A groundbreaking study from Boston University School of Public Health (BUSPH) and Emory University Rollins School of Public Health has provided robust evidence refuting claims that extending state Medicaid coverage increases the misuse of prescription opioids and benzodiazepines among vulnerable populations. The study, published in the Journal of Substance Use and Addiction Treatment, analyzed federal health data collected in 2012, 2015, and 2018 from nearly 20,000 low-income individuals who inject drugs across 13 states. The findings challenge earlier narratives that linked Medicaid expansion with the opioid crisis.

The research specifically targeted a clinically and socially vulnerable group—people who inject drugs and live below 138 percent of the federal poverty line. Despite longstanding concerns that increased access to Medicaid might lead to higher levels of non-prescribed opioid and benzodiazepine use, the study found no association between expanded Medicaid coverage and misuse of these medications. Instead, the data indicate that Medicaid expansion offers a critical gateway to life-saving health services for a population that faces elevated risks of HIV, tuberculosis, and overdose.

“Our findings provide strong empirical data that indicate there is no link between Medicaid expansion and non-prescribed use of opioids and benzodiazepines,” says study lead and corresponding author Dr. Danielle Haley, assistant professor of community health sciences at BUSPH. “This insight allows us to focus on what we do know from the literature about Medicaid expansion—that there are potential life-saving benefits for people who use drugs.” This clear statement from Dr. Haley underscores the importance of basing policy decisions on verified data rather than unfounded assumptions.

The study meticulously accounted for a range of state-level and individual factors, including race, health status, income, employment, and access to drug monitoring programs. By controlling for these variables, the researchers demonstrated that the feared “spillover” effects of Medicaid expansion on prescription drug misuse simply do not exist. Instead, the expansion appears to fulfill a critical need by ensuring that low-income people who inject drugs have access to essential medical care.

Dr. Haley further elaborates on the context, stating, “The timing of the opioid overdose crisis far predates the expansion of Medicaid, which began in 2014 under the Affordable Care Act. What has really driven overdose deaths over the last several years are synthetic opioids, such as fentanyl. We need to support policies that ensure individuals have access to appropriate pain medication while advancing best practices for prescribing these drugs.” Her remarks highlight that while policy debates continue over opioid prescribing practices, Medicaid expansion itself is not the culprit behind increased misuse.

Moreover, the study’s results have significant implications for policymakers. As debates persist in Congress regarding potential cuts to Medicaid funding, the evidence suggests that reducing coverage could leave millions without access to critical health services. Dr. Haley emphasizes, “FDA-approved medications for opioid use disorder are very effective in treating opioid use disorder, and also reducing overdose, Dr. Haley says. ‘There are multiple issues that still need to be addressed, but having health insurance is a critical gateway for people to access these life-saving services. It is important to address the barriers that Medicaid enrollees who inject drugs encounter in actually receiving the treatment and services their insurance provides.’”

This research not only refutes previous concerns but also reinforces the vital role of Medicaid in supporting public health. It serves as a timely reminder that evidence-based policy decisions can lead to improved health outcomes and reduced structural inequities in society.