The study highlights Medicaid’s critical role in supporting addiction treatment and urges policy actions to expand take-home methadone doses and reduce clinic visit barriers to improve access and reduce overdose deaths.

Policy implications stress maintaining and expanding Medicaid access, alongside reforms like increasing take-home methadone and lowering visit barriers to initiate and sustain treatment.

Across racial groups, Black and Hispanic patients had lower odds of starting treatment within 180 days compared with White patients, highlighting persistent disparities in OUD medication access under Medicaid.

The study assessed methadone, buprenorphine, and naltrexone, finding methadone and buprenorphine linked to lower overdose risk than naltrexone, with only about 31% of treated individuals receiving medication and notable early overdose incidents among those treated.

Differential overdose outcomes emerged across the three FDA-approved OUD meds, with methadone and buprenorphine associated with lower overdose rates than naltrexone.

Methadone and buprenorphine significantly reduced overdose risk compared with no medication, and methadone offered the greatest risk reduction among the meds studied.

Over a four-year period, treatment within 180 days modestly improved from 27% to 34%, signaling only partial progress and ongoing barriers to timely care.

Black patients were about one-third less likely than White patients to receive methadone or other OUD medications within 180 days, with Hispanic patients also facing disparities, underscoring racial gaps in access within Medicaid.

In a large study of 1.17 million Medicaid enrollees diagnosed with OUD between 2016 and 2019, about 69% did not receive any OUD medication within 180 days, revealing a substantial gap in timely treatment.

The findings come as Medicaid funding debates intensify, with potential cuts that could further restrict access to medications for OUD during a period of rising overdose deaths.

Lead author emphasizes expanding medication use for OUD and reducing dropout by improving access, particularly expanding methadone access due to its strong protective effect against overdose.