Repealing the Affordable Care Act (ACA) would seriously affect the fight against the growing opioid epidemic, according to a recent editorial published in PLoS Medicine.

In addition, the proposed cuts to Medicaid would cause millions of Americans to lose health insurance coverage, making it even harder for individuals with an opioid use disorder to access treatment.

In 2015, more than 2.6 million Americans had an opioid use disorder and more than 33,000 died from an opioid overdose.

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The age-adjusted opioid-related death rate is now more than 3 times higher than it was in 2000.

Despite these discouraging figures, Leana S. Wen, MD, from the Baltimore City Health Department in Maryland, and colleagues note that there are effective therapies for opioid addiction and overdose. Naloxone is effective for acute opioid overdose, and the chronic phase of opioid use disorder can be successfully treated using both medication (methadone, buprenorphine, and naltrexone) and psychosocial interventions. Such therapy has been found to reduce illicit drug use, criminal behavior, and both all-cause and overdose mortality.

Yet only 10% of Americans with substance use disorders receive treatment. About one-third of those who fail to seek treatment do so because of cost or lack of insurance coverage. But drug addiction is costly in terms of morbidity and mortality. Higher rates of HIV infection and hepatitis C, and overdoses among the addicted population, translate into higher medical costs. There is also a cost to the criminality often associated with addiction. The National Institutes of Health estimates that for every $1 invested in addiction treatment, society saves $12.

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The researchers point out that nearly one-third of those who receive substance use disorder therapy rely on Medicaid. Other proposed changes would no longer require insurance companies to cover opioid use disorder treatment, suggesting that even among those who do not lose their insurance coverage entirely, access to treatment would be limited.

According to the authors, Americans will ultimately pay for the cost of this epidemic – one way or another.


Wen LS, Behrle EB, Tsai AC. Evaluating the impact of Affordable Care Act repeal on American’s opioid epidemic. PLoS Med. 2017;14(8):e1002380.