William Patterson University, Wayne, NJ, USA.
George Washington University, Washington, DC, USA.
Med Care Res Rev. 2021 Dec;78(6):713-724. doi: 10.1177/1077558720967227. Epub 2020 Oct 22.
The Medicaid expansions made addiction treatment more accessible but they also made it less costly to obtain the prescription opioids that can trigger an addiction. We investigated the association between the Medicaid expansions and drug-related deaths. We add to the literature by explicitly accounting for the properties of illicit drug markets and by conducting a simulation-based power analysis to assess whether a plausible change in drug-related mortality could be detected with our data. We identify three main challenges in isolating the effect of the Medicaid expansions on drug-related mortality that cannot be sufficiently addressed with current data: (a) nonparallel preexpansion trends in drug-related mortality, (b) the contemporaneous surge in the supply of illicitly manufactured fentanyl, and (c) lack of statistical power. We argue that more comprehensive data are needed to answer this question.
医疗补助计划的扩张使成瘾治疗更容易获得，但也使获得可能引发成瘾的处方类阿片类药物的成本降低。我们调查了医疗补助计划扩张与与药物相关的死亡之间的关联。我们通过明确考虑非法毒品市场的特性，并进行基于模拟的功效分析来评估我们的数据是否能够检测到与药物相关的死亡率的合理变化，从而为文献做出了补充。我们确定了在隔离医疗补助计划扩张对与药物相关的死亡率的影响方面存在的三个主要挑战，这些挑战无法通过当前的数据得到充分解决：（a）与药物相关的死亡率在扩张前没有平行的趋势，（b）非法制造的芬太尼供应同时激增，以及（c）缺乏统计能力。我们认为，需要更全面的数据来回答这个问题。
