Opioid analgesic policies and prescription drug abuse in state Medicaid programs

Shellie Keast Ph.D., Pharm.D., M.S.

Principal Investigator (subcontract)

Agency: DHHS/CDC (through Oregon State University)


The US is in the midst of an epidemic of prescription drug overdose morbidity and mortality. In 2010, there were more than 38,000 drug overdose deaths in the US, surpassing motor vehicle accidents (33,687) as the number one cause of unintentional death. The number of people dying from opioid analgesic overdose has more than tripled between 1999 and 2008. This decade-long trend in overdose deaths can be attributed largely to comparable growth in the volume of controlled medications prescribed through legitimate medical channels. The adverse consequences of prescription drug abuse are particularly important to state Medicaid programs as individuals enrolled in Medicaid are more likely to have substance abuse disorders and are disproportionately represented among overdose deaths. State Medicaid programs employ a diversity of pharmacy benefits designs and policies aimed at improving utilization and reducing costs. Alternatively, through selective promotion of potentially less safe medications, program administrators may inadvertently implement policies with unintended consequences for patients.

The long-term goal of this project is to identify Medicaid drug benefit design characteristics that can reduce the incidence of prescription drug abuse and its attendant adverse health consequences. In response to RFA-CE-14-002 (Research to Prevent Prescription Drug Overdoses), the objective of this proposal is to quantify the variation in state Medicaid drug policies for prescription drugs of abuse and determine their impact on inappropriate or risky utilization and adverse outcomes. To accomplish this objective, we will develop a multi-state collaborative of three Medicaid programs (Oregon, Colorado, Oklahoma) to evaluate longitudinal changes in opioid-related drug policy, utilization, and relevant outcomes.