By Tami L. Mark; Benjamin D. Huber

IMPORTANCE: Medicaid programs have expanded coverage of substance use disorder treatment and undertaken many other initiatives to reduce drug overdoses among beneficiaries. However, to date, no information has been published that tracks overdose deaths among the Medicaid population. OBJECTIVE To determine the rate of drug overdose among Medicaid beneficiaries. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study, US Centers for Medicare & Medicaid Services data from 2016 to 2020 that linked enrollment and demographic data from all Medicaid beneficiaries in the US with the US Centers for Disease Control and Prevention National Death Index were used to determine the rate of drug overdose death among Medicaid beneficiaries. The Medicaid population rates were compared with those of the total US population, overall and by age and sex. EXPOSURE Participation in the Medicaid program. MAIN OUTCOME Death of a drug overdose. RESULTS In 2020, the drug overdose death rate among Medicaid beneficiaries was 54.6 per 100 000, a rate that was twice as high as the drug overdose rate among all US residents (27.9 per 100 000). In 2020, Medicaid beneficiaries comprised 25.0% of the US population but 48% of all overdose deaths (44 277 of 91 783). For each age and sex group older than 15 years, overdose deaths were higher for the Medicaid population than for the US population, with the greatest difference occurring among adults ages 45 to 64 years. From 2016 to 2020, Medicaid overdose deaths increased by 54%. CONCLUSIONS AND RELEVANCE The results of this study suggest that more research is needed to understand why Medicaid beneficiaries have higher rates of drug overdoses than all US residents. Additionally, research is needed to understand how best to prevent overdoses among Medicaid beneficiaries. The federal government should s

JAMA Health Forum. 2024;5(12):e244365. doi:10.1001/jamahealthforum.2024.4365

By Mafalda Pardal, Elle Wadsworth, Beau Kilmer

Potent synthetic opioids, illegally produced, are starting to emerge in Europe. Considering the damaging harms caused by the opioid crisis in North America, which has led to a substantial surge in overdose deaths, it is crucial that European leaders understand the challenges associated with synthetic opioids. In this Perspective, we present and discuss the current situation in Europe concerning synthetic opioids, and draw on earlier and ongoing crises involving this group of substances to reflect on likely challenges ahead and ways to improve preparedness.

Santa Monica, CA: RAND, 2024. 20p.

By The Congressional Budget Office

The United States has been experiencing an opioid crisis since the mid-1990s, and opioids have had a significant effect on public health and on the nation’s economic and social outcomes. In this report, the Congressional Budget Office examines the consequences and timeline of the crisis, the contributing factors and federal responses to it, and the effects of the coronavirus pandemic on the crisis.

Deaths. More than 500,000 opioid-involved deaths have occurred since 2000, and the United States has the world’s highest number of opioid-involved deaths per capita. Although federal funding to address the opioid crisis has increased in recent years, opioid overdose mortality has increased as well. Deaths from opioid-involved overdoses were among the leading causes of death in 2020.

Health and Other Effects. The use and misuse of opioids can result in serious health effects: People with certain harmful behaviors that result from opioid misuse—such as an increase in the amount and frequency of opioid use or failure to fulfill major responsibilities at work, home, or school—have opioid use disorder (OUD), which can affect people’s participation in the labor force and their ability to care for their children. Treatment for OUD is used far less than behavioral health professionals recommend.

Changes Over Time. The opioid crisis has occurred in waves distinguished by the different types of opioids involved in overdose deaths and the use of opioids in combination with other drugs.

Contributing Factors. A rise in opioid prescribing, changes in illegal opioid markets, and greater demand for opioids due to worsening economic and social conditions for certain populations are key contributors to the crisis.

Federal Laws. Between 2016 and 2018, three laws enacted in response to the crisis aimed to lower the demand for and supply of opioids and to reduce their harm. The funding in those laws complemented annual appropriations to agencies tasked with responding to substance use disorder, including opioid use disorder.

The Crisis After the Enactment of the Laws and During the Pandemic. Opioid-involved deaths continued to increase after the laws were enacted—initially more slowly than in preceding years but then more rapidly during the pandemic. Opioid misuse increased during the pandemic as people experienced worsened mental health, more social isolation, greater job losses, and reduced access to treatment. In addition, the use of more potent synthetic opioids led to a sharp increase in overdose deaths. The pandemic and other factors have made it difficult to isolate the effect of the laws on the opioid crisis.

Washington, DC: CBO, 2022. 38p.

By Raminta Daniulaityte, Kaylin Sweeney , Seol Ki, Bradley N. Doebbeling and Natasha Mendoza

Background: Worsening of the overdose crisis in the USA has been linked to the continuing proliferation of non-pharmaceutical fentanyl (NPF). The recent wave of NPF spread in the USA has been fueled by an increased presence of counterfeit pills that contain NPF. This qualitative study aims to characterize the motivation and practices of counterfeit NPF pill initiation and use among individuals using illicit opioids in Arizona. Methods: Between October 2020 and May 2021, semi-structured interviews were conducted with 22 individuals meeting the following eligibility criteria: (1) 18 years or older; (2) residence in Arizona; and (3) use of illicit opioids in the past 30 days and/or opioid use disorder treatment in the past 12 months. Participants were recruited through referrals by a harm reduction organization, craigslist ads, and referrals by other participants. Interviews were conducted virtually via Zoom. Qualitative interviews were transcribed and analyzed thematically using NVivo. Results: Out of 22 participants, 64% were male, and 45% were ethnic minorities. Age ranged between 25 and 51 years old. Participants noted significant recent increases in the availability of counterfeit NPF pills (“blues,” “dirty oxys”) that were most commonly used by smoking. The majority indicated frst trying NPF pills in the past year, and the frst use often occurred in situations of reduced access to heroin or pharmaceutical opioids. Participant decisions to switch over to more frequent NPF pill use or to maintain some levels of heroin use were shaped by local drug availability trends and personal experiences with NPF efects. They were also infuenced by conficting views of social acceptability of pharmaceutical-like drugs, perceived harms of NPF in terms of overdose risks and increased difculty of quitting, and perceived benefts of switching to the non-injection route of opioid administration (e.g., from injecting heroin to smoking NPF pills). Conclusion: Our fndings highlight the need for the implementation of novel policy, treatment, and harm reduction approaches to address the growing unpredictability of drug supply and NPF pill-specifc risks, attitudes, and behaviors.

Harm Reduction Journal (2022) 19:52

By Nazgol Ghandnoosh and Casey Anderson

More people died from opioid-related deaths in 2015 than in any previous year. This record number quadrupled the level of such deaths in 1999. Unlike the heroin and crack crises of the past, the current opioid emergency has disproportionately affected white Americans—poor and rural, but also middle class or affluent and suburban. This association has boosted support for preventative and treatment-based policy solutions. But the pace of the response has been slow, critical components of the solution—such as health insurance coverage expansion and improved access to medication assisted treatment—face resistance, and there are growing efforts to revamp the failed and costly War on Drugs.

This report examines the sources of the opioid crisis, surveys health and justice policy responses at the federal and state levels, and draws on lessons from past drug crises to provide guidance on how to proceed.

Washington, DC: The Sentencing Project, 2017. 35p.

By Hernando Zuleta González

The increase in the area cultivated with coca in Colombia has cast doubt on the country’s anti-drug strategy and has encouraged skepticism about the possibility of a complete and definitive peace. Furthermore, this perception of failure has given rise to policy proposals based on the idea that illicit crops are a criminal issue, not a development one. This paper is a complete review of the available evidence and aims at organizing the information related to this debate and shedding light on the convenience or inconvenience of certain policies. There are six highly relevant facts: (i) With respect to reducing cocaine supply, the efforts in seizures and destruction of infrastructure are more efficient than the efforts in eradication. (ii) Seizures and destruction of infrastructure may help in reducing coca plantations. (iii) There is no evidence to support the hypothesis that the consumption of cocaine in Colombia has increased. (iv) Most regions of the country have seen a decrease in the amount of coca crops. However, at least one armed group is present in the regions where the cultivated area has increased. (v) Coca growing municipalities are, on average, poorer than the rest of the country. These municipalities have a low tax revenue, and reduced levels of connectivity and institutional development. (vi) The increase in the consumption of cocaine in the United States is concentrated in a specific age group and in certain states. This fact makes it difficult to relate the increase in consumption to an exogenous increase in the supply.

Bogotá, Colombia: Universidad de los Andes–Facultad de Economía–CEDE, 2019. 40p.