Insights About The Opioid Crisis

From the Editor-In-Chief Health AffairsVol. 44, No. 9 Insights About The Opioid CrisisDonald E. Metz and The Editorial Staff AffiliationsDonald E. Metz, executive editor and interim editor-in-chiefThe Editorial StaffPUBLISHED:September 2025Open Accesshttps://doi.org/10.1377/hlthaff.2025.01002AboutSectionsView PDFPermissions ShareShare onFacebookXLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsDownload Exhibits TOPICSOpioid use disorderSubstance use disorderTreatmentMedicaidTraditional MedicareQuality of careQuality measurementMortalityMedicare AdvantageHarm reductionAdolescents Although recent data from the Centers for Disease Control and Prevention show signs of a reduction in annual opioid overdose deaths beginning in mid-2023, those rates remain above where they were when the opioid epidemic was declared a public health emergency in 2017. Beyond the mortality data, millions of Americans use opioids and could benefit from harm reduction and treatment services. This issue addresses a range of topics surrounding the ongoing crisis.Systemic Barriers Brendan Saloner and Pooja Lagisetty observe that although many inventive approaches to delivering lifesaving and harm-reducing opioid treatments exist, underuse has prevented them from achieving population-level effects. Access problems are often cited for this underuse, but the authors note that such explanations often overlook upstream challenges to expanding effective programs that could reach more people who would benefit. Their overview article focuses on the complex interplay between technical feasibility and the unique sociocultural contexts in which programs operate. Rosalie Liccardo Pacula and coauthors discuss the difficulty that policy makers face when trying to extract lessons from policy evaluations that are often based on different methodological approaches and described using different vocabularies. This diversity can generate "a confusing amalgamation of 'opioid policy' research studies" that may appear to contradict one another. The authors provide a "unifying framework" for communicating opioid policy evaluations to promote greater understanding among nonresearchers.Geography David Powell and coauthors investigate how geography contributes to the disproportionate increase in opioid-related mortality among Black Americans. They find that between 2010 and 2020, compared with Whites, roughly 40 percent of the additional growth in Black opioid-related overdoses was due to varying geographic exposure to fentanyl, "emphasizing the need for…interventions that address area-level vulnerabilities."Gaps In Care Several articles in the issue explore gaps in care among specific populations. Manuel Cano and coauthors examine adolescent opioid use disorder (OUD) and find that nationally, only 31 percent of adolescents with OUD reported receiving treatment in the past year. Lauren Kelly and coauthors find that nursing facilities are often poorly equipped to provide evidence-based treatment to a growing population of aging patients with substance use disorders, including OUD. They offer a road map for improving care, highlighting opportunities to reform care delivery covering payment, regulatory and financial barriers, and quality measures. Lindsay Allen and coauthors present an analysis of disparities in naloxone-related interventions. Across each of the domains studied, they document significantly lower engagement among Black, Hispanic, and Asian US adults, raising questions about whether differential access to harm reduction resources has contributed to elevated overdose mortality rates in recent years.Care By Payer Several articles examine outcomes by payer. Tami Mark and coauthors find that fewer than 40 percent of Medicare beneficiaries with OUD received care in alignment with eight nationally recognized OUD quality measures in 2020. They also explore differences between Medicare and Medicaid, and traditional Medicare and Medicare Advantage. Karen Shen and coauthors find higher rates of OUD medication among Medicaid enrollees compared with commercial enrollees in Wisconsin. After they control for a range of factors, a substantial difference between prescribing rates remains unexplained, indicating a possible role for direct plan-level effects or unobserved patient characteristics. Stephen Crystal and coauthors look at state-level, all-payer changes in buprenorphine prescribing after the implementation of key federal policy changes designed to increase prescribing. In contrast to previous studies that had shown little impact at the national level, the authors find significant heterogeneity among states, with early adopters of Medicaid expansion showing the most dramatic increases. Other topics include Medicaid waivers and mandates, the justice system, pharmacies, and private equity.Community Voices The issue includes several Community Voices articles. An Entry Point focuses on a program that incorporates people with lived experience of substance use into research teams. We also feature interviews of Willie Pearl Evans from Minnesota's Department of Health and Philip Cooper of Operation Gateway in North Carolina, as well as Narrative Matters essays and poetry.Acknowledgments We thank Pooja Lagisetty of the University of Michigan and Brendan Saloner of Brown University for serving as theme issue advisers. We also thank the Foundation for Opioid Response Efforts, Dogwood Health Trust, Vital Strategies, and Kaiser Permanente for their support of this issue. Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article Metrics History Published online 2 September 2025 Information© 2025 Project HOPE—The People-to-People Health Foundation, Inc.PDF downloadRelated articlesThe Opioid Crisis: Scaling Up Treatment And Harm Reduction Programs To Reach More People Who Would Benefit02 Sep 2025Health Affairs