he says.

In many state and county correctional systems, prisoners grappling with addiction issues receive no treatment. However, by providing treatment to the incarcerated — many of whom are serving out sentences for drug-related crimes — states can reduce recidivism rates and save money that would otherwise be spent on courts and jails, Thompson notes.

UMass Medical School is currently taking part in a collaborative that is studying the use of MAT in four New England correctional systems.

“In far too many correctional health facilities, patients who would want or benefit from MAT and behavioral health interventions are not treated while incarcerated,” Thompson tells the magazine. “This population is a captivated audience and could benefit significantly from interventions offered.”

The Trump administration and Congress also need to look at ways to close the gaps in the current treatment system that can cause patients with SUD to relapse.

“Far too often, patients fail to transition from an acute care setting to a step-down program or outpatient program,” Lenz tells the magazine. “This failure to transition can put the patients at an increased risk of relapse.”

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