The economic burden of opioid use disorder and fatal opioid overdose in the United States, 2017

Abstract

Background: The United States (U.S.) is experiencing an ongoing opioid crisis. Economic burden estimates that describe the impact of the crisis are needed when considering federal and state resources devoted to addressing overdoses. In this study, we estimate the societal costs for opioid use disorder and fatal overdose from all opioids in 2017.

Methods: We estimated costs of fatal overdose from all opioids and opioid use disorder based on the incidence of overdose deaths and the prevalence of past-year opioid use disorder for 2017. Incidence of fatal opioid overdose was obtained from the National Vital Statistics System; prevalence of past-year opioid use disorder was estimated from the National Survey of Drug Use and Health. Costs were estimated for health care, criminal justice and lost productivity. Costs for the reduced quality of life for opioid use disorder and life lost due to fatal opioid overdose were valued using U.S. Department of Health and Human Services guidelines for valuing reductions in morbidity and mortality.

Results: Costs for opioid use disorder and fatal opioid overdose in 2017 were estimated to be $1.02 trillion. The majority of the economic burden is due to reduced quality of life from opioid use disorder and the value of life lost due to fatal opioid overdose.

Conclusions: These estimates can assist decision makers in understanding the magnitude of opioid use disorder and fatal overdose. Knowing the magnitude and distribution of the economic burden can inform public policy, clinical practice, research, and prevention and response activities.

Keywords: Costs; Opioid; Overdose; Use disorder.

Figure. Sensitivity Analysis

Source: Author’s calculations using the National Survey of Drug Use and Health, the National Vital Statistics System, mortality data; Opioid Overdose deaths identified based on International Classification of Diseases, Tenth Revision codes for drug overdoses: X40-X44, X60-X64, X85, and Y10-Y14; the type of drug involved was based on ICD-10 codes for opioids (all T40.0-T40.4 and T40.6), and (Value of Statistical Life) Office of the Assistant Secretary for Planning and Evaluation. Guidelines for regulatory impact analysis. Washington, DC: U.S. Department of Health and Human Services; 2016. (Health Related Quality of Life) Woody GE, Poole SA, Subramaniam G, et al. Extended vs short-term buprenorphine-naloxone for treatment of opioid-addicted youth: a randomized trial. JAMA. 2008;300(17):2003–2011. Harris, A. H., Gospodarevskaya, E., & Ritter, A. J. (2005). A randomised trial of the cost effectiveness of buprenorphine as an alternative to methadone maintenance treatment for heroin dependence in a primary care setting. Pharmacoeconomics, 23(1), 77–91. (Fatal Overdose Undercount) Barocas, J., White, L., Jianing Wang, J., Walley, A., LaRochelle, M., Bernson, D., Land, T., Morgan, J., Samet, J., and Linas, B., 2018:Estimated Prevalence of Opioid Use Disorder in Massachusetts, 2011–2015: A Capture-Recapture Analysis. American Journal of Public Health 108, 1675–1681. (Nonfatal Use Disorder Undercount) Bronson, J. and Carson, E. Prisoners in 2017. 2019. U.S. Department of Justice, Washington, D.C.; Criminal Justice DrugFacts. 2020. National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services.; The Connection Between Homelessness and Addiction. 2020. Additions Center. (Health care costs) Davenport, S., A., Weaver, M., Caverly. 2019. Costs and Comorbidities of Opioid Use Disorder. Society of Actuaries. Milliman.