Overdose Epidemic

Understanding the opioid epidemic’s economic toll

Andis Robeznieks , Senior News Writer

Nearly 70,000 people died from drug-related overdose between January 2017 and January 2018, according to the Centers for Disease Control and Prevention, with about 48,000 related to opioids, the majority of which is due to heroin and illicit fentanyl.  

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A report from Altarum, an Ann Arbor, Michigan-based health care research and consulting firm sheds light on another dimension of the opioid epidemic. The report says the societal benefit of eliminating opioid overdoses, death and use disorders reached $115 billion in 2017, up from $95.3 billion for 2016.

The total exceeds $1 trillion when the costs from 2001 to 2017 are added up. Another $500 billion is expected to be added to this sum by 2020.

Lost earnings and productivity account for much of these costs and they also result in fewer tax dollars collected. Altarum estimated direct health care costs totaled $12.2 billion in 2016. Indirect health care costs totaled an estimated $9.2 billion.

Altarum also lists many “nonmonetized impacts” including decreased quality of life, emotional burdens and “disparate community impacts,” such as decreased property values and loss of perceived community well-being.

Altarum’s recommendations for combating the opioid epidemic closely mirror those put forth by the  AMA Opioid Task Force. The task force has outlined  steps that physicians, patients, insurers and policymakers should be taking to address the epidemic. These include:

  • Improving access to treatment.
  • Educating physicians on safe prescribing and evidence-based treatment.
  • Educating patients on safe storage and disposal of opioids.
  • Greater use of Prescription Drug Monitoring Programs (PDMPs).
  • Putting an end to the stigma that surrounds opioid-use disorder.

“We know what works. We can point to states where making access to medication-assisted treatment has been a priority, and the mortality rates are doing down,” said Patrice A. Harris, MD, chair of the AMA Opioid Task Force. “This epidemic will not be reversed until we deal with access issues and stigma associated with opioid misuse.”

Another important economic dimension of the opioid epidemic and lack of comprehensive pain care is that, too often, insurance-benefit designs discourage nonopioid alternatives such as rehabilitation programs and behavioral medicine interventions. These nonmedication approaches help patients learn tools to better manage their pain and return to greater levels of physical and vocational function.

A major report, Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research, estimated that the economic costs of chronic pain totaled between $560 billion and $635 billion.

The report—issued by what is now called the Health and Medicine Division of the National Academies of Sciences, Engineering and Medicine—noted that “interdisciplinary, biopsychosocial approaches are the most promising for treating patients with persistent pain.” Yet system and organizational barriers, “many of them driven by current reimbursement policies,” block these approaches from being routinely provided, the report said.

Time to pay for effective treatments

Steven Stanos, DO, medical director of the Swedish Health System’s Swedish Pain Services in Seattle, said he still sees those barriers firsthand.

“Stemming the tide of the opioid overdose crisis needs to focus on improving access to comprehensive pain care while balancing the need to continue to provide opioid management judiciously for those patients who benefit from the treatment and get those patient with opioid use disorder the effective care they need,” Dr. Stanos said.

Dr. Stanos described how Swedish offers a four-week, three half-days per week structured outpatient team based pain management “boot camps” help patients with chronic pain learn skills to better manage their pain and improve their function.

Insurance coverage barriers exist for many of the evidence-based treatments including psychological services, relaxation training, as well as group educational and therapy classes, he said, adding that even when therapy is covered, low reimbursement does not even cover the cost to deliver the services.

Another problem involves multiple co-pays for same-day services. For some patients, the individual co-pays for these sessions add up to “hundreds of dollars a day,” he said.

Dr. Stanos said he sees potential progress with some payers more willing to expand access by agreeing to  lump-sum “day rates” or “case rates” to improve reimbursement and decrease financial roadblocks for patients.