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The opioid addiction epidemic and its impact on health care costs


The opioid addiction crisis has escalated into a formidable challenge within the U.S. health care system, causing widespread devastation. The opioid epidemic has not only devastated communities and individual lives but has also inflicted a substantial economic toll on the health care system. The opioid epidemic has led to a surge in health care costs, stemming from the increased demand for addiction treatment, including psychiatric and psychological evaluations, emergency room visits, and medical interventions to address opioid-related complications. The financial strain is evident in the rising expenses associated with overdose treatments, rehabilitation programs, and the management of associated health conditions.

Case studies

The following are two case studies I have encountered in my clinical practice that demonstrate the financial strain the opioid epidemic has on the U.S. health care system.

A 19-year-old female with a known history of schizoaffective disorder presented to the emergency room following a suicide attempt through opioid overdose. Upon arrival at the ER, the patient presented with a Glasgow Coma Scale of 3, exhibiting decerebrate posturing of all limbs and respiratory failure, necessitating immediate intubation. Subsequently, the patient underwent a tracheostomy and PEG placement. Due to the severity of her condition, the patient was transferred to a long-term care facility for continued management. Currently, the patient remains comatose on ventilator support. The extent of her condition requires 24-hour complete nursing care and multispecialty care. Unfortunately, the patient has experienced further complications, including the development of seizures and sepsis, attributing to her prolonged state of unconsciousness. These complications required additional medical interventions and ongoing costly treatment, furthering the financial burden on the health care system.

An 18-year-old male with a history of anxiety and depression presented with severe addiction to opioids and alcohol. Initial attempts at outpatient treatment proved unsuccessful, necessitating admission to an inpatient addiction rehabilitation facility for detoxification. This was not completely covered by his health insurance and required him to ask family members and charity organizations to assist with covering the cost. During rehabilitation, the patient required expensive medications to manage withdrawal symptoms effectively. Following discharge from rehab, the patient continued to require ongoing treatment under the care of an opioid addiction specialist, psychiatrist, and psychotherapist. Despite the critical nature of these ongoing treatments, they are both constant and costly, and unfortunately, are not fully covered by most insurance companies.

As illustrated in the two aforementioned case studies: in the first instance, the opioid overdose in the young female has resulted in a prolonged financial burden on the health care system, as the patient is incapable of covering her medical expenses. In the second study, the young male with opioid abuse is unable to afford the necessary treatment for managing his addiction. This has shifted the financial burden to fall on either private insurance companies or the public health care system.

As the opioid crisis intensifies, the need for specialized addiction treatment and rehabilitation programs has increased, leading to a rise in health care costs. The expenses include medication treatment, counseling services, and support for individuals seeking recovery. The long-term nature of addiction recovery contributes to the sustained financial impact on the health care system.

Ways the opioid epidemic is impacting the U.S. health care system financially

Opioid abuse often leads to emergency room visits due to overdoses and infections. These visits incur significant costs for medical interventions, diagnostic procedures, and post-overdose care. The opioid epidemic has put a strain on public health care programs and resources by diverting funds away from other essential health care initiatives. The allocation to manage the repercussions of opioid addiction diminishes the effectiveness of other health care campaigns, leading to a ripple effect of increased health care costs. Individuals dealing with opioid addiction experience challenges in maintaining employment, leading to reliance on social support programs, causing an economic strain on the health care system.

Efforts to curb the financial burden of the opioid epidemic on the health care system should focus on preventive measures, treatment accessibility, and policy reforms. By educating practitioners on the signs and symptoms of addiction, offering in-office treatment options for outpatient services, implementing stringent opioid prescription guidelines, and expanding access to mental health services, we can help contribute to reducing the economic burden on the health care system.

Brocha Kagan is a physician assistant.






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