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Fighting Opioid Overdoses Can Be Cost-Effective

September 17, 2018
The opioid crisis is one of the most recognizable domestic issues of contemporary America. Deaths attributed to drug overdoses have steadily risen over the last decade, and reached roughly 64,000 in 2016, a figure greater than the total number of Americans who died in the entirety of the Vietnam war.[1] [2] This makes drug overdoses the leading cause of death for Americans below age 50, and about two thirds of these deaths were due to opioids.[3][4]

Efforts to halt the opioid epidemic’s growth and to reduce its deadly impact on the nation have only had a marginal effect on abating the crisis.[5] Beyond the alarming death toll, the rise of opioid abuse and overdose has had a measurable impact on the economy, as well. Studies estimate that these drugs have cost the US economy $1 trillion since 2001 in treatment costs, lost productivity, etc..[6] Opioid abuse is also linked to the economy itself, having a disparate impact in areas of the country and groups of people who are suffering from the inequities of the current economic era.[7]

Image: Overdose Deaths Involving Opioids 2000-2016, Source: CDCImage: Overdose Deaths Involving Opioids 2000-2016, Source: CDC

Opinion is divided on how to combat the problem.[8] Some politicians have suggested that we go after the drug companies that have for decades peddled opioids as a panacea for pain relief, despite their addictive qualities and new research that compromise widely held misconceptions on the effectiveness of these drugs.[9][10] This stands true for the overprescribing doctors, who receive kickbacks for providing their patients with certain drugs.[11] In fact, 50% of those who overdosed did so on drugs acquired from a prescription.[12] While it is important to bring justice to those who knowingly enabled this drug addiction, such a scheme would not alleviate the current situation, and it carries legal drawbacks.[13]

Other policies, like expanding medication assisted treatment, or MAT, have also had a limited impact because of the stigma surrounding these services.[14] Furthermore, while MAT is an important component of treating drug addiction, it is only successful about half the time.[15] While more laws and regulations are passed to expand the number of beds in treatment centers or to make administering addiction treatment drugs easier, the expansion of the MAT model will take time and considerably more investment in order to have an impact.[16][17][18]

There is also a raft of proposed legislation in Congress, and maybe one will offer the perfect solution.[19] But as the death toll rises, reaching 91 deaths a day across America, it is unclear when any of the measures in the pipeline will pass or what their impact will be.[20][21]

With the crisis continuing unabated and no quick solution on the horizon, there is one proven, safe, and economical preventative measure already in existence. Naloxone is a drug that can halt an opioid overdose when administered correctly – it is cheap, easy to use, and effective.[22] It comes in spray (Narcan) and injectable (Evzio) forms.[23] Upon encountering an individual experiencing an opioid overdose, anyone can administer naloxone and, usually, prevent the overdose from becoming fatal.[24] Beyond that, naloxone has absolutely no effect on people who are not overdosing – it is completely safe, even if one accidentally administers it to themselves.[25]

While naloxone will not cure opioid addiction, it can play an important role in reversing overdoses and saving lives.[26] In fact, in areas where laypeople are trained and equipped with naloxone, there has been a significant reduction in overdose deaths.[27] Unfortunately, naloxone’s uptake across America has been lagging.[28]

Some city police departments have begun pilot programs to train officers in the use of naloxone. Afterwards, they are equipped with a few doses of the product.[29][30] As those most likely to find someone overdosing and to intervene, this is a good first step to saving lives. The same is true for emergency medical personnel and firefighters.[31] In April 2018, U.S. Surgeon General Jerome Adams issued a rare national advisory that encouraged a rapid expansion of naloxone use among both ordinary laypeople and municipal workers, which may provide the impetus necessary to rapidly expand these efforts.[32]

Not everyone suffering a possibly fatal overdose will have the relative fortune of being saved by one of these municipal employees equipped with naloxone. More rather, they will probably be discovered by friends or family members.[33] And yet, restrictions still exist for individuals trying to gain access to naloxone because it is a prescription drug with no predetermined recipients (and so third-party prescribing laws are necessary).[34] Cost and, in some states, a legally prescribed need for training, are also barriers that further impede access to the potentially lifesaving drug.[35][36] Furthermore, there are still some states that prevent drug chains, such as CVS and Walgreens, from legally stocking naloxone over the counter in every state, despite the drug chains’ express desire to do so.[37][38] For a lifesaving drug that has no ill effects, these restrictions are preventing the adoption of a lifesaving intervention.

In response to these barriers, cities and states have increased their efforts to expand training and access to naloxone.[39] But this, too, has led to issues, such as naloxone taking a larger share of equipment budgets and price increases by pharmaceutical companies – more than quintupling in 2016 for a certain naloxone formulation – as demand rises and no competition exists.[40][41][42] Furthermore, efforts to expand training and access have not always been successful, as federal policy controls many aspects of naloxone use.[43] Nevertheless, the developing momentum should prevail, and governments should not shy away from climbing costs. With the President’s Council of Economic Advisers’ estimated cost of overdoses in America reaching $500 billion in 2015, simple math would dictate that states and cities will save in the long run by covering naloxone’s costs – although there are also peer-reviewed models that support this contention.[44][45] Cities can also partner with nonprofits to reduce some of the cost burden and expand naloxone access.[46]

There are signs that the epidemic’s growth is slowing and leveling out.[47][48] While leveling out at nearly 64,000 deaths is not necessarily good news, there are indications that America’s mobilization against the opioid crisis is beginning to bear fruit.[49] By continuing to focus on expanding naloxone use and access, despite certain barriers, cities across America are finally tapping into a cost-effective and lifesaving measure in the fight to curb overdoses.

Student Blog Disclaimer
  • The views expressed on the Student Blog are the author’s opinions and don’t necessarily represent the Penn Wharton Public Policy Initiative’s strategies, recommendations, or opinions.

References

  [1]https://www.nytimes.com/interactive/2017/06/05/upshot/opioid-epidemic-drug-overdose-deaths-are-rising-faster-than-ever.html

  [2] https://www.vox.com/policy-and-politics/2017/6/6/15743986/opioid-epidemic-overdose-deaths-2016

  [3] https://www.nytimes.com/interactive/2017/06/05/upshot/opioid-epidemic-drug-overdose-deaths-are-rising-faster-than-ever.html

  [4] https://www.cnn.com/2017/12/21/health/drug-overdoses-2016-final-numbers/index.html

  [5] https://www.cdc.gov/drugoverdose/data/index.html

  [6] https://www.cnbc.com/2018/02/12/economic-cost-of-the-opioid-crisis-1-trillion-and-growing-faster.html

  [7] Carpenter, C. S., McClellan, C. B., & Rees, D. I. (2017). Economic conditions, illicit drug use, and substance use disorders in the United States. Journal of Health Economics, 52, 63-73.

  [8] https://www.nytimes.com/interactive/2018/02/14/upshot/opioid-crisis-solutions.html

  [9] Dineen, Kelly K., and James M. DuBois. “Between a rock and a hard place: can physicians prescribe opioids to treat pain adequately while avoiding legal sanction?.” American Journal of Law & Medicine 42.1 (2016): 7-52.

  [10] https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm

  [11] https://www.cnn.com/2018/03/11/health/prescription-opioid-payments-eprise/index.html

  [12] Shipton, Edward A., Elspeth E. Shipton, and Ashleigh J. Shipton. “A Review of the Opioid Epidemic: What Do We Do About It?.” Pain and therapy (2018): 1-14.

  [13] Dineen, Kelly K., and James M. DuBois. “Between a rock and a hard place: can physicians prescribe opioids to treat pain adequately while avoiding legal sanction?.” American Journal of Law & Medicine 42.1 (2016): 7-52.

  [14] https://www.vox.com/science-and-health/2017/7/20/15937896/medication-assisted-treatment-methadone-buprenorphine-naltrexone/

  [15] Sordo, Luis, et al. “Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies.” bmj 357 (2017): j1550.

  [16] https://www.nytimes.com/2018/02/25/science/fda-medication-assisted-therapy.html

  [17] https://www.congress.gov/bill/114th-congress/house-bill/34/

   [18] https://www.cnn.com/2018/02/26/health/medication-assisted-treatment-opioid-azar/index.html

  [19] https://www.cnn.com/2018/06/08/politics/house-congress-opioids-legislation-bipartisan-legislation/index.html

  [20]https://www.cdc.gov/features/fighting-opioid-overdose/index.html

  [21] https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2018/04/26/the-health-202-congress-is-moving-on-opioids-legislation-but-is-it-enough/5ae0ac0430fb04371192687e/?utm_term=.bf5588d2ffb4

  [22] http://time.com/4999223/what-is-narcan/

  [23] https://www.cdc.gov/drugoverdose/prevention/reverse-od.html

  [24] https://www.nytimes.com/2018/04/06/us/naloxone-narcan-opioid-overdose.html

  [25] https://www.nytimes.com/2018/04/06/us/naloxone-narcan-opioid-overdose.html

  [26] Walley, Alexander Y., et al. “Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis.” Bmj 346 (2013): f174.

  [27] https://www.washingtonpost.com/national/health-science/pharmacists-slow-to-dispense-lifesaving-overdose-drug/2018/01/03/0628c8e2-f06f-11e7-95e3-eff284e71c8d_story.html?utm_term=.0caad114105a

  [28] https://www.stltoday.com/news/local/crime-and-courts/all-st-louis-city-police-officers-to-begin-carrying-drug/article_4b817ae5-deef-5177-979e-05e0fcb7545e.html

  [29] https://www.cnn.com/2014/05/27/us/new-york-police-heroin-antidote/index.html

  [30] Davis, Corey S., et al. “Expanded access to naloxone among firefighters, police officers, and emergency medical technicians in Massachusetts.” American journal of public health 104.8 (2014): e7-e9.

  [31] https://www.surgeongeneral.gov/priorities/opioid-overdose-prevention/naloxone-advisory.html

  [32] http://www.chicagotribune.com/ct-lns-overdose-prevention-st-0325-20150324-story.html

  [33] https://www.nytimes.com/2018/04/06/us/naloxone-narcan-opioid-overdose.html

  [34] https://www.npr.org/sections/health-shots/2018/05/07/607760827/reversing-an-overdose-isnt-complicated-but-getting-the-antidote-can-be

  [35] Winstanley, Erin L., et al. “Barriers to implementation of opioid overdose prevention programs in Ohio.” Substance abuse 37.1 (2016): 42-46.

  [36] https://www.nytimes.com/2018/04/06/us/naloxone-narcan-opioid-overdose.html

  [37] Davis, Corey S., and Derek Carr. “Legal changes to increase access to naloxone for opioid overdose reversal in the United States.” Drug and alcohol dependence 157 (2015): 112-120.

  [38] https://news.walgreens.com/404.cfm?404;http://news.walgreens.com:80/press-releases/general-news/walgreens-stocking-life-saving-narcan-nasal-spray-in-all-pharmacies-nationwide.htm?404;http://news.walgreens.com:80/press-releases/general-news/walgreens-stocking-life-saving-narcan-nasal-spray-in-all-pharmacies-nationwide.htm

  [39] Kerensky, Todd, and Alexander Y. Walley. “Opioid overdose prevention and naloxone rescue kits: what we know and what we don’t know.” Addiction science & clinical practice 12.1 (2017): 4.

  [40] https://www.npr.org/sections/health-shots/2017/08/08/541626627/first-responders-spending-more-on-overdose-reversal-drug

  [41] https://www.washingtonpost.com/business/the-4500-injection-to-stop-heroin-overdoses/2017/01/27/becaaca4-dcf6-11e6-ad42-f3375f271c9c_story.html?utm_term=.72cc0afedafd

  [42] https://www.nejm.org/doi/full/10.1056/NEJMp1609578?page=0

  [43] https://www.nytimes.com/2018/04/12/nyregion/overdose-antidote-naloxone-investigation-hard-to-buy.html

  [44] https://www.whitehouse.gov/sites/whitehouse.gov/files/images/The%20Underestimated%20Cost%20of%20the%20Opioid%20Crisis.pdf

  [45] Langham, Sue, et al. “Cost-Effectiveness of Take-Home Naloxone for the Prevention of Overdose Fatalities among Heroin Users in the United Kingdom.” Value in health 21.4 (2018): 407-415.

  [46] https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6423a2.htm

  [47] https://www.nytimes.com/2018/02/19/nyregion/opioid-overdose-heroin-deaths-new-york.html

  [48] https://www.bostonglobe.com/metro/2018/05/22/opioid-overdose-deaths-continue-decline-but-chiefly-among-whites/ByP1lYu5VkOhm5jpWmqtjJ/story.html

  [49] https://www.nytimes.com/interactive/2017/06/05/upshot/opioid-epidemic-drug-overdose-deaths-are-rising-faster-than-ever.html

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RESOURCE SPOTLIGHT:

  • <h3>USDA Nutrition Assistance Data</h3><p><img width="180" height="124" alt="" src="/live/image/gid/4/width/180/height/124/485_usda_logo.rev.1407789238.jpg" class="lw_image lw_image485 lw_align_right" srcset="/live/image/scale/2x/gid/4/width/180/height/124/485_usda_logo.rev.1407789238.jpg 2x, /live/image/scale/3x/gid/4/width/180/height/124/485_usda_logo.rev.1407789238.jpg 3x" data-max-w="1233" data-max-h="850"/>Data and research regarding the following <strong>USDA Nutrition Assistance</strong> programs are available through this site:</p><ul><li>Supplemental Nutrition Assistance Program (SNAP) </li><li>Food Distribution Programs </li><li>School Meals </li><li>Women, Infants and Children </li></ul><p> Quick link: <a href="http://www.fns.usda.gov/data-and-statistics" target="_blank">http://www.fns.usda.gov/data-and-statistics</a></p><p>See all <a href="/data-resources/">data and resources</a> »</p>
  • <h3>HUD State of the Cities Data Systems</h3><p><strong><img width="200" height="200" alt="" src="/live/image/gid/4/width/200/height/200/482_hud_logo.rev.1407788472.jpg" class="lw_image lw_image482 lw_align_left" srcset="/live/image/scale/2x/gid/4/width/200/height/200/482_hud_logo.rev.1407788472.jpg 2x, /live/image/scale/3x/gid/4/width/200/height/200/482_hud_logo.rev.1407788472.jpg 3x" data-max-w="612" data-max-h="613"/>The SOCDS provides data for individual Metropolitan Areas, Central Cities, and Suburbs.</strong> It is a portal for non-national data made available through a number of outside institutions (e.g. Census, BLS, FBI and others).</p><p> Quick link: <a href="http://www.huduser.org/portal/datasets/socds.html" target="_blank">http://www.huduser.org/portal/datasets/socds.html</a></p><p>See all <a href="/data-resources/">data and resources</a> »</p>
  • <h3>Federal Reserve Economic Data (FRED®)</h3><p><strong><img width="180" height="79" alt="" src="/live/image/gid/4/width/180/height/79/481_fred-logo.rev.1407788243.jpg" class="lw_image lw_image481 lw_align_right" data-max-w="222" data-max-h="97"/>An online database consisting of more than 72,000 economic data time series from 54 national, international, public, and private sources.</strong> FRED®, created and maintained by Research Department at the Federal Reserve Bank of St. Louis, goes far beyond simply providing data: It combines data with a powerful mix of tools that help the user understand, interact with, display, and disseminate the data.</p><p> Quick link to data page: <a href="http://research.stlouisfed.org/fred2/tags/series" target="_blank">http://research.stlouisfed.org/fred2/tags/series</a></p><p>See all <a href="/data-resources/">data and resources</a> »</p>
  • <h3>Federal Aviation Administration: Accident & Incident Data</h3><p><img width="100" height="100" alt="" src="/live/image/gid/4/width/100/height/100/80_faa-logo.rev.1402681347.jpg" class="lw_image lw_image80 lw_align_left" srcset="/live/image/scale/2x/gid/4/width/100/height/100/80_faa-logo.rev.1402681347.jpg 2x, /live/image/scale/3x/gid/4/width/100/height/100/80_faa-logo.rev.1402681347.jpg 3x" data-max-w="550" data-max-h="550"/>The NTSB issues an accident report following each investigation. These reports are available online for reports issued since 1996, with older reports coming online soon. The reports listing is sortable by the event date, report date, city, and state.</p><p> Quick link: <a href="http://www.faa.gov/data_research/accident_incident/" target="_blank">http://www.faa.gov/data_research/accident_incident/</a></p><p>See all <a href="/data-resources/">data and resources</a> »</p>
  • <h3>Congressional Budget Office</h3><p><img width="180" height="180" alt="" src="/live/image/gid/4/width/180/height/180/380_cbo-logo.rev.1406822035.jpg" class="lw_image lw_image380 lw_align_right" data-max-w="180" data-max-h="180"/>Since its founding in 1974, the Congressional Budget Office (CBO) has produced independent analyses of budgetary and economic issues to support the Congressional budget process.</p><p> The agency is strictly nonpartisan and conducts objective, impartial analysis, which is evident in each of the dozens of reports and hundreds of cost estimates that its economists and policy analysts produce each year. CBO does not make policy recommendations, and each report and cost estimate discloses the agency’s assumptions and methodologies. <strong>CBO provides budgetary and economic information in a variety of ways and at various points in the legislative process.</strong> Products include baseline budget projections and economic forecasts, analysis of the President’s budget, cost estimates, analysis of federal mandates, working papers, and more.</p><p> Quick link to Products page: <a href="http://www.cbo.gov/about/our-products" target="_blank">http://www.cbo.gov/about/our-products</a></p><p> Quick link to Topics: <a href="http://www.cbo.gov/topics" target="_blank">http://www.cbo.gov/topics</a></p><p>See all <a href="/data-resources/">data and resources</a> »</p>
  • <h3>NOAA National Climatic Data Center</h3><p><img width="200" height="198" alt="" src="/live/image/gid/4/width/200/height/198/483_noaa_logo.rev.1407788692.jpg" class="lw_image lw_image483 lw_align_left" srcset="/live/image/scale/2x/gid/4/width/200/height/198/483_noaa_logo.rev.1407788692.jpg 2x, /live/image/scale/3x/gid/4/width/200/height/198/483_noaa_logo.rev.1407788692.jpg 3x" data-max-w="954" data-max-h="945"/>NOAA’s National Climatic Data Center (NCDC) is responsible for preserving, monitoring, assessing, and providing public access to the Nation’s treasure of <strong>climate and historical weather data and information</strong>.</p><p> Quick link to home page: <a href="http://www.ncdc.noaa.gov/" target="_blank">http://www.ncdc.noaa.gov/</a></p><p> Quick link to NCDC’s climate and weather datasets, products, and various web pages and resources: <a href="http://www.ncdc.noaa.gov/data-access/quick-links" target="_blank">http://www.ncdc.noaa.gov/data-access/quick-links</a></p><p> Quick link to Text & Map Search: <a href="http://www.ncdc.noaa.gov/cdo-web/" target="_blank">http://www.ncdc.noaa.gov/cdo-web/</a></p><p>See all <a href="/data-resources/">data and resources</a> »</p>
  • <h3>National Center for Education Statistics</h3><p><strong><img width="400" height="80" alt="" src="/live/image/gid/4/width/400/height/80/479_nces.rev.1407787656.jpg" class="lw_image lw_image479 lw_align_right" data-max-w="400" data-max-h="80"/>The National Center for Education Statistics (NCES) is the primary federal entity for collecting and analyzing data related to education in the U.S. and other nations.</strong> NCES is located within the U.S. Department of Education and the Institute of Education Sciences. NCES has an extensive Statistical Standards Program that consults and advises on methodological and statistical aspects involved in the design, collection, and analysis of data collections in the Center. To learn more about the NCES, <a href="http://nces.ed.gov/about/" target="_blank">click here</a>.</p><p> Quick link to NCES Data Tools: <a href="http://nces.ed.gov/datatools/index.asp?DataToolSectionID=4" target="_blank">http://nces.ed.gov/datatools/index.asp?DataToolSectionID=4</a></p><p> Quick link to Quick Tables and Figures: <a href="http://nces.ed.gov/quicktables/" target="_blank">http://nces.ed.gov/quicktables/</a></p><p> Quick link to NCES Fast Facts (Note: The primary purpose of the Fast Facts website is to provide users with concise information on a range of educational issues, from early childhood to adult learning.): <a href="http://nces.ed.gov/fastfacts/" target="_blank">http://nces.ed.gov/fastfacts/#</a></p><p>See all <a href="/data-resources/">data and resources</a> »</p>
  • <h3>Internal Revenue Service: Tax Statistics</h3><p><img width="155" height="200" alt="" src="/live/image/gid/4/width/155/height/200/486_irs_logo.rev.1407789424.jpg" class="lw_image lw_image486 lw_align_left" srcset="/live/image/scale/2x/gid/4/width/155/height/200/486_irs_logo.rev.1407789424.jpg 2x" data-max-w="463" data-max-h="596"/>Find statistics on business tax, individual tax, charitable and exempt organizations, IRS operations and budget, and income (SOI), as well as statistics by form, products, publications, papers, and other IRS data.</p><p> Quick link to <strong>Tax Statistics, where you will find a wide range of tables, articles, and data</strong> that describe and measure elements of the U.S. tax system: <a href="http://www.irs.gov/uac/Tax-Stats-2" target="_blank">http://www.irs.gov/uac/Tax-Stats-2</a></p><p>See all <a href="/data-resources/">data and resources</a> »</p>
  • <h3>The World Bank Data (U.S.)</h3><p><img width="130" height="118" alt="" src="/live/image/gid/4/width/130/height/118/484_world-bank-logo.rev.1407788945.jpg" class="lw_image lw_image484 lw_align_left" srcset="/live/image/scale/2x/gid/4/width/130/height/118/484_world-bank-logo.rev.1407788945.jpg 2x, /live/image/scale/3x/gid/4/width/130/height/118/484_world-bank-logo.rev.1407788945.jpg 3x" data-max-w="1406" data-max-h="1275"/>The <strong>World Bank</strong> provides World Development Indicators, Surveys, and data on Finances and Climate Change.</p><p> Quick link: <a href="http://data.worldbank.org/country/united-states" target="_blank">http://data.worldbank.org/country/united-states</a></p><p>See all <a href="/data-resources/">data and resources</a> »</p>
  • <h3>MapStats</h3><p> A feature of FedStats, MapStats allows users to search for <strong>state, county, city, congressional district, or Federal judicial district data</strong> (demographic, economic, and geographic).</p><p> Quick link: <a href="http://www.fedstats.gov/mapstats/" target="_blank">http://www.fedstats.gov/mapstats/</a></p><p>See all <a href="/data-resources/">data and resources</a> »</p>
  • <h3>The Penn World Table</h3><p> The Penn World Table provides purchasing power parity and national income accounts converted to international prices for 189 countries/territories for some or all of the years 1950-2010.</p><p><a href="https://pwt.sas.upenn.edu/php_site/pwt71/pwt71_form.php" target="_blank">Quick link.</a> </p><p>See all <a href="/data-resources/">data and resources</a> »</p>
  • <h3>National Bureau of Economic Research (Public Use Data Archive)</h3><p><img width="180" height="43" alt="" src="/live/image/gid/4/width/180/height/43/478_nber.rev.1407530465.jpg" class="lw_image lw_image478 lw_align_right" data-max-w="329" data-max-h="79"/>Founded in 1920, the <strong>National Bureau of Economic Research</strong> is a private, nonprofit, nonpartisan research organization dedicated to promoting a greater understanding of how the economy works. The NBER is committed to undertaking and disseminating unbiased economic research among public policymakers, business professionals, and the academic community.</p><p> Quick Link to <strong>Public Use Data Archive</strong>: <a href="http://www.nber.org/data/" target="_blank">http://www.nber.org/data/</a></p><p>See all <a href="/data-resources/">data and resources</a> »</p>