Currently Viewing:
Supplements Combating the Opioid Epidemic
Currently Reading
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
Participating Faculty
Posttest

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

Conclusions

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: hagemeier@etsu.edu.
 
1. NIH fact sheets—pain management. National Institutes of Health website. report.nih.gov/nihfactsheets/ViewFactSheet.aspx?csid=57. Updated March 29, 2013. Accessed February 28, 2018.
2. Herndon CM, Strickland JM, Ray JB. Pain management. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill Education; 2017. accesspharmacy.mhmedical.com/content.aspx?aid=1148575483. Accessed April 20, 2018.
3. Nahin RL. Estimates of pain prevalence and severity in adults: United States, 2012. J Pain. 2015;16(8):769-780. doi: 10.1016/j.jpain.2015.05.002.
4. Institute of Medicine Committee on Advancing Pain Research, Care, and Education. Relieving Pain in America. Washington, DC: National Academies Press; 2011. doi: 10.17226/13172.
5. CDC: National Center for Health Statistics. Summary health statistics: National Health Interview Survey, 2016. ftp.cdc.gov/pub/Health_Statistics/NCHS/NHIS/SHS/2016_SHS_Table_A-5.pdf. Published 2016. Accessed April 10, 2018.
6. Get the facts on pain. American Academy of Pain Medicine website. www.painmed.org/patientcenter/facts_on_pain.aspx. Accessed February 28, 2018.
7. Anwar K. Pathophysiology of pain. Dis Mon. 2016;62(9):324-329. doi: 10.1016/j.disamonth.2016.05.015.
8. Bonnie RJ, Ford MA, Phillips JK, et al. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. Washington, DC: National Academies Press (US); 2017. doi: 10.17226/24781.
9. Dueñas M, Ojeda B, Salazar A, Mico JA, Failde I. A review of chronic pain impact on patients, their social environment and the health care system. J Pain Res. 2016;9:457-467. doi: 10.2147/JPR.S105892.
10. Toblin RL, Quartana PJ, Riviere LA, Walper KC, Hoge CW. Chronic pain and opioid use in US soldiers after combat deployment. JAMA Intern Med. 2014;174(8):1400-1401. doi: 10.1001/jamainternmed.2014.2726.
11. Manchikanti L, Atluri S, Hansen H, et al. Opioids in chronic noncancer pain: have we reached a boiling point yet? Pain Physician. 2014;17(1):e1-e10.
12. Portenoy RK, Foley KM. Chronic use of opioid analgesics in non-malignant pain: report of 38 cases. Pain. 1986;25(2):171-186.
13. America’s addiction to opioids: heroin and prescription drug abuse. National Institute of Drug Abuse website. drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2016/americas-addiction-to-opioids-heroin-prescription-drug-abuse. Updated May 14, 2014. Accessed February 20, 2018.
14. Schumacher MA, Basbaum AI, Naidu RK. Opioid agonists and antagonists. In: Katzung BG, ed. Basic Clinical Pharmacology. 14th ed. New York, NY: McGraw-Hill Education; 2017. accesspharmacy.mhmedical.com/content.aspx?aid=1148437600.
15. Kestenbaum MG, Vilches AO, Messersmith S, et al. Alternative routes to oral opioid administration in palliative care: a review and clinical summary. Pain Med. 2014;15(7):1129-1153. doi: 10.1111/pme.12464.
16. Federation of State Medical Boards of the United States, Inc. Model policy for the use of controlled substances for the treatment of pain. 2004. Indian Health Service website. www.ihs.gov/painmanagement/includes/themes/newihstheme/display_objects/documents/modelpolicytreatmentpain.pdf. Accessed April 20, 2018.
17. Joranson DE, Ryan KM, Gilson AM, Dahl JL. Trends in medical use and abuse of opioid analgesics. JAMA. 2000;283(13):1710-1714.
18. Department of Veterans Affairs. Pain as the 5th vital sign toolkit. VA website. www.va.gov/PAINMANAGEMENT/docs/Pain_As_the_5th_Vital_Sign_Toolkit.pdf. Published October 2000. Accessed February 28, 2018.
19. Phillips DM. JCAHO pain management standards are unveiled. Joint Commission on Accreditation of Healthcare Organizations. JAMA. 2000;284(4):428-429.
20. Felter C. The US opioid epidemic. Council on Foreign Relations website. www.cfr.org/backgrounder/us-opioid-epidemic. Updated December 26, 2017. Accessed February 28, 2018.
21. Daubresse M, Chang HY, Yu Y, et al. Ambulatory diagnosis and treatment of nonmalignant pain in the United States, 2000–2010. Med Care. 2013;51(10):870-878. doi: 10.1097/MLR.0b013e3182a95d86.
22. CDC. Annual surveillance report of drug-related risks and outcomes. Washington, DC: CDC National Center for Injury Prevention and Control; 2017. cdc.gov/drugoverdose/pdf/pubs/2017-cdc-drug-surveillance-report.pdf. Accessed February 28, 2018.
23. Opioid overdose: prescribing data. CDC website. cdc.gov/drugoverdose/data/prescribing.html. Updated August 30, 2017. Accessed February 28, 2018.
24. McDonald DC, Carlson K, Izrael D. Geographic variation in opioid prescribing in the U.S. J Pain. 2012;13(10):988-996. doi: 10.1016/j.jpain.2012.07.007.
25. Eriksen J, Sjøgren P, Bruera E, Ekholm O, Rasmussen NK. Critical issues on opioids in chronic non-cancer pain: an epidemiological study. Pain. 2006;125(1-2):172-179. doi: 10.1016/j.pain.2006.06.009.
26. Kalso E, Edwards JE, Moore AR, McQuay HJ. Opioids in chronic non-cancer pain: systematic review of efficacy and safety. Pain. 2004;112(3):372-380. doi: 10.1016/j.pain.2004.09.019.
27. Krebs EE, Gravely A, Nugent S, et al. Effect of opioid vs nonopioid medications on pain-related function in patients with chronic back pain or hip or knee osteoarthritis pain. JAMA. 2018;319(9):872-882. doi: 10.1001/jama.2018.0899.
28. The opioid epidemic by the numbers. Department of Health and Human Services website. hhs.gov/opioids/sites/default/files/2018-01/opioids-infographic.pdf. Updated January 2018. Accessed February 28, 2018.
29. HHS acting secretary declares public health emergency to address national opioid crisis [news release]. Washington, DC: US Department of Health and Human Services; October 26, 2017. hhs.gov/about/news/2017/10/26/hhs-acting-secretary-declares-public-health-emergency-address-national-opioid-crisis.html. Accessed February 28, 2018.
30. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Washington, DC: American Psychiatric Association; 2013.
31. Substance use disorders. Substance Abuse and Mental Health Services Administration website. samhsa.gov/disorders/substance-use. Updated October 27, 2015. Accessed April 10, 2018.
32. Combating misuse and abuse of prescription drugs: Q&A with Michael Klein, PhD. FDA website. www.fda.gov/ForConsumers/ConsumerUpdates/ucm220112.htm. Published July 28, 2010. Accessed March 12, 2018.
33. Jones CM, Paulozzi LJ, Mack KA. Sources of prescription opioid pain relievers by frequency of past-year nonmedical use. JAMA Intern Med. 2014;174(5):802-803. doi: 10.1001/jamainternmed.2013.12809.
34. Fudin J, Pratt Cleary J, Schatman ME. The MEDD myth: the impact of pseudoscience on pain research and prescribing-guideline development. J Pain Res. 2016;9:153-156. doi: 10.2147/JPR.S107794.
35. Calculating total daily dose of opioids for safer dosage: how much is 50 or 90 MME/day for commonly prescribed opioids? CDC website. cdc.gov/drugoverdose/prescribing/guideline.html. Updated August 29, 2017. Accessed February 28, 2018.
36. Drugs@FDA: FDA approved drug products: Janssen Pharms. FDA website. www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=085055. Accessed March 11, 2018.
37. Guy GP, Zhang K, Bohm MK, et al. Vital signs: changes in opioid prescribing in the United States, 2006–2015. MMWR Morb Mortal Wkly Rep. 2017;66(26):697-704. doi: 10.15585/mmwr.mm6626a4.
38. Wu LT, Woody GE, Yang C, Blazer DG. How do prescription opioid users differ from users of heroin or other drugs in psychopathology: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Addict Med. 2011;5(1):28-35. doi: 10.1097/ADM.0b013e3181e0364e.
39. Rudd RA, Seth P, David F, Scholl L. Increases in drug and opioid-involved overdose deaths—United States, 2010–2015. MMWR Morb Mortal Wkly Rep. 2016;65(5051):1445-1452. doi: 10.15585/mmwr.mm655051e1.
40. Opioid overdose: understanding the epidemic. CDC website. cdc.gov/drugoverdose/epidemic/index.html. Updated August 30, 2017. Accessed February 28, 2018.
41. Overdose death rates. National Institute on Drug Abuse website. drugabuse.gov/related-topics/trends-statistics/overdose-death-rates. Updated September 2017. Accessed February 28, 2018.
42. CDC. Vital signs: overdoses of prescription opioid pain relievers—United States, 1999–2008. MMWR Morb Mortal Wkly Rep. 2011;60(43):1487-1492.
43. Fibbi M, Silva K, Johnson K, Langer D, Lankenau SE. Denial of prescription opioids among young adults with histories of opioid misuse. Pain Med. 2012;13(8):1040-1048. doi: 10.1111/j.1526-4637.2012.01439.x.
44. Prescription opioid overdose data. CDC website. cdc.gov/drugoverdose/data/overdose.html. Updated August 1, 2017. Accessed April 10, 2018.
45. Griffin ML, Bennett HE, Fitzmaurice GM, Hill KP, Provost SE, Weiss RD. Health-related quality of life among prescription opioid-dependent patients: results from a multi-site study. Am J Addict. 2015;24(4):308-314. doi: 10.1111/ajad.12188.
46. Chen VCH, Ting H, Wu MH, Lin TY, Gossop M. Sleep disturbance and its associations with severity of dependence, depression and quality of life among heroin-dependent patients: a cross-sectional descriptive study. Subst Abuse Treat Prev Policy. 2017;12(1):16. doi: 10.1186/s13011-017-0101-x.
47. Center for Substance Abuse Treatment. Medication-assisted treatment for opioid addiction in opioid treatment programs. Rockville, MD: Substance Abuse and Mental Health Services Administration (US); 2005. Report No: (SMA) 12-4214. www.ncbi.nlm.nih.gov/books/NBK64164/pdf/Bookshelf_NBK64164.pdf.
48. Nebhinani N, Anil BN, Mattoo SK, Basu D. Family burden in injecting versus noninjecting opioid users. Ind Psychiatry J. 2013;22(2):138-142. doi: 10.4103/0972-6748.132928.
49. Mattoo SK, Nebhinani N, Kumar BNA, Basu D, Kulhara P. Family burden with substance dependence: a study from India. Indian J Med Res. 2013;137(4):704-711.
50. Guy GP, Pasalic E, Zhang K. Emergency department visits involving opioid overdoses, U.S., 2010–2014. Am J Prev Med. 2018;54(1):e37-e39. doi: 10.1016/j.amepre.2017.09.003.
51. Birnbaum HG, White AG, Schiller M, Waldman T, Cleveland JM, Roland CL. Societal costs of prescription opioid abuse, dependence, and misuse in the United States. Pain Med. 2011;12(4):657-667. doi: 10.1111/j.1526-4637.2011.01075.x.
52. Council of Economic Advisers (CEA). The underestimated cost of the opioid crisis: executive summary. Washington, DC: Council of Economic Advisers (CEA); 2017. whitehouse.gov/sites/whitehouse.gov/files/images/The Underestimated Cost of the Opioid Crisis.pdf. Accessed February 28, 2018.
53. Meyer R, Patel AM, Rattana SK, Quock TP, Mody SH. Prescription opioid abuse: a literature review of the clinical and economic burden in the United States. Popul Health Manag. 2014;17(6):372-387. doi: 10.1089/pop.2013.0098.
54. Florence CS, Zhou C, Luo F, Xu L. The economic burden of prescription opioid overdose, abuse, and dependence in the United States, 2013. Med Care. 2016;54(10):901-906. doi: 10.1097/MLR.0000000000000625.
55. The Comprehensive Addiction and Recovery Act (CARA). 114th Congress, PL 114-198, 2016.
cadca.org/comprehensive-addiction-and-recovery-act-cara. Accessed March 11, 2018.
 
PDF
 
Copyright AJMC 2006-2020 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
x
Welcome the the new and improved AJMC.com, the premier managed market network. Tell us about yourself so that we can serve you better.
Sign Up