06-05-2025
Tennessee's opioid crisis is improving. Medicaid cuts could jeopardize that
There are signs of hope in the opioid crisis here in Tennessee. The question now is how to build on this progress and ultimately defeat a scourge that has devastated lives, families and entire communities across our state.
According to the U.S. Centers for Disease Control and Prevention, Tennessee recorded a nearly 32% percent decline in overdose deaths between November 2023 (when the toll was 3,891 lives lost) and November 2024 (2,651). That's an even steeper drop than the 26.5% decrease nationally during the same period, and the trend appears to be continuing.
Opioid treatment programs help patients gain stability and employment
Many factors are driving this welcome news, including the wider availability of Naloxone (better known by its commercial name Narcan), which rapidly reverses opioid overdoses, as well as the state's investment in public education, evidence-based treatment programs, and community response efforts.
Jaime Harper, director of faith-based initiatives for the Tennessee Department of Mental Health and Substance Abuse Services, left, speaks about the opioid crisis with Julie Barnes, director of substance use services, Mental Health Co-op during a community opioid briefing at Metro Nashville Health Department.
We're also seeing the benefits of federal and state regulatory changes over the last year. These reforms improve access to telehealth, mobile units, and greater flexibility in take-home doses of methadone at opioid treatment programs (or OTPs).
These treatment programs are critical, as patients also receive behavioral counseling, medical appointments, and case management from skilled professionals.
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At the 13 outpatient OTPs I oversee in Tennessee, it's clear that this combination is working. Patients can devote more time to family and work, spend less time commuting to treatment, and gain greater confidence in managing their opioid use disorder (or OUD). That's crucial at a time when fentanyl is still widely available and far more lethal than other opioids.
For someone with OUD, getting into and staying in treatment can quite literally be lifesaving. But getting people the treatment they need also depends on their ability to pay. That's why it's essential that Congress preserve current levels of Medicaid funding for people with OUD.
Medicaid cuts and restrictions can derail progress in opioid fight
Approximately 1,600 of the roughly 6,400 patients we serve at any given time rely on Medicaid. That's down from 1,800 patients in the early part of last year, which was just prior to the end of broader COVID-era Medicaid coverage. While state grants fill some gaps, financial burdens can put patients at risk for not seeking care, or leaving treatment early.
Proposals in Congress to require more people to work to qualify for Medicaid must be carefully considered. Many people living with opioid addiction are in crisis and struggle to get or hold down a job. But when they're in treatment, and their lives stabilize because of it, they are more likely to work.
An internal Behavioral Health Group analysis shows that 63% of Medicaid patients in Tennessee (45% nationwide) report an improvement in employment status after entering treatment.
Other ways to provide support for patients with OUD include aligning Medicaid reimbursement with the Medicare model and aligning state and federal guidelines to keep treatment decisions between patients and their medical and behavioral health providers.
These are just a few of the proven steps we can – and must – take to build on the progress we're seeing in the fight against opioid addiction. Failing to act will cost lives we could otherwise save, and it could delay our efforts to overcome one of the greatest public health crises of our time.
Amanda Karistai, Vice President of Operations for Behavioral Health Group
Amanda Karistai, MBA, LCSW-BACS, is Vice President of Operations for Behavioral Health Group (BHG), which manages the largest network of opioid treatment programs across Tennessee.
This article originally appeared on Nashville Tennessean: We need a strong Medicaid to keep fighting the opioid crisis | Opinion
