Opioid Deaths Are Falling, Though Proposed Medicaid Changes Could Disrupt Access to Treatment

Copy link to quick take

New CDC data show opioid deaths fell sharply from about 79,000 in 2023 to about 55,000 in 2024, accelerating a decline that began in mid-2023. While exact reasons are unclear, policies expanding treatment, increasing naloxone distribution, and reducing fentanyl supply likely contributed. Several of these policies started under the first Trump administration and were expanded greatly under the Biden administration, which was in office during this period of declining deaths.

Medicaid plays a large part in responding to the opioid epidemic. Medicaid is the primary source of coverage for adults with opioid use disorder (OUD), covering nearly half of all adults with OUD, over two-thirds of those receiving outpatient OUD treatment, and more than half of those receiving medication treatment. In recent years, state Medicaid programs have expanded access to OUD treatment and medications, which reduces the risk of overdose death.
 
However, recent federal proposals may affect Medicaid coverage and treatment access at a time when opioid deaths are declining but future trends are uncertain. The House Energy and Commerce Committee advanced a reconciliation bill that includes an estimated $625 billion in federal spending reductions over 10 years. Overall Medicaid enrollment declines projected by CBO are 10.3 million and 7.6 million more uninsured could result in interruptions in care and treatment among adults with OUD. The bill includes work requirements, increased cost-sharing, and more frequent Medicaid eligibility reviews, and many provisions target adults enrolled through the Affordable Care Act (ACA) Medicaid expansion, which is how over six in ten Medicaid-covered adults with OUD gained Medicaid coverage. While the bill exempts individuals with substance use disorders from work requirements, implementation of work requirements in Arkansas show that safeguards intended to protect coverage for people qualifying for exemptions were often confusing and hard to navigate resulting in many medically frail individuals losing coverage. Continuous Medicaid coverage supports ongoing treatment, and research has linked cessation of medication-based OUD treatment to a six-fold higher risk of death in the four weeks immediately following treatment disruption.

Other federal proposals could further affect the opioid response, including restructuring by HHS that folds the Substance Abuse and Mental Health Services Administration (SAMHSA) into another agency, and the President’s pending discretionary budget request for 2026 proposes over $1 billion in SAMHSA cuts. Collectively, these federal proposals—particularly potential Medicaid reductions—introduce uncertainty about sustaining recent declines in opioid deaths, so what happens in federal budgets and the Medicaid debates bears watching.