This report was put together by Kyra Henderson and Maddie Sale for a presentation at a recent opioid conference. The report describes trends in Medicaid prescription opioid and MAT use, including a finding that opioid prescriptions per enrollee decreased 54% from 2013-2022. In addition, they look at various state-level policy changes seeking to restrict inappropriate use of opioids, conducting a pre-versus-post comparison of prescription opioid usage related to the dates of these policy changes. The final section of the slides provides excerpts of opioid-related questions that have appeared in Medicaid MCO procurements, demonstrating some of the ways in which states are using their request for proposal (RFP) process to promote innovation and elevate the MCOs’ mechanisms to effectively serve enrollees who have opioid use disorder.