As the recent, untimely deaths of actors Philip Seymour Hoffman and Cory Monteith show, abuse of prescription drugs such as oxycodone, Percocet and Vicodin is a lethal problem in the United States. The human and economic toll is significant, not just in terms of lives ruined and lost, but also in driving up health care and criminal justice costs and reducing productivity in the workplace.
Prescription opioid abuse accounts for more deaths than heroin and cocaine combined. Over 11 million individuals use painkillers for non-medical reasons each year, and our research shows that the cost to society at large is more than $55 billion. These numbers are likely rising.
Here in Massachusetts, the number of opiate-related deaths has nearly doubled over the last decade, rising from 363 in 2000 to 642 in 2011, and now exceeds the death toll arising from car crashes. Since November 2013, Massachusetts State Police force reports almost 200 deaths from heroin overdoses alone.
On the national level, an itemized breakdown of the price tag for prescription opioid abuse reveals a number of significant cost drivers: emergency room visits and substance abuse treatment, among other medical costs, drive more than $24 billion in costs for private insurers, Medicare and Medicaid; correctional facilities and increased policing increase spending for the criminal justice system costs more than $5 billion; and employers bear a whopping $25 billion for related absenteeism and disability. This is a huge economic burden for society to pay.
What is being done?
Several major stakeholders – from states and government agencies to drug companies and retailers – have taken action and their efforts have achieved measurable results. For example, pharmaceutical manufacturers have developed innovative abuse-deterrent formulations (ADF) – crush- and tamper-resistant pills – designed to prevent abuse and make it harder to extract the chemicals needed to create heroin. Our research shows that ADFs have the potential to significantly reduce health care costs associated with prescription opioid abuse.
In addition, as required by the Food and Drug Administration, several pharmaceutical manufacturers have developed Risk Evaluation and Mitigation Strategies to manage the negative consequences of abuse.
Timely analysis of insurance claims data provides a promising opportunity to help stem the tide of prescription opioids abuse. An assessment of both medical claims as well as prescription claims can help detect patients who may be at risk for prescription opioid abuse. Analysis of these data shows that prior histories of mental health issues such as depression, as well as pharmacy and doctor “shopping,” are strongly associated with prescription opioid abuse. Armed with these insights, more than half of the states, as well as retail pharmacies, drug wholesalers, and the Drug Enforcement Agency (DEA), have initiated prescription drug monitoring programs (PDMPs) at various levels in the distribution chain designed to better detect drug abuse. Massachusetts currently has active PDMP that reports its findings to law enforcement and regulatory agencies.
The road ahead
Make no mistake; efforts to combat painkiller abuse are helping to address the problem and save costs. But a scattershot approach will not stem this flood for long or heal the devastation left in its wake. Only a comprehensive approach – driven by the federal government in partnership with the states – that coordinates the efforts of doctors, communities, policymakers, employers, insurers and law enforcement efforts will turn the tide of this epidemic. Efforts by Medical Review Groups of data collected by PDMPs to share with law enforcement and regulatory agencies are a step in the right direction.
Alan G. White is a managing principal for Analysis Group Inc. in Boston.
