{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T07:07:19Z","timestamp":1790060839587,"version":"4.0.1"},"reference-count":44,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2022,11,5]],"date-time":"2022-11-05T00:00:00Z","timestamp":1667606400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Rural Health"],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>The opioid crisis remains a major public health concern in the United States. Naloxone is used to reverse opioid overdoses. This study examined Medicaid expansion on naloxone prescriptions in retail pharmacies in metropolitan (metro) and nonmetropolitan (nonmetro) areas (2011\u20102017).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We used population average models to evaluate the association of Medicaid expansion at the state level on the number of naloxone prescriptions dispensed and the percentage paid by Medicaid, including adjustment for opioid\u2010related and state\u2010level policy covariates. Difference\u2010in\u2010difference modeling was performed as a sensitivity analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>States that expanded Medicaid had higher unadjusted naloxone dispensing rates and Medicaid\u2010paid percentage of naloxone in metro and nonmetro areas. Medicaid expansion was not associated with the number of naloxone dispensed in either metro (adjusted rate ratio (ARR) = 1.26, 95% CI: [0.80, 1.97]) or nonmetro (ARR = 0.67, 95% CI: [0.37, 1.19]) areas after covariate adjustment. In metro areas, Medicaid expansion was associated with a significant increase of 3.86 percentage points (95% CI: [0.09, 7.63]) in the Medicaid\u2010paid percentage of naloxone dispensing compared to nonexpansion states, but this association was not significant in nonmetro areas. There was also a significant time by Medicaid expansion interaction on the Medicaid\u2010paid percentage of naloxone dispensed (metro: estimate = 0.74, 95% CI: [0.36, 1.12]; nonmetro: estimate = 0.68, 95% CI: [0.17, 1.18]).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Medicaid expansion increased naloxone access by increasing the Medicaid\u2010paid percentage of naloxone prescriptions in metro areas. States with Medicaid expansion had a faster rate of increase in the Medicaid\u2010paid percentage of naloxone than states without Medicaid expansion in nonmetro areas.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jrh.12719","type":"journal-article","created":{"date-parts":[[2022,11,5]],"date-time":"2022-11-05T09:10:13Z","timestamp":1667639413000},"page":"347-354","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Medicaid expansion and access to naloxone in metropolitan and nonmetropolitan areas"],"prefix":"10.1111","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5715-6095","authenticated-orcid":false,"given":"Yue","family":"Cheng","sequence":"first","affiliation":[{"name":"Institute for Pharmaceutical Outcomes &amp; Policy (IPOP), Department of Pharmacy Practice and Science, College of Pharmacy University of Kentucky  Lexington Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia R.","family":"Freeman","sequence":"additional","affiliation":[{"name":"Institute for Pharmaceutical Outcomes &amp; Policy (IPOP), Department of Pharmacy Practice and Science, College of Pharmacy University of Kentucky  Lexington Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Slade","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, College of Public Health University of Kentucky  Lexington Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minji","family":"Sohn","sequence":"additional","affiliation":[{"name":"College of Pharmacy Ferris State University  Big Rapids Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffery C.","family":"Talbert","sequence":"additional","affiliation":[{"name":"Institute for Biomedical Informatics, College of Medicine University of Kentucky  Lexington Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Delcher","sequence":"additional","affiliation":[{"name":"Institute for Pharmaceutical Outcomes &amp; Policy (IPOP), Department of Pharmacy Practice and Science, College of Pharmacy University of Kentucky  Lexington Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,11,5]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"crossref","unstructured":"MattsonCL TanzLJ QuinnK KariisaM PatelP DavisN. 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