NEW RESEARCH: LETHAL OUTCOMES AS PREDICTED FOR MEDICAID FUNDED MEDICAL OPIOID TREATMENTS
Examined, the study replicates results of recent NIH megastudy: a worsening crisis driven by increased provision of gold standard medical opioid cures while community Narcan campaigns hide lethal effects
by Clark Miller
Published January 10 , 2025
The study, published here, compared over the years 2015 to 2020 outcomes for states with Medicaid enrollees who were identified as having an opioid use disorder (OUD) and newly able to access standard medical treatments (substitute opioid provision of methadone or buprenorphine, “Suboxone” = medication assisted treatment (MAT) or medication for opioid use disorder, (MOUD) with treatment engagement and nonfatal opioid overdoses as outcome measures, 17 such states selected and compared to 18 states not using the Affordable Care Act (ACA) waiver to allow such use of Medicaid funds.
Some valuable background, from here –
The study, published this month in Health Affairs, comes as Oregon is fighting an epidemic of opioid overdoses driven by illicit fentanyl use. On a national level, the study scrutinizes a 2015 change made to Medicaid, which provides health care to nearly 80 million low-income people nationwide. That federal change allowed states to seek a waiver so large institutions can provide Medicaid-funded addiction treatment.
That change, made in response to rising overdoses, marked a shift in decades of federal policy dating back to the 1960s that prohibited funding addiction treatment in residential facilities with more than 16 beds. But the change that opened up a flow of money to larger institutions has not been enough to combat overdoses, the study found. …
The study looked at 17 states that participated in the waivers that allowed the larger institutions to treat addiction from 2017 to 2019 and compared their outcomes to 18 states that did not. In all, the study included about 1.7 million people on Medicaid who’d been diagnosed with an opioid addiction, and about two-thirds of them lived in states with waivers.
Those 17 states with the waivers are: Alaska, Delaware, Indiana, Kansas, Kentucky, Louisiana, Michigan, New Hampshire, Nebraska, New Jersey, New Mexico, Pennsylvania, Ohio, Virginia, Washington, West Virginia and Wisconsin. …
The federal government started that waiver to increase access to methadone and other medication treatments for opioid addiction that are used to prevent withdrawal symptoms for people after they stop using the drugs.
The researchers looked at outcomes in states with the waiver and found only modest increases in medication for people enrolled in Medicaid.
The use of methadone, considered the gold standard in treating opioid addiction, increased by 2.3 percentage points with coverage changes, with about 7,300 more people every three months taking the medication in states with the waiver.
And providers increased the use of all opioid treatment medications for people on Medicaid with a severe addiction by 3.7 percentage points – a jump of 4,000 more people in an average three-month period in states with the waiver. They included people on Medicaid with a severe addiction who stayed in a hospital or residential facility.
Let’s summarize and clarify
As reported in the research article and in the media account, in the states using waivers to expand medical substitute opioid dispensing, there were in fact statistically significant increases in provision of both methadone and of methadone or Suboxone (buprenorphine) for enrollees who accessed inpatient or residential treatment for OUD.
The headlines, anomalously, are accurate: not claiming that in the Medicaid expansion states there were no increases in use of substitute opioids methadone and Suboxone – those increased by “about 7,300 more people every three months taking the medication in states with the waiver” for methadone and by “a jump of 4,000 more people” for methadone or Suboxone – headlines sticking to the accurate outcome that despite those significant gains there were no benefits for opioid nonfatal overdoses.
We know why (and here) those predicted outcomes were found – we’ll get to that.
The lies, driven by a desperate need to equivocate, came in more carefully composed form, as in the original research report noting that although there were no benefits in overdose reductions or deaths, “However, they may have moderately improved the use of medication treatment for those with severe OUD”.
There is no “may have” – the differences were statistically significant, again: “about 7,300 more people every three months taking the medication in states with the waiver” for methadone and by “a jump of 4,000 more people” for methadone or Suboxone.
We’ll get to that too.
First, more important background, from this January 2024 post, excerpts below –
Their key findings –
And a graphic illustrating trends for expansion along with opioid overdose incidence for one state pre- and over pandemic years –
It’s important to affirm, as reported widely, that a primary and successful desired outcome of Medicaid expansion has been to increase enrollment of individuals trapped in compulsive opioid use and the crisis on the rationale that state insurance paying for increased access to America’s gold standard, proven treatments for opioid use disorder (OUD) including medications for OUD (MOUD) would benefit them and predict gains against the lethal crisis.
Our nationwide, population-based study found no evidence that Medicaid Expansion reduced OORM rates among people with lower education attainment. This more refined model does not corroborate previous empirical studies reporting either positive or negative associations between Medicaid expansion and OORM rates . . .
Our capacity to directly compare our results with past evidence, however, is limited, since to improve the rigor we narrowed analyses to less educated individuals to approximate the low-income population eligible for Medicaid; adjusted the outcome for unreported opioid overdoses; and controlled for the percentage of fatal overdoses from synthetic opioids including fentanyl.
[emphasis added]
Similarly, in STAT, citing CDC reports, the Medicaid lethal overdose effects are longstanding, and in one study the largest percentage of deaths were tied to the “miracle molecule” prescribed MAT drug methadone compared to other prescribed opiods –
Research indicates that Medicaid beneficiaries are prescribed opioids at twice the rate of the rest of the population, and are at three-to-six times greater risk of a fatal overdose.
Back to our current post
What could possibly be wrong with this picture, these outcomes? Is it simply a mystery?
We have it, after all, from our institutions most trustingly charged with and responsible for providing accurate information to protect the public health and safety – media and public health institutions – that a clear consensus for decades has established that medical provision of those substitute opioids saves lives, so well established that safety standards have been relaxed. Now new federal legislation will relax standards further to allow more of the “miracle” medications to be dispensed to diseased brains. So soundly are the medications established as effective, that a unified expert consensus holds after decades of climbing deaths while increasing doses have been dispensed, top experts understanding that,“From a scientific standpoint, we all think these two medicines are incredibly effective,” Potee said. “We consider them to be miracle molecules.”
So, that’s that. It goes without saying.
Maybe more background will help, more information.
For 6 of the waiver states in the study, we have readily available relevant information that will help clarify these outcomes including 2 NIH HEAL study states Ohio and Kentucky, as well as
West Virginia, and
Indiana (upcoming post)
Let’s take a look.
In the NIH HEAL study states Kentucky and Ohio, data, direct reports, and trends provide a clear picture of a pattern consistently found in additional states and locales examined, including (in addition to Pennsylvania, Michigan, West Virginia and Indiana) –
In those locales consistently:
1) Intensive, intensively funded, community-based, targeted, successful campaigns to distribute Narcan and naloxone kits to laypersons, with trainings, have resulted in hundreds of thousands to millions of units distributed in each of those locales and year-to-year increases in Narcan reversals of potentially lethal opioid overdoses by hundreds to thousands each year, increases each year.
2) Many or most of the community reversals are not reported formally or in any case do not become part of a medical or institutional dataset of the type mined for academic/ scientific studies, explained and evidenced here.
3) As described here, as Narcan reversals of otherwise fatal opioid overdoses surge, as widely reported in community settings, more and more nonfatal overdoses go unreported or in any case not formally or in an organized way collected so that they contribute to accurate estimates and are included in tracking of nonfatal overdoses in media accounts, research papers, and for example, county or state opioid dashboards.
Meaning, opioid overdoses are being significantly, grossly underreported and their real incidence unrecognized. Meaning, incidence of high-risk opioid use is being significantly under-estimated. That is, the meaning of outcome measures and severity of the epidemic are being distorted in ways that hide its worsening course.
What about for the Medicaid study we’re considering here that found that provision of the “miracle molecule” methadone as well as buprenorphine increased in the intervention states, including for those with more severe OUD, most likely to benefit from it?
That necessarily predicts gains in reduction of high-risk opioid use and nonfatal overdose, reduction in high-risk opioid use the only means by which substitute opioid provision can have therapeutic, life-saving effect.
But there was no such gain in “waiver” states in the study despite significantly increased provision of the “proven”, life-saving cures.
Wait, that’s a lie.
It’s not that there were no differences. We know that over the time period of the study there were persistent increases in incidence of nonfatal opioid overdoses – a direct measure of high-risk opioid use, thus of severity of the crisis and of gold standard treatment failure – and that those nonfatal overdoses were being increasingly, grossly undercounted.
We know that because consistently, in all states and locales providing information (in posts linked to in the lists above), professionals and others directly involved in services to high-risk opioid users including dramatically surging campaigns to saturate communities with potentially fatal opioid OD reversing naloxone report that those reversals are occurring in communities and not reported, while accordingly EMS responses and ED visits for nonfatal ODs are decreasing precisely due to the shift to community saves.
Each incidence of a Narcan reversal including those not reported represents a nonfatal overdose and an incidence of high-risk opioid use.
Look at the numbers and direct reports from the states, programs and communities linked to above. Those unreported nonfatal overdoses have been increasing by hundreds and thousands year-by-year as measured by dramatic year-by-year increases in unreported community Narcan saves.
In the new study we’re considering here, how were “nonfatal overdoses” identified and quantified in those Medicaid states with increased provision of gold-standard treatments? Strictly by use of Medicaid medical data sets, including an overdose only if it resulted in medical attention.
That is to say, the study in question has replicated the revelatory massive NIH study that also reaffirms the obvious: while a lethal opioid crisis worsens, dramatic, community based, successful Narcan campaigns are hiding evidence for the persistent lethality of American experts’ gold standard treatments for it, are serving as harm reduction against its effects.
That conclusion is inescapable, incontrovertible, and was predicted all along.
It turns out, as explained and established here in multiple posts, that precisely as in the avoidable – avoidable if not for the cowardice and gross incompetence of American Media – generation of the opioid crisis as we know it enabled by fabrications by America’s medical/research/media collusion, there has never, not ever, been a legitimate body of research evidence to confidently establish, let alone strongly support, the use of substitute opioids (bupe or methadone) as treatments or as beneficial for opioid dependence.
Instead, all lines of diverse evidence point to what should be obvious – the runaway dispensing of opioids that are routinely used with other, illicit opioids (methadone), and/or serve as consumable, commodity and currency in street economies of illicit high-risk opioid use (bupe) have in fact fueled the lethal epidemic.
The most potent ways in which the “miracle” doctor-dispensed pills and other magic potions predict failure is to instill in compulsive substance users the belief that passive interventions to adjust brain chemistry are “treatments”, are addressing a generic neurobiological block or deficit or disease of the brain that explains addiction, instead lethally instilling passivity, dependence and lies, and robbing compulsive substance users of the necessary factor established as central to stopping problem use, self-efficacy, the shift to belief in one’s own competence, autonomy, strength, and effective use of resources with inner psychological change to do away with the compulsion to escape distressing inner states by use of chemicals.
Treating entirely non-medical conditions with medical cures seems to be a reliable predictor of lethal epidemic.
“Crisis is a necessary condition for a questioning of doxa, but is not in itself a sufficient condition for the production of a critical discourse.”
– Pierre Bourdieu Outline of a Theory of Practice (1972)
In Bourdieu’s Theory of Practice, heterodoxy is dissent, challenge to what “goes without saying” – the accepted, constructed doxa, “knowledge”, reality, that goes without saying precisely because it “comes without saying”, without real scrutiny, untested, unquestioned. The function of doxa is not knowledge or truth or promotion of the collective good, but to protect and serve the interests of those with the power, the cultural capital, to create it.
