A Canary in the Coal Mine: How Medicaid Cuts Could Impact Millions of Americans With Opioid Use Disorder

In 2020, during the COVID-19 public health emergency, the US Congress provided increased funding to states to maintain continuous Medicaid enrollment. In March 2023, Congress ended these funds and states resumed Medicaid eligibility redeterminations, described as “Medicaid unwinding.” Researchers conducted a cross-sectional study using a difference-in-differences design to assess if Medicaid unwinding impacted buprenorphine treatment receipt among people with opioid use disorder. They used nationally representative buprenorphine dispensing data from retail pharmacies to measure and compare changes in buprenorphine prescriptions and insurance coverage from July 2017 to December 2022, and July 2023 to December 2023.

Compared with the earlier time period, in the latter time period…

• The number of days with active buprenorphine prescriptions decreased by 3.9 days.
• The probability of having no days with active buprenorphine prescriptions increased by 1.8 percent.
• The probability of having one or more active buprenorphine prescriptions paid for by private insurance increased by 1.9 percent.
• The probability of having one or more active cash-pay prescriptions increased by 0.9 percent.

Comments: These findings suggest that Medicaid unwinding was associated with disruptions in buprenorphine receipt. The results raise concerns about how the proposed changes in the “One Big Beautiful Bill Act”—which is projected to cause 10.9 million people to lose Medicaid coverage over the next 10 years—will impact people who rely on Medicaid for buprenorphine. The bill may lead to a reversal in the recently observed decreases in US overdose deaths.

Susan L. Calcaterra, MD, MPH, MS

Reference: Constantin J, Kenney GM, Simon K, Chua KP. Medicaid unwinding and changes in buprenorphine dispensing. JAMA Netw Open. 2025;8(5):e258469.