The evidence doesn't justify steps by state Medicaid programs to restrict opioid addiction treatment with buprenorphine

UMMS Affiliation

Department of Family Medicine and Community Health; Center for Health Policy and Research; Clinical and Population Health Research

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Document Type



Adolescent; Adult; Aged; *Analgesics, Opioid; Buprenorphine; Databases, Factual; Female; Humans; Insurance Claim Review; Male; Massachusetts; *Medicaid; Middle Aged; Opiate Substitution Treatment; Opioid-Related Disorders; United States; Young Adult


Community Health and Preventive Medicine | Preventive Medicine | Primary Care


Many state Medicaid programs restrict access to buprenorphine, a prescription medication that relieves withdrawal symptoms for people addicted to heroin or other opiates. The reason is that officials fear that the drug is costlier or less safe than other therapies such as methadone. To find out if this is true, we compared spending, the use of services related to drug-use relapses, and mortality for 33,923 Massachusetts Medicaid beneficiaries receiving either buprenorphine, methadone, drug-free treatment, or no treatment during the period 2003-07. Buprenorphine appears to have significantly expanded access to treatment because the drug can be prescribed by a physician and taken at home compared with methadone, which by law must be administered at an approved clinic. Buprenorphine was associated with more relapse-related services but $1,330 lower mean annual spending than methadone when used for maintenance treatment. Mortality rates were similar for buprenorphine and methadone. By contrast, mortality rates were 75 percent higher among those receiving drug-free treatment, and more than twice as high among those receiving no treatment, compared to those receiving buprenorphine. The evidence does not support rationing buprenorphine to save money or ensure safety.

DOI of Published Version



Health Aff (Millwood). 2011 Aug;30(8):1425-33. Link to article on publisher's site

Journal/Book/Conference Title

Health affairs (Project Hope)

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Link to Article in PubMed

PubMed ID