Economic Burden of the Opioid Epidemic

By | September 29, 2016
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opioid-photoAccording to the U.S. Department of Health & Human Services, in 2014, more than 240 million prescriptions were written for opioids, which is more than sufficient for each American adult to have one full bottle of opioids. Prescription drugs are second only to marijuana as the most abused category of drug in the United States.

A recent article by Curtis Florence, PhD of the CDC and colleagues, published in Medical Care’s October issue, finds that the total societal economic burden of opioid overdose, abuse, and dependence is estimated to be $78.5 billion. The authors address healthcare, substance abuse treatment, criminal justice, and lost productivity costs as components of the societal economic burden. The authors estimate more than one-third of this burden is a result of needed healthcare and substance abuse treatment, and nearly one-quarter of the burden is societal costs related to healthcare, substance abuse treatment, and criminal justice expenses.

The Office of National Drug Control Policy, Executive Office of the President [PDF], has made strides to alleviate the opioid epidemic. The federal government has called for improved education for parents, young persons, patients, and healthcare providers about the dangers of opioid use. There is a fairly common misperception that prescription opioids are safer substances to use than are non-prescription opioids, such as heroin, because prescription opioids have been prescribed by a physician and approved by the U.S. Food & Drug Administration. Improved education about the harmful effects of prescription opioids when taken for non-medical purposes may help to reduce this misperception.

The federal government has also emphasized the importance of educating providers about appropriate and responsible prescribing practices. The Office of National Drug Control Policy calls for prescription drug monitoring programs implemented in every state and used by all providers. Furthermore, a 2009 national survey by the Substance Abuse & Mental Health Services Administration found that more than 70% of persons who use prescription opioids for non-medical purposes acquired these drugs from friends and family members. Thus, the federal government calls for development of methods to facilitate appropriate prescription drug disposal in all communities.

The Office of National Drug Control Policy has emphasized enforcement of laws the prohibit providers from illegitimately prescribing prescription opioids, as well as laws that crack down on “doctor shopping,” a method some non-medical opioid users use to increase their access to prescription drugs. These strategies aim to reduce the public health and economic burden of the opioid epidemic.

I would argue that an additional path to alleviating the public health and economic burden of opioid overdose, abuse, and dependence is improved access to mental healthcare. A 2011 study from Johns Hopkins University Bloomberg School of Public Health noted the correlation between non-medical prescription opioid use, opioid use disorder, and mood and anxiety disorders. My experiences with non-medical prescription opioid users suggest that often, many non-medical opioid users have traumatic pasts, which may have directly or indirectly resulted in their opioid addiction. Reduced stigma surrounding mental health, as well as improved access to mental healthcare, might also help to alleviate the current epidemic and its economic burden on society.

Rebekah Rollston

Rebekah Rollston

Rebekah L. Rollston, MD, MPH, is a Family Medicine Physician at Cambridge Health Alliance, Instructor in Medicine at Harvard Medical School, Faculty of the Massachusetts General Hospital Rural Health Leadership Fellowship (in partnership with the Indian Health Service Rosebud Hospital), Editor-in-Chief of the Harvard Medical School Primary Care Review, and Head of Research at Bicycle Health, a digital health startup that provides biopsychosocial treatment of opioid use disorder via telehealth. She earned her Medical Degree from East Tennessee State University Quillen College of Medicine (in the Rural Primary Care Track) and her Master of Public Health (MPH) from The George Washington University Milken Institute School of Public Health. Dr. Rollston’s professional interests focus on social determinants of health & health equity, gender-based violence, sexual & reproductive health, addiction medicine, rural health, homelessness & supportive housing, and immigrant health.
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About Rebekah Rollston

Rebekah L. Rollston, MD, MPH, is a Family Medicine Physician at Cambridge Health Alliance, Instructor in Medicine at Harvard Medical School, Faculty of the Massachusetts General Hospital Rural Health Leadership Fellowship (in partnership with the Indian Health Service Rosebud Hospital), Editor-in-Chief of the Harvard Medical School Primary Care Review, and Head of Research at Bicycle Health, a digital health startup that provides biopsychosocial treatment of opioid use disorder via telehealth. She earned her Medical Degree from East Tennessee State University Quillen College of Medicine (in the Rural Primary Care Track) and her Master of Public Health (MPH) from The George Washington University Milken Institute School of Public Health. Dr. Rollston’s professional interests focus on social determinants of health & health equity, gender-based violence, sexual & reproductive health, addiction medicine, rural health, homelessness & supportive housing, and immigrant health.