Medication Use Up for OUD as Diagnoses Decline Among Medicaid Beneficiaries

Although total Medicaid beneficiaries with opioid use disorder (OUD) have declined since 2019, the percentage of patients receiving medications for OUD (MOUD) has increased, according to a new study published in JAMA Network Open.¹

Approximately 73,690 Americans died from drug overdoses in the 12 months leading up to April 2025, and nearly 70% of them involved opioids. Yet, despite the significant decline over the last 2 decades, opioid overdoses are still a major public health concern and the leading cause of preventable death in the US. Aside from expanding access to MOUD for patients with OUD, the CDC published opioid prescribing guidelines for clinicians in 2016 and updated them in 2022 to further help manage the crisis. Honing in on Medicaid beneficiaries can also help address the problem. Although they only represent 25% of the population, they made up 48% of overdose-related deaths in 2020, and since 2014, the number of Medicaid beneficiaries receiving MOUD has been steadily increasing.^1,2

Understanding how OUD diagnoses and receipt of MOUD change over time and vary by state can help inform policies that may expand access, ease prescribing restrictions, and target states with disproportionate treatment rates.

The study authors used Transformed Medicaid Statistical Information System Files (TAF) data for July 2018 to December 2023. The study population consisted of Medicaid beneficiaries aged 18 to 64 years who were not dual-enrolled in Medicare. Using these data, they measure OUD diagnosis, receipt of MOUD, continued MOUD for 180 days, or OUD-related hospitalization or emergency department (ED) visit.

The study included 126,430,422 beneficiary measurement year observations in 47 states and the District of Columbia. Among beneficiaries, 59.5% tp 61.2% were female. Approximately half were 35 years or older. The majority of beneficiaries included were White (41.9%-46.5%) compared with American Indian or Alaska Native (1.7%-1.9%), Asian (4.8%-5.3%), Black (20.1%-21.1%), Hispanic (24.5%-28.5%), Native Hawaiian or Pacific Islander (0.6%-1.2%), multiracial (0.2%-0.9%), and other races and ethnicities (0%-0.9%).

The percentage of Medicaid beneficiaries diagnosed with OUD decreased from 4.2% (n = 738,060) in 2019 to 3.6% (n = 1,046,075) in 2023. Delaware, Massachusetts, and Maryland had the largest percentage-point (PP) decline, whereas West Virginia, North Dakota, and Kentucky had the largest PP increase.

In the 47 states plus the District of Columbia, the combined percentage of beneficiaries diagnosed with OUD and who received MOUD increased from 60.0% (n = 443,010 of 738,060) in 2019 to 69.1% (n = 723,177 of 1,046,075) in 2023. At the end of 2023, the states with the highest percentage of MOUD recipients were Vermont (87.1%), Rhode Island (85.7%), and Maine (85.1%), and the lowest percentages were in Georgia (44.1%), Texas (45.2%), and Mississippi (48.1%).

Comparatively, the percentage of beneficiaries who experience an OUD-related hospitalization or ED visit decreased by 0.3 PP from 2019 to 2023.

“Many policies and programs were rolled out to increase use of MOUD, such as expanding coverage of MOUD under Medicaid programs and through the SUPPORT Act, making it easier for clinicians to prescribe buprenorphine, easing restrictions on take-home methadone, making telehealth access to MOUD prescriptions easier, and requiring more addiction programs to offer MOUD,” the study authors wrote.

This study was limited by OUD diagnoses and treatment measures due to limited diagnostic coding and data restrictions, especially among temporary or deceased enrollees. Variations in state billing practices and reliance on claims data also limit the overall accuracy and generalizability of the findings.

“Future research could leverage this information to identify important factors that may help focus US resources and policy to address the OUD epidemic,” the study authors concluded.

References

1. Lu TT, Dowd WN, Mark TL, et al. Cascade of care for opioid use disorder among Medicaid beneficiaries. JAMA Network Open. 2026;9(4):e267439. doi:10.1001/jamanetworkopen.2026.7439

2. McCrear S. The 10th anniversary of the CDC’s opioid prescribing guidelines: new evidence and patient-centered decisions. AJMC^®. March 24, 2026. Accessed April 21, 2026. https://www.ajmc.com/view/the-10th-anniversary-of-the-cdc-s-opioid-prescribing-guidelines-new-evidence-and-patient-centered-decisions