The Long Arc of Substance Use Policy Innovation in Medicaid: Looking Back, Looking Forward

This Perspective examines the role of Medicaid in the innovation of substance use disorder (SUD) treatment. In 2023, an estimated 49 million Americans met criteria for an SUD and more than 100,000 people died of a drug overdose.^1, 2 Compared with the general population, people with SUD experience worse self-rated health, a higher burden of other chronic diseases, and more hospital care.^3, 4 The social and economic consequences of SUD are also pervasive.^5, 6 People with SUD are much more likely to be involved with the criminal legal system, unhoused, and unemployed than the general population.⁷ With treatment, SUD symptoms are just as manageable as other chronic diseases like diabetes, asthma, and hypertension.⁸ In spite of these benefits, only one-quarter of people with SUD receive treatment in any year.¹ Furthermore, treatment is often too limited in its scope and duration to be effective. Many people discontinue care before achieving meaningful benefits.⁷

References

1. Substance Abuse and Mental Health Services Administration. Key substanceuse and mental health indicators in the United States: results from the 2023 National Survey on Drug Use and Health. 2024. Accessed January 1, 2025.samhsa.gov/data/report/2023-nsduh-annual-national-report
2. Garnett MF, Miniño AM. 2024. Drug overdose deaths in the United States,2003–2023. National Center for Health Statistics (U.S.). 2024. Accessed January 1, 2025. doi.org/10.15620/cdc/170565
3. Gryczynski J, Schwartz RP, O’Grady KE, Restivo L, Mitchell SG, and Jaffe JH. Understanding patterns of high-cost health care use across different substance user groups. Health Aff (Millwood). 2016;35(1):12-19.
4. Peterson C, Li M, Xu L, Mikosz CA, Luo F. Assessment of annual cost of substance use disorder in US hospitals. JAMA Netw Open. 2021;4(3):e210242.
5. Mokdad AH, Ballestros K, Echko M, et al; US Burden of Disease Collaborators.The state of US health, 1990–2016: burden of diseases, injuries, and risk factors among US states. JAMA. 2018;319(14):1444-1472.
6. US Department of Health and Human Services. Addiction and sub-stance misuse reports and publications. 2023. Accessed January 1, 2025.hhs.gov/surgeongeneral/reports-and-publications/addiction-and-substance-misuse/index.html
7. Substance Abuse and Mental Health Services Administration (US); Office of theSurgeon General (US). Facing Addiction in America: The Surgeon General’s Reporton Alcohol, Drugs, and Health. US Department of Health and Human Services; 2016. Accessed January 1, 2025. www.ncbi.nlm.nih.gov/books/NBK424857/
8.  National Institute on Drug Abuse. Principles of drug addiction treatment: a research-based guide ( third edition). 2014. Revised January 2018. Accessed January 1, 2025. nida.nih.gov/sites/default/files/podat-3rdEd-508.pdf