By Katie Horneffer, Intern, Care4Carolina
Every day, five North Carolinians die from an opioid overdose. Each one of these deaths sends shock waves through a community: another friend, classmate, parent, or child lost to this ongoing crisis. Like the rest of the country, North Carolina’s opioid crisis has only gotten worse during COVID-19, as social isolation took a toll and services shut down. Unlike most of the rest of the country, however, North Carolina has still not closed its health insurance coverage gap—meaning that people suffering from opioid use disorder have much more difficulty accessing treatment that could save their lives.
With health insurance coverage, people are better able to access and pay for counseling, medication, rehabilitation, and other services that can help them beat opioid use disorder. Compared to the uninsured, people with Medicaid are nearly twice as likely to receive the treatment that they need. But in North Carolina, about 1/3 of people seeking care for drug overdoses in emergency departments are uninsured. States that have closed their coverage gaps have already seen the positive impact on access to treatment, reporting an 18% drop in the number of people unable to access substance use services.
Research shows that medication is one of the most effective ways to treat opioid use disorder. Medication for opioid use disorder works best if patients continue to use it consistently for 6-12 months. But this medication can be expensive: one type, buprenorphine, costs $160 for a month’s supply. With health insurance, patients can ensure continued access to this medication for the time that they need to beat their disorder. Patients with health insurance are also more likely to be prescribed this medication when they enter a residential treatment facility, since the facility won’t be at risk of picking up the cost. In fact, in states that closed their coverage gap, residential treatment facilities were over 9 times as likely to use medication to treat opioid use disorders. Given the robust evidence around the effectiveness of medication treatment, this means that patients in these states are able to receive higher-quality care for their opioid use disorder.
Beyond improved substance use treatment, closing the coverage gap would increase access to healthcare in general, which could also play an important role in combatting the opioid epidemic. Opioid use disorders tend to go hand-in-hand with mental health disorders; nearly 70% of uninsured adults with an opioid use disorder also report a mental illness. Therefore, this population needs not only opioid-specific services but also greater access to comprehensive healthcare that can help them address other mental health problems. Closing the gap would also increase access to primary care, getting individuals connected to the diagnosis and treatment that they need. Overall, some estimates suggest that closing the gap would help 150,000 North Carolinians with mental health or substance use disorders access affordable healthcare.
This increased access to treatment and other health services would impact the most tragic consequence of the opioid crisis: overdose deaths. States that closed their coverage gap saw a 6% decrease in deaths from opioid overdoses. After Ohio closed its coverage gap, Dayton—a city slightly larger than Wilmington which had one of the highest overdose rates in the country—saw deaths drop by over 50%. Closing the coverage gap isn’t just about opioid use disorder treatment: it’s about saving lives.
For decades, the opioid epidemic has been causing unmeasurable grief, stress, and loss. North Carolina has poured money into addressing this epidemic for years, but we have not yet used one of the most important tools at our disposal: closing the coverage gap. With the recent spike in the crisis caused by the COVID-19 pandemic, now is the time to do everything we can to treat opioid use disorder and prevent future suffering.