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Opioids in Medicaid: Concerns About Opioid Use Among Beneficiaries in Six Appalachian States


Opioid abuse and overdose deaths remain at crisis levels in the United States generally and in the Appalachian region. In 2018, an estimated 9.9 million Americans misused prescription opioids, and nearly 47,000 Americans died from opioid overdoses. In 2017, Appalachian counties had an opioid overdose death rate that was 72 percent higher than in non-Appalachian counties throughout the country. Further, multiple reports from across the six Appalachian States under review in this data snapshot show dramatic increases in opioid-related overdoses and deaths since the start of the COVID-19 pandemic. This data snapshot is part of a larger strategy by OIG to fight the opioid crisis and protect beneficiaries from prescription drug misuse and abuse.


We used data from the Transformed Medicaid Statistical Information System (T-MSIS) for six States in the Appalachian region-Alabama, Kentucky, Ohio, Tennessee, Virginia, and West Virginia-to identify beneficiaries enrolled in Medicaid who received at least one opioid during 2018. We determined beneficiaries' morphine equivalent dose, which is a measure that equates all of the various opioids and strengths into one standard value. We also identified prescribers whose opioid prescribing to beneficiaries at serious risk of misuse or overdose stood out compared to other prescribers.


Nearly 6,000 beneficiaries in the 6 Appalachian States received high amounts of opioids and did not have cancer or sickle cell disease and were not in hospice care treatment. Among those beneficiaries, more than 450 were at serious risk of prescription opioid misuse or overdose. Nineteen prescribers stood out by prescribing opioids to more beneficiaries at serious risk than others who prescribed opioids to such beneficiaries.


Medicaid beneficiaries across the six Appalachian States are at risk for opioid misuse or overdose, and the COVID-19 pandemic may be putting Medicaid beneficiaries at greater risk of opioid misuse or overdose in 2020 and beyond. Specifically, the measures taken to address the COVID-19 pandemic may have contributed to the dramatic increases in opioid-related overdoses and deaths in these States since the start of the pandemic. Additionally, individuals with opioid use disorder could be particularly hard hit by COVID-19 as COVID-19 attacks the lungs, and respiratory disease is known to increase the risk of fatal overdose among people taking opioids.

OIG is committed to fighting the opioid crisis and protecting beneficiaries from prescription drug abuse and misuse. We are working with our law enforcement partners to bring resources and expertise to these six States through the Appalachian Regional Prescription Opioid Strike Force.