The United States is in the grip of an epidemic of opioid addiction and overdose. The Centers for Disease Control and Prevention (CDC) found that, from 2000 to 2015, nearly a half million people died because of opioid drugs, such as prescription painkillers, heroin, fentanyl, and newer, dangerous synthetics. Many people who struggled with prescription narcotics are now turning to heroin, which is cheaper and, with tougher opioid regulations, easier to find.
Nearly every demographic in the country has been affected by opioid addiction and overdose, which means that the US economy feels the impact. While countries around the world struggle with an opioid epidemic, the United States consumes 80 percent of the global opioid supply. More Americans abused opioid drugs than cigarettes, cigars, or e-cigarettes in 2015. From medical costs to labor shortages, the opioid epidemic is harming the country in many ways.
History of the Opioid Epidemic
Although the modern opioid epidemic is ravaging the United States and much of the world, addiction struggles involving opiatesdate back thousands of years. The history of opiates dates back to early human civilization when the analgesic and intoxicating properties of the opium poppy were first discovered. The drug has been used in medicine and as a substance of abuse ever since.
Morphine was the first synthetic opiate developed from opium, and it was created as a painkiller. It was so widely used to treat soldiers during the Civil War that addiction to morphine gained the nickname “soldier’s disease.”
To combat the addictive properties of morphine, heroin was developed in the 19th century. Faster-acting and intended to be safer, heroin was a very popular prescription drug for decades until it was found to be more addictive and dangerous than morphine. When the Controlled Substances Act (CSA) became law, heroin was placed in the list of Schedule I drugs, which are dangerous and have no medical use; morphine, on the other hand, is still prescribed for pain management.
A new synthetic narcotic, oxycodone, was approved by the Food and Drug Administration (FDA) for medical use in 1950. Since the 1960s, various prescription drugs containing oxycodone have proven problematic for thousands of Americans.
After the 1970 passage of the CSA, President Richard Nixon declared a “War on Drugs” with a 1973 executive order, citing not prescription narcotics, but heroin as the most dangerous opioid being abused in the country. The executive order created the Drug Enforcement Administration (DEA), which helps monitor substances of abuse and places then in schedules according to the CSA.
Although hydrocodone-based drugs were introduced to the US market in the late 1970s, most doctors began avoiding prescription narcotics by the 1980s. The War on Drugs created “opiophobia,” the fear of prescription opioids, throughout the medical community. Although the War on Drugs mainly focused on low-income, urban heroin addicts, and even struggled with a racial bias against non-white populations, the tighter control doctors held over prescribing painkillers helped stem part of the opioid addiction crisis.
By the 1990s, however, physicians faced criticism that their reluctance to prescribe opioid painkillers led to unnecessary pain among many of their patients, especially those who had undergone surgery or who suffered an injury requiring months to heal. Both pharmaceutical companies, who had developed new opioid drugs like OxyContin, and pain treatment societies began lobbying for greater treatment for all kinds of pain, not just cancer-related chronic pain. By 1999, physicians began relaxing their rules around prescribing narcotic drugs, and people with work-related injuries, post-surgical pain, dental pain, and non-cancer chronic pain conditions like fibromyalgia began receiving various doses of opioid drugs. Estimates suggest that there were 11 million prescriptions for opioid drugs by 1999, and in that year, 4 million people, ages 12 and older, in the United States began abusing prescription opioids for nonmedical reasons because they were so widely available.
A decade after physicians relaxed prescribing practices, and pharmaceutical companies flooded televisions and print publications with advertisements for opioid drugs, lawmakers and medical professionals found that thousands of adolescents and adults across the nation struggled with prescription painkiller addiction, abuse, and overdose. By 2010, states began passing laws to monitor prescriptions for narcotics, close pill mills, force doctors to monitor their patients more closely, and crack down on those who diverted these drugs for illicit use. Although the number of people who abuse prescription narcotics has been declining due to these efforts, the number of people who abuse heroin is on the rise.
Among those who began abusing Percocet, Vicodin, OxyContin, and other prescribed narcotics, one survey found that 66 percent eventually switched to other narcotic drugs, especially heroin. Recent studies suggest that as many as 26 percent of those receiving prescription painkillers for non-cancer pain become addicted to these drugs. When they cannot get prescription opioids, they turn to heroin rather than seeking treatment, which is much harder to access.
As of 2017, about 80 percent of those currently struggling with heroin addiction began abusing prescription opioids. As new designer synthetic opiates, like illicit fentanyl and grey death, make their way to the black market, more people are overdosing because they do not know what they are consuming.
In 2014, there were 240 million prescriptions for opioid drugs, enough for every adult in the country to have a bottle.
The Economic Impact of Opioid Abuse
Substance use disorders in general cost the United States $420 billion every year from healthcare costs, lost economic productivity, and crime. Drug abuse takes its toll on industries and companies, costing $81 billion annually. Of the 14.8 million Americans struggling with illicit drugs, including heroin, 70 percent are currently employed. People who are intoxicated on the job risk their own safety as well as the safety of those around them, and they are often unable to perform basic job-related tasks. This is true of both blue-collar and white-collar workers.
Societal costs associated with the opioid epidemic were found to be $55.7 billion in 2007, rising steeply from $8.2 billion in 2001. This includes excess medical spending, around $2.6 billion in 2006; criminal justice, around $1.4 billion; and workplace costs, around $4.6 billion. By 2009, medical spending went up to $25 billion; workplace costs increased to $25.6 billion; and criminal justice costs increased to $5.1 billion. The National Institute on Drug Abuse (NIDA) reported that, by 2013, total estimated costs associated with the opioid epidemic rose to $78.5 billion.
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Unemployment and Labor Shortage
A 2017 report from Goldman Sachs found that drug abuse, particularly opioid addiction, was a “key factor” explaining why adults, predominantly male workers, were unable or unwilling to find jobs. The Labor Department found that a declining number of adult Americans were seeking employment. The shrinking labor force, compared to the growing adult population in the country, is considered one of the reasons that the US economy has stagnated since the Great Recession in 2008.
Employment of American males between the ages of 25 and 54 has fallen 10 percent since 1954, when this demographic’s employment was at its peak. The all-time reported low occurred in 2014, with 87.9 percent of adult males currently employed; in 2017, that number was slightly higher, at 88.4 percent. While many other factors – including declining numbers of jobs, fewer entry-level jobs, globalization, and increased use of technology – contribute to declining numbers of employed American adults, opioids are a significant factor.
The Atlanta Federal Reserve found, at the beginning of 2017, that 1.8 million working-age adults in the country reported being out of work for “other” reasons – they were not retired, disabled, in school, or caring for a loved one. At the same time, about 881,000 workers reported taking an opioid the day before the survey.
Workplace costs in 2011 were predominantly driven by:
- Lost wages related to premature death, at $11.2 billion
- Reduced employment and compensation, at $7.9 billion
- Presenteeism, or working while sick or intoxicated, at $2 billion
- Absenteeism and absence due to incarceration, at $1.8 billion each
- Excess disability costs, at $807 million
Workplace costs also involved those who left work to care for a loved one struggling with opioid addiction.
Criminal Justice Costs
Criminal justice costs in 2011 were associated mainly with correctional facility costs, at $2.3 billion, and police enforcement, at $1.5 billion. Of the $5.1 billion in 2011 that went to opioid-related criminal justice costs:
- 1 percent involved correctional facilities
- 7 percent involved police protection
- 1 percent involved legal fees and adjudication
- 2 percent involved property loss due to crime
People who struggle with opioid addiction are more likely to require medical services, especially emergency services due to overdose. Among those struggling with opioid addiction who had private insurance between 2002 and 2012, excess costs from additional related medical care ranged from $14,054 to $20,546. For public programs like Medicaid, excess costs during that time ranged from $5,874 to $15,183.
One survey found that privately insured individuals struggling with opioid abuse incurred about $24,193 in total direct healthcare costs per person; in comparison, privately insured individuals who did not struggle with opioid abuse incurred about $3,647 in similar costs. Among Medicaid-enrolled individuals struggling with opioid addiction, they incurred about $26,724 of total direct healthcare costs per person while those who were not struggling with opioid addiction incurred $11,542 per person.
The American Society of Addiction Medicine (ASAM) reported that, in 2011, excess medical and prescription costs due to opioid addiction and abuse were $23.7 billion. By 2013, estimated healthcare costs increased to $26 billion.
The associated costs of treating opioid addiction include the following:
- Methadone is about $6,552 per person, per year.
- Buprenorphine is about $5,980 per person, per year.
- Naltrexone is about $14,112 per person, per year.
While these may seem like high numbers for individual treatment, using evidence-based treatments including maintenance medications to help those struggling with opioid abuse reduces costs associated with emergency medical treatment, death, loss of working years, and other issues. While there are a few years of medical costs, these individuals will be able to contribute to the economy on a long-term basis and will have reduced lifetime medical costs.
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Stopping the Loss of Life and Financial Impact of the Opioid Epidemic
The CDC reports that 91 people in the US die from opioid overdoses every day, and nearly 1,000 people are treated in emergency rooms because they have misused a prescription opioid. Deaths from prescription opioid drugs have quadrupled since prescribing practices were relaxed in 1999.
With evidence-based treatment, including medically supervised detox, better access to maintenance medications, and therapy through a rehabilitation program, people struggling with opioid addiction can overcome their condition, reduce their risk of relapse, and return to society. They can return to work, get job retraining, or act as caregivers so others in their family can focus on work. Investing in better access to appropriate treatment will reduce the overall economic impact of opioid addiction and overdose.
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