Opioid Addiction and Doctor Prescribing

Opioid epidemic may have cost US governments $37.8 billion in tax revenue

Science News, Source: Penn State

Date: April 11, 2019

Wendy:  This article looks at the impact of the opiod crisis in terms of human capital.  Opiods and related drug use of course has a powerful and fully destructive impact on individuals, families, communities, states and the nation in human terms but losing so many that could be healthy contributing members of society.  Instea

Researchers found that Pennsylvania was one of the states with the most lost revenue, with approximately $638.2 million lost to income and sales tax. The study looked at data between 2000 and 2016.

Joel Segel, assistant professor of Health Policy and Administration, said that the results — recently published in the journal Medical Care — could help governments that are hoping to make up for lost revenue.

“This is a cost that was maybe not thought about as explicitly before, and a cost that governments could potentially try to recoup,” Segel said. “Instead of focusing on the cost of treating people with opioid use disorder, you could think about it in terms of a potential benefit to getting people healthy, back on their feet, and back in the workforce.”

Previous research estimated that in 2016 there were nearly 2.1 million Americans with an opioid use disorder, and approximately 64,000 deaths were the result of an opioid overdose. According to the National Institute on Drug Abuse, there were 2,235 opioid-related overdose deaths in Pennsylvania alone.

Segel said that while previous studies have looked at the cost of the opioid epidemic in terms of substance abuse treatment and other medical costs, he and the other researchers were interested in exploring other costs that may not have been captured before.

“We wanted to take a systematic approach to how we could think about some of the tax revenue that is lost if someone is unable to work due to opioid use,” Segel said. “This could be an important consideration for either state or federal budgets.”

The researchers used data from the National Survey on Drug Use and Health, as well as information from a previous study that estimated declines in the labor force due to the opioid epidemic. They used the TAXSIM calculator from the National Bureau of Economic Research to estimate losses in tax revenue.

After analyzing the data, the researchers found that from 2000 to 2016, there was an estimated decline of 1.6 million participants in the labor force, with about 68,000 of those in Pennsylvania. There were about 180,000 overdose deaths, with approximately 6,100 occurring in Pennsylvania.

Additionally, the researchers estimated losses of $11.8 billion to state governments and $26 billion to the federal government in tax revenue due to reductions in the labor force. For state governments, this included lost sales tax and income tax revenue. Losses to the federal government were entirely due to lost income tax revenue.

Segel said the results help show the value of treating people with opioid use disorder, and should be considered when treatment programs are being considered and evaluated.

“The state of Pennsylvania has been developing some innovative programs, and our results are something to consider as these programs are being considered for implementation,” Segel said. “Not only are treatment programs beneficial to the individual and to society, but if you’re thinking about the total cost of these treatment programs, future earnings from tax revenue could help offset a piece of that.”

 

Doctors Play A Role In The Opioid Addiction Epidemic, Study Finds

A quarter of patients given a short-term prescription for painkillers transitioned to long-term use.

Staff Writer, The Huffington Post
Posted: 09/04/2015 06:22 PM EDT | Edited: 09/04/2015 06:25 PM EDT

We know how opioid addictions end: all too often, in death by overdose. About 16,000 Americans every year die of an overdose of opioid painkillers, such as oxycodone or fentanyl, according to the Centers for Disease Control and Prevention.

We know less about how opioid addictions start. It’s much harder to find and study people who start taking too many pills than it is to count dead bodies. But it’s becoming clear that the opioid addictions, which have ruined millions of lives over the past decade, rarely begin the way you might imagine a life-ruining addiction begins — on some gang-ridden street corner.

Many start with an innocuous visit to the doctor’s office.

To begin to figure out how many, a team at the Mayo Clinic, led by pain specialist Dr. W. Michael Hooten, analyzed the medical records of 293 patients given a short-term prescription for opiates for the first time in 2009. These patients were being treated for acute pain — from traumas such as sprained ankles or major surgeries — so their doctors did not expect them to become long-term users of painkillers.

Yet just over 1 in 4 of these patients went on to use opioid painkillers for longer than 90 days, researchers found. A quarter of this subset engaged in so-called long-term use, defined as receiving at least 120 days’ worth of pills or more than 10 separate prescriptions.

It’s not yet clear how many of these patients developed an opioid addiction, Hooten said. (He’s planning on conducting further research in an effort to find out.) Past research has indicated that the “long-term” use category seems to be a key threshold for dependence: a large share of patients who take more than 120 days’ worth of opioids for longer than 90 days are still taking them a year later.

“This study looked at behavior in 2009. If you went back and found the people who were long-term users then, I can guarantee you that many of them became addicted,” said Dr. Andrew Kolodny, an expert in opioid addiction who was not involved in the study. “And I would not be surprised if some of them wound up dying of opioid overdoses.”

The other key finding of the study was that patients who used painkillers for at least 90 days were much more likely than the rest to have issues with other types of addiction. About 37 percent of smokers in the study used painkillers for at least 90 days, compared to 20 percent of non-smokers, and 51 percent of those with a history of substance abuse did, compared with 24 percent of those with no history.

“The patients’ age, their sex and even the severity of their medical problems are as not good predictors of short- or long-term use as a history tobacco use or of substance abuse,” Hoten said.

This correlation indirectly supports the idea that the transition to long-term use was an addictive-type behavior, Hoten said. It also suggests that doctors should be especially cautious when prescribing opioid painkillers to patients with a history of substance abuse or smoking.

“Before you provide an opioid prescription to a patient, it’s important to recognize that if they have a tendency to abuse substances, you should have a heightened sense of vigilance,” Hooten said.

Doctors and governmental agencies have already take steps to cut down on abuse of opioid painkillers — in part because it’s become increasingly clear that the drugs are not very effective for treating chronic pain.

“They don’t work well when you take them long term. They can even make pain worse,” Kolodny explained.

Several states require that doctors check an electronic prescription database to see whether patients are receiving opioid painkiller prescriptions from other doctors before writing a prescription for the drugs.

But the efficacy of such measures is limited because those with drug addictions who get cut off by their doctor often seek out other sources of painkillers. They can buy or steal them friends and family or purchase them from a drug dealer or off the Internet. A tragically large share of them also switch to heroin, abuse of which has almost doubled since 2002.

For that reason, Kolodny said, it’s crucial that doctors think carefully about whether to prescribe an opioid painkiller in the first place — and that patients think carefully about whether to begin treatment with those drugs, especially if they have a history of addiction.

That’s not to say that doctors should never prescribe opioid painkillers. “These are extremely important medicines for end-of-life care,” Kolody said. “I think they play a very important role when used short-term — for a few days after major surgery or a serious accident, for example. But using them long-term is a very bad idea.”