Medicaid And Methadone For Opioid Use Disorder: Expanded Coverage Increased Distribution In 10 States, 2019–24

Methadone is a vital medication for opioid use disorder, yet it remains underused because of restrictive federal and state regulations. Before 2018, not all state Medicaid programs covered methadone treatment. This prompted passage of the 2018 Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act, mandating Medicaid coverage of methadone by 2020. This study evaluated the impact of expanded coverage on methadone distribution and opioid overdoses. Using controlled substance distribution data from the period 2016-24, as well as national mortality data, we compared states newly covering methadone in Medicaid to states with existing coverage. New coverage of methadone was associated with an increase of 86.6 grams per 100,000 population (a 13.2 percent relative change) in treatment versus control states. Still, there was an increase of 14.4 percent in opioid overdose deaths in treatment versus control states in the post period. These results suggest that the SUPPORT Act boosted population-level methadone distribution, although rising overdose rates indicate a need for broader addiction treatment policy solutions to effectively address the crisis.