The Real Cost of Opioid Addiction

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The Real Cost of Opioid Addiction

By Adam Bisaga MD 05/01/18
Book cover for Overcoming Opioid Addiction

Addiction to prescription opioids and heroin is expensive, no matter how you slice it. With an estimated 2.4 million Americans addicted to opioids and more than 50 thousand opioid-related overdose deaths, the costs of opioid addiction are unprecedented. The Council of Economic Advisers recently estimated that the economic cost of the opioid crisis was over half a trillion dollars in 2015. In addition to the cost of the premature loss of life, the public must pay for uninsured ambulance rides to emergency rooms for overdoses, criminal justice system expenses, treating babies born dependent on opioids, as well as opioid-related injuries, lost productivity, and the spread of infectious diseases such as HIV and hepatitis C.

In 2015, the overall healthcare and substance abuse treatment costs of opioid addiction were greater than $37 billion. Individuals with opioid addiction incur on average $15,000 of additional healthcare expenses per year, which is much more than healthcare costs of treating an individual with cancer, heart disorder, or diabetes. Yet public funding is still being used to pay for expensive treatments that are ineffective against opioid addiction.

As the rates of opioid-related overdose deaths have dramatically accelerated in the past two years, costs will continue to increase. Several bills were recently proposed that put aside an additional funding to combat the epidemic. However, to adequately address the opioid crisis, we may not need much more money. We do, however, need to divert funds to treatment programs proven to work and take advantage of the nation’s existing medical infrastructure—namely hospitals, emergency rooms, and community health programs. This is not however happening fast enough.

The FDA has approved three medications to treat opioid addiction: methadone, buprenorphine, and naltrexone. Each has its pros and cons which makes it possible to match the right medication to the needs of the individual patient. All help to minimize cravings for the drug and thereby increase chances of abstinence and improved health. All are far more effective than traditional treatment: detoxification followed by treatment without medication. Up to 90 percent of opioid-addicted patients who do not receive medication as part of treatment relapse within the first three months, sometimes fatally. The evidence is overwhelming. Yet public money continues to support these programs.

Treatment with medication costs money, yet it is far less expensive than traditional programs or sustaining those who continue to use. When administered by a certified outpatient clinic twice a week, buprenorphine costs less than $6,000 per year, per person. Methadone maintenance therapy costs $6,500. At $14,000 per year, per person, injection naltrexone is the most expensive, yet the cost pales in comparison to continued use. Residential treatment can cost $5,000 to more than $30,000 per month.

To help direct patients to immediate care, some states have opened “on demand” clinics. Most of these programs offer effective treatment to people who would otherwise fall through the cracks. We certainly need to expand medical specialized centers for complex cases, but many cases are quite straightforward. Why not rely on an existing, well-established system already poised to discuss and deliver medical care to patients?

Our medical system continues to separate opioid use disorder, a well-accepted chronic disorder, from other medical conditions. But many opioid-addicted individuals could effectively receive long-term care within general medical clinics.

Most people addicted to opioids will eventually end up in the emergency room, either because of an overdose, a drug-related accident, or in an attempt to secure more opioids. Some of them will have complications of their addiction that will require inpatient hospital treatment. Most ERs or hospital services will treat the immediate medical condition and refer these individuals to addiction treatment. As much as some of these patients might want help, the symptoms of the untreated disorder are so severe that most will use before they have a chance to reach out to a treatment center. These patients are lost in the system. We had a chance to help them by offering treatment with medication on the spot from a facility that already exists, and we let them go, sometimes with great judgment.

Most people addicted to opioids and their families are at a loss when it comes to understanding what effective treatment for opioid addiction looks like. They do not know that a single dose of buprenorphine could be the beginning of the end of their relentless cravings for opioids. These people either go to traditional treatment or continue to use. Connecting people addicted to opioids with the best resources should be easy and affordable, not a mystery to be solved. Health-care providers can be the link between addiction and recovery.

Treating a substantial proportion of patients with opioid addiction is not overly difficult. Physicians, physician assistants, and nurse practitioners can receive a short course of training through federally funded free programs such as Providers Clinical Support System (PCSS). Once stabilized, more difficult cases can be referred to addiction specialists.

Currently, about 3–4 percent of U.S. physicians are certified to administer buprenorphine. Imagine what could happen if 25 percent were willing to do the same.

Treating opioid addiction effectively is incredibly rewarding. As opioid-addicted patients begin to feel again, to wake up to the world around them, and get closer to who they really are as human beings, we realize the real cost of addiction: the loss of precious and meaningful lives.

Adam Bisaga, MD, is an addiction psychiatrist, clinician, researcher, and professor of psychiatry at Columbia University. He conducts research on new treatments for opioid addiction and oversees a national program that mentors physicians treating opioid addictions. He is a UN expert involved in international addiction training and program development. He is also the author of Overcoming Opioid Addiction: The Authoritative Medical Guide for Patients, Families, Doctors, and Therapists.

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