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America's opioid crisis

Opioid Epidemic May Have Cost States at Least $130 Billion in Treatment and Related Expenses – And That’s Just The Tip of the Iceberg

Every state bears the burden of the opioid crisis. Photo: Digital Deliverance/Shutterstock.com

Joel Segel, Pennsylvania State University; Douglas L. Leslie, Pennsylvania State University; Gary Zajac, Pennsylvania State University; Max Crowley, Pennsylvania State University, and Paul L. Morgan, Pennsylvania State University

The devastating health effects of the opioid epidemic have been well documented, with over 700,000 overdose deaths and millions more affected.

And Americans are learning more every day about the role drug companies and distributors played in flooding towns and cities across the country with pain pills.

We know comparatively less, however, about the financial costs of the crisis. Several studies have emerged in recent years that estimate the national economic costs of the epidemic at anywhere from US$53 billion to $79 billion in a single year.

But given that states have led the charge in suing opioid makers with the aim of recovering some of their own costs, we wanted to know more specifically how the crisis has hurt their budgets. This is critical to understanding what they can recover from their lawsuits.

So we led a team of 20 researchers at Penn State in a series of studies that looked at the various ways state budgets have borne the burden of the opioid crisis. The result is the first comprehensive tally of state opioid costs.

The high cost of overdoses and treatment

The most prominent – and largest – costs are those related to medical care.

Although prior studies have estimated the medical costs of opioid misuse, none has provided a comprehensive accounting of costs to states’ Medicaid programs. These costs include those related to overdoses, treatment for opioid-related conditions and other care they may receive due to resulting health consequences such as hepatitis C and HIV.

Our team crunched the data from 17 states’ Medicaid claims databases and then extrapolated the data to make national-level estimates. We estimate that overall, state Medicaid programs spent at least $72 billion due to opioid misuse from 1999 to 2013, the most recent year with available data.

Based on an estimate of Medicaid costs of $8.4 billion in 2013, we estimate states likely spent an additional $40 billion since then, bringing the total bill to at least $112 billion.

Lower employment, less tax revenue

In addition to effects on health care use, opioid misuse can also lead to significant declines in employment, which in turn can then rob states of expected tax revenue.

Using an online tax simulator and an existing study on the effect of individuals leaving the workforce due to opioid misuse, we were able to estimate how much tax revenue states may have lost.

We estimate that states may have lost nearly $12 billion in tax revenue from 2000 to 2016 due to the effect of opioid misuse on individuals’ ability to work. Ongoing costs are about $700 million a year, bringing an estimated total through 2018 to over $13 billion.

There are other costs to states associated with a share of the population being unable to work, such as rising eligibility for cash assistance, nutrition programs, state-funded health insurance and other safety-net programs.

While we do not have good data available to provide estimates, moving forward these will be important costs for states to consider.

The costs of prosecuting and incarcerating people who misuse opioids can add up. Photo: AP Photo/Elise Amendola

Criminal justice costs

Criminal justice is another important component of opioid-related costs to states.

To date, many cost studies have focused on how those in prison or jail may be unable to work. Yet states and local municipalities spend considerable resources on arrests, courts and corrections that result from opioid misuse.

While several studies have attempted to estimate these costs, none have comprehensively examined the full set of opioid-related criminal justice costs at the state level. Due to the difficulty of obtaining reliable data, our team focused on Pennsylvania. We estimate that, from 2007 to 2016, the opioid crisis cost the criminal justice system in the state $526 million.

These figures are highly variable from year to year and among all the states, making it very difficult to come up with a comprehensive, nationwide estimate. Given that Pennsylvania has both a large population and has been hit unusually hard by the opioid crisis, costs in Pennsylvania are likely higher than average.

However, the Pennsylvania estimates demonstrate the costs are high and are likely to veer well into the billions of dollars nationwide.

Children are affected by their loved ones’ addictions – and states pay for it. Photo: AP Photo/David Goldman

Caring for children

While much of the attention has focused on those misusing opioids, one of the populations hardest hit by opioid misuse is children.

Opioid misuse has been shown to lead to increased interventions from state welfare and child protection agencies. While data remain limited, our team used a modeling approach to show that opioid misuse may be associated with $2.8 billion in costs to the child welfare system across all states from 2011 to 2016.

Additionally, babies born to mothers who were using opioids prenatally may be born with withdrawal symptoms – namely, neonatal abstinence syndrome – that require significant care. The effects of neonatal abstinence syndrome, and the related costs, may continue for a long time as affected children may require significant special education resources.

Data in this area are inherently difficult to identify in each state. However, we found that for a cohort of children born with neonatal abstinence syndrome in Pennsylvania in 2015, additional costs to provide special education services might have been about $8.3 million. A very rough estimate of the nationwide costs would be in the ballpark of at least $50 million per year.

Tip of the iceberg

Collectively our studies tallied about $85 billion in estimated financial costs to state budgets during the periods identified in each one. After extrapolating that to cover costs through 2018, we think the total comes to at least about $130 billion, with an ongoing bill of $6 billion to $10 billion every year.

While these figures might be lower than some other estimates that either include broader economic costs or fail to account for variations from year to year, the bottom line is that our data show states are bearing a very high financial burden in this crisis.

Our estimates also provide a benchmark states can use in litigation as they seek to recoup these costs to help cover the ongoing expenses associated with containing and ending the epidemic – and hint at why so many opioid manufacturers are mulling bankruptcy.

Yet our analysis is just the tip of the iceberg, as it covers only costs to state governments and excludes the broader economic costs of the crisis. Individuals and their families have also suffered enormously and are likely bearing even greater costs – both financial and emotional.

Joel Segel, Assistant Professor of Health Policy and Administration, Pennsylvania State University; Douglas L. Leslie, Professor of Public Health Sciences and Psychiatry, Pennsylvania State University; Gary Zajac, Managing Director of the Criminal Justice Research Center, Pennsylvania State University; Max Crowley, Assistant Professor of Human Development and Family Studies, Pennsylvania State University, and Paul L. Morgan, Eberly Fellow, Professor Education and Demography, and Director of the Center for Educational Disparities Research, Pennsylvania State University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

A public health crisis?

Quick Response Teams Aim to Get More Opioid Overdose Patients into Treatment

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One West Virginia city is trying a new approach to persuade more overdose patients to seek treatment. The idea is simple: Within 24 to 72 hours of an overdose, a “quick response team” fans out into the community and tries to meet with the patient to discuss treatment options. A handful of similar programs exist around the country, but West Virginia’s first team launched in December in Huntington with the help of two federal grants. Health officials said it already has been remarkably successful.

The Idea

“We’ve been having a lot of overdoses in Huntington and Cabell County and really the big thing that stood out to many of us is what are we doing afterwards?” said Bob Hansen, director of the Huntington quick response program.

He saw an article about a similar program in Colerain, Ohio. They invited the heads of that program to Huntington, did a training and loved it. So Hansen and several other key players in the local opioid-response programs orchestrated applications for two federal grants. They got both.

Colerain reported more than 80 percent of the people they visited were getting into treatment programs. Huntington was hoping for one in five.

They’re now in their fourth month and Hansen said they’re getting up to 40 percent of the people they engage with into treatment.

“And you think if we maintain that percentage over time it kind of has a cumulative effect. So you have to think by year three we should be really hitting the people to the point to getting more and more into programs,” he said.

In the Field

On a recent afternoon, the team reviewed cases for the day, then hopped in the car to begin tracking down the patients. Its members include police officer Chris Trembley and her teammates, Sue Howland who works for Prestera and Larrecsa Cox, a paramedic.

“I wouldn’t approach her at the hacienda, which is the house she’s been staying at — I would just watch for her. Because the house she’s been staying at, the guy there will make it [harder],” Trembley said to her teammates. “But if we happen to catch her out and about I think she’s kind of at that stage. Because for her to call last night is completely unlike her.”

“So she overdosed last week – on Wednesday. The on-duty supervisor called,” explained paramedic Cox about their first patient of the day. Cox is the only full-time staffer on the team. The representatives from the police department and Prestera rotate.

“She’s kind of — she’s actually a lot depressed,” said Cox. “At first when we went down there she wasn’t all that receptive, but the more we talked to her, she kind of warmed up to us, especially Sue. The next day we went back and spoke to her again … so we’re just going back today to follow up with her again.”

The first time they visited, the patient wasn’t ready to go into treatment, Cox said. “Yeah she’s still not ready. And we respect that. If someone’s not ready it’s best we know that — it doesn’t work if they’re forced into it.”

Howland, the counselor from Prestera, said at least they’re building a rapport with both her and her family. The patient, who’s 26, is living with grandparents.

Meeting with Patients

When the team arrives at the house, the grandfather lets us in and the team winds through the house and down into the basement where the patient is still sleeping.

“We just came by to make sure you went and you’re still doing good. Just touch base with you. Is there anything we can do for you?” Howland said.

The woman shook her head, becoming more animated as they ask about how well she’s eating, how her headaches have been and on her relationship with her grandparents. They’re there for about ten minutes. Then they leave.

Sue Howland talks with Chris Trembley before going out to meet patients. Photo by Kara Leigh Lofton.

Police officer Trembley said it’s all about the little wins.

“Maybe you just didn’t go use today. That’s one day. Maybe you might have used but because folks have talked to you and you were feeling good about things maybe you didn’t go out and shoplift today. Ok, that’s still a thing.”

Challenges

They visit another patient and then get in the car for one more try before Trembley has to suit up for an evening shift on patrol.

“Fake address.”

“Yeah.”

“So they didn’t give you a real address?

“Yeah, that’s common.”

“Very common.”

“Or a wrong phone number.”

“Like an area code from Mexico.”

“Got us.”

As the team leaves the fake address, Chris sees a drug exchange.

“That’s worth watching later today,” she said.

“What over here?” said Howland. “That’s a hot spot.”

“No, I’m pretty sure I just saw a hand-to-hand right there.”

The  team goes back to the station to drop off Trembley for her shift.

Charleston health officials are working on their own QRT with the grant from the DHHR in the coming months. Cabinet Secretary Bill Crouch called the move an “essential” part of the DHHR’s State Opioid Response Plan. The goal, he said, is to expand the effort until there’s a QRT in every major city in West Virginia.

This article was originally published on West Virginia Public Broadcasting.

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America's opioid crisis

Diamonds and Demons: Portrait of a Tennessee Community in Recovery

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We’re faced with an epidemic to opiates and it has affected just about every living room in this community, very much like it has across our entire nation.” –– Charlene Hipsher, Roane County District Attorney General’s Office.

The statistics are numbingly familiar. In 2016, more than 64,000 Americans died from a drug overdose, making it the leading cause of accidental death in the United States. Appalachian communities, including many in East Tennessee, are especially hard hit.

A participant speaks to the judge at the Roane County recovery court. Photo by Phil Batta and Jess Mador.

More Tennesseans died last year from an overdose than ever before in recorded state history: 1,631. Many of the deaths were linked to opioids such as fentanyl, heroin and painkillers.

At the epicenter of East Tennessee’s opioid crisis is Roane County, a mostly rural community about an hour outside Knoxville.

The epidemic has, “filled up our jails,” says District Attorney General Russell Johnson.

Jails are so overcrowded, many inmates sleep on floor mats. Many also suffer from untreated mental illness, trauma and health problems.

But, “more jail, more jail, more jail,” is not effective in helping addicts who commit nonviolent crimes, Roane County Judge Dennis Humphrey says.

A search for solutions prompted county officials to launch a specialized “recovery court” in 2016. The rigorous program aims to connect addicts with the intensive treatment they need to get clean and stay out of trouble.

Ernest Bright, one of the Roane County recovery court’s first graduates. Photo by Phil Batta and Jess Mador.

In this short TruckBeat documentary, we witness the court in action and meet one of its first graduates.

We learn how the program is changing the way many people in Roane County see the opioid epidemic –– and themselves.  And we explore the issues behind an East Tennessee lawsuit against opioid manufacturers, including OxyContin-maker Purdue Pharma.

“The Appalachian region is known for hardworking people. Prescription drug manufacturers targeted this area because hardworking people have aches and pains,” says Hipsher.

Cinematographer Phil Batta:

We began following the story of East Tennessee’s opioid epidemic in Roane County in 2015.

As TruckBeat’s cinematographer, I recognized that filming around sensitive topics like addiction, health and poverty in Appalachia posed ethical questions, constraints and creative challenges.

We approached the story with empathy, considering how visual choices could influence viewers’ perception of the community.

The Roane County courthouse in Kingston, East Tennessee, is the site of the county’s recently launched drug treatment “recovery court.” The strict program is designed to connect addicts who commit nonviolent crimes with the treatment and services they need to get clean and stay out of trouble. Photo by Phil Batta and Jess Mador.

Diamonds And Demons follows a graduate of Roane County’s recovery court.

Ernest Bright, one of the Roane County recovery court’s first graduates on graduation day. Photo by Phil Batta and Jess Mador.

I needed to symbolize his sorrow, struggles and hope.

 

 

Bare courtroom benches and a circle of unoccupied chairs at a Narcotics Anonymous meeting signify wasted human potential and the loss of loved ones to addiction. The empty seats are also an invitation to participate in solving the epidemic.

Filming inside the Roane County jail, we had a bird’s eye view of prisoner pods from behind a one-way mirror. We could see the inmates, but they couldn’t see us.

This invisible vantage point risked dehumanizing the inmates. To counterbalance our privileged view, I relied on composition, showing inmates intertwined with jail officials inside cell blocks, and human moments, such as inmates giving each other haircuts.

Trust is critical when working in often-stereotyped communities like those in Appalachia. As documentarians, the importance of answering, “why are we here?” cannot be overstated.

We cultivated relationships with key community members, who allowed our camera into places where people’s lives hung in the balance. We built personal networks that positioned us as collaborators in telling Roane County’s story, to the benefit of all involved.

TruckBeat’s serial format helped us capture a more accurate story of the place and the issues. Publishing quickly to the web meant subjects could see how we represented them in almost real time.

That we were invited back again and again to continue filming is a testament to the mutual trust we established.

About the story:

Diamonds And Demons is the fifth video documentary in TruckBeat’s Roane County series, which also includes dozens of audio stories produced at Knoxville’s WUOT public radio, and live storytelling events.

Credits:

Produced by: Jess Mador and Phil Batta for TruckBeat.
The video featured music by: Ars Sonor and Yuichiro Fujimoto

About TruckBeat: 

TruckBeat is an independently produced interactive health storytelling project featuring the voices and images of East Tennessee. TruckBeat was created by independent producer Jess Mador, in partnership with Matt Shafer Powell at WUOT, Knoxville’s NPR-member station. We take our bread truck turned mobile studio out on the road to report on community health topics in depth: addiction, obesity, mental health, access to health care – and why ZIP codes may matter more to health than genetics. TruckBeat originally launched in 2015 as part of AIR’s 15-city Localore: Finding America initiative.

Bios:

Jess Mador (@jessicamador) is TruckBeat’s Lead Producer. She’s an award-winning multimedia journalist who has produced stories for news organizations around the country, including Minnesota Public Radio, NPR News and PBS stations. She has a Master’s degree from the Columbia University Graduate School of Journalism. Mador is currently managing editor at NPR member-station WYSO in Yellow Springs, Ohio, while also continuing to produce TruckBeat independently.

Phil Batta is an award-winning cinematographer and director who specializes in creating short-form documentaries and visually rich multi-platform media for social impact. His work appears on PBS, The New Yorker, UK Channel 4, ITN, The Guardian, ABC7, CNN and ITVS. He’s also shot and edited projects honored as official selections at international film festivals and exhibitions.

More about TruckBeat:

On Oct. 7 in Washington, D.C., TruckBeat (@WeAreTruckBeat) was recognized by the Online News Association (ONA) for excellence in digital reporting, winning first prize in the Topical Reporting, Small Newsroom category. TruckBeat was also a finalist for Excellence and Innovation in Visual Digital Storytelling, Small Newsroom category.

Links:

TruckBeat homepage: https://www.truckbeat.org/

Vimeo direct link: https://vimeo.com/236213973

Facebook:

https://www.facebook.com/truckbeatproject/

https://www.facebook.com/jess.mador

https://www.facebook.com/philipp.batta

Instagram:

https://www.instagram.com/jessmador/

https://www.instagram.com/philbatta/

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