Impact of Medicaid expansion on naloxone dispensing: A narrative review

This narrative review aims to describe changes in naloxone dispensing and availability rates between states that have implemented Medicaid expansion compared to those that have not.

The review searched four databases (January 2014-March 2025), using predefined inclusion and exclusion criteria and dual independent screening with consensus resolution; data extraction included study design, population, data sources, metrics of naloxone access, main findings, and limitations.

Four articles met the inclusion criteria. Two studies found that Medicaid expansion was associated with an increase in naloxone prescriptions by 38-78 per state per quarter and Medicaid-paid prescriptions by 14.21-140.8 per 100,000 individuals per quarter. A third secret shopper study found that naloxone nasal spray availability was higher at pharmacies in states that implemented Medicaid expansion compared to those that did not. In contrast, one study found that Medicaid expansion was not significantly associated with an increase in naloxone prescriptions.

Few studies have explored the association between Medicaid expansion and improved access to naloxone. Three of four studies found that expansion was associated with increased naloxone prescriptions and pharmacy availability. Future studies should incorporate standardized measures to assess the impact of Medicaid expansion on naloxone dispensing across a greater number of states and utilize longitudinal data to evaluate its impact over time.