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Introduction to the Opioid Epidemic: The Economic Burden on the Healthcare System and Impact on Quality of Life
Nicholas E. Hagemeier, PharmD, PhD
The Role of Managed Care Professionals and Pharmacists in Combating Opioid Abuse
Kirk Moberg, MD, PhD
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Introduction to the Opioid Epidemic: The Economic Burden on the Healthcare System and Impact on Quality of Life

Nicholas E. Hagemeier, PharmD, PhD
Florence et al estimated the total economic burden of prescription opioid overdose, abuse, and dependence to be $78.5 billion in 2013.54 However, a recent executive summary released by the Council of Economic Advisers states that prior publications have underestimated the total cost of the opioid crisis, and it estimated the economic burden in 2015 to be $504 billion, which was more than 6 times higher than other estimates.52 Fatality costs comprise over 85% of total costs.52 Aside from fatality and healthcare costs, other costs include foregone earnings from employment and higher costs to the criminal justice system.52 Although this estimate is the first to include illicit drug use (eg, heroin, illicitly produced fentanyl), the authors note that only 14% of individuals with an OUD present with heroin use disorder in isolation.52


The opioid epidemic has been responsible for hundreds of thousands of lives lost over the past 2 decades, and millions more individuals and their families have been negatively affected by the misuse or abuse of prescription opioids. Although the origins of increased opioid use were well-intended attempts at optimal pain management, the result has become a costly increase in OUDs and death, with little evidence of improvement in chronic noncancer pain. National and government organizations, particularly the CDC, have recognized and initiated interventions to raise awareness and reduce opioid prescribing practices, and prescription rates have correspondingly stabilized. Additionally, the Comprehensive Addiction and Recovery Act (CARA), which was signed into law in 2016, was the first major federal addiction legislation in 40 years; CARA involves 6 pillars necessary for a complete, coordinated response to the opioid crisis: (1) prevention, (2) treatment, (3) recovery, (4) law enforcement, (5) criminal justice reform, and (6) overdose reversal.55 Initiatives such as these will combat both the supply and demand of the opioid epidemic; however, as prescription opioid abuse lessens, illicit abuse of opioids and overdose deaths from all opioids are increasing, indicating that much work remains to be done. 

Author affiliations: Department of Pharmacy Practice, East Tennessee State University Gatton College of Pharmacy, and ETSU Center for Prescription Drug Abuse Prevention and Treatment, Johnson City, Tennessee.
Funding source: This activity is supported by an educational grant from Daiichi Sankyo, Inc.
Author disclosure: Dr Hagemeier has no relevant financial relationships with commercial interests to disclose.
Authorship information: Analysis and interpretation of data; concept and design; critical revision of the manuscript for important intellectual content; drafting of the manuscript; supervision.
Address correspondence to:
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