The Republican tax bill signed into law earlier this month could result in a significant death toll for people seeking treatment for opioid addiction, according to a group of health economics researchers.
Specifically, cuts to Medicaid could result in large numbers of the program’s beneficiaries losing access to medications for opioid use disorder, per the new estimate, which was published by researchers at Boston University and the University of Pennsylvania.
“We estimate that the bill will cause approximately 156,000 people to lose access to treatment for opioid use disorder and that the overdose rate among that group will double, leading to approximately 1,000 additional fatal overdoses each year,” reads the policy memo, which was addressed to House Speaker Mike Johnson (R-La.) and Sen. Majority Leader John Thune (R-S.D.).
The projection relies on estimates from the Congressional Budget Office about likely impacts to Medicaid coverage, as well as other existing data that shows people who use medications like methadone and buprenorphine to treat opioid addiction are vastly less likely to die of a drug overdose. Researchers then used a public health modeling tool specifically tailored to the drug crisis to map out the likely impacts.
“There were estimates for how many people were likely to lose Medicaid access, and of those, how many people likely have substance use disorder and are engaged with medicines,” Benjamin Linas, a Boston University physician-researcher who co-authored the memo, told STAT. “We let the model go for a year to see what would happen, and we found that for people who are on a medication, their rates of overdose were about half of what they were for the people who were not.”
The projection comes amid a period of relative good news for the overdose epidemic: Drug deaths have steadily declined for the last year and a half, appearing to recede to pre-Covid-19 levels.
Medicaid is easily the nation’s largest funder of addiction treatment, however, and Linas and his coauthors argued that enacting deep cuts to the program risks backtracking on the recent progress.
Their findings are consistent with the addiction medicine community’s consensus that people taking methadone or buprenorphine are vastly less likely to experience a fatal overdose. Despite their effectiveness, however, the medications remain highly stigmatized and underused — only about one-fifth of Americans with opioid use disorder receive them.
The death toll from overdose remains considerable, and the Centers for Disease Control and Prevention reports that about 78,000 Americans died in the 12-month period ending in February. The running 12-month death toll in late 2023 exceeded 110,000.
The estimate of the Trump tax law’s impact is “obviously very alarming,” said Regina LaBelle, a former high-ranking Obama administration drug policy official and professor of addiction policy at Georgetown University. But she also called the estimate “the tip of the iceberg,” saying it focuses only on the people whose deaths can most directly be tied to a loss of insurance coverage and ensuing loss of medication access.
“Those are the people who we can point to, the knowable population that are going to be more at risk for overdose,” LaBelle said. “What happens with the vast majority of people with a substance use disorder who don’t get any type of treatment and are likely to lose coverage? The 1,000 is a conservative estimate based on who’s getting the medications.”
STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.
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