The THRIVE Center for Emerging Young Adults

 

Dr. Silver Responds To Questions About:

The American Opiate Epidemic

Question:

Doesn't making Naloxone available increase the chance that opiate addicts will just keep using drugs, now that they can be rescued and not die from an overdose? Why should hard-working, law-abiding citizens like me have to shoulder the cost of Naloxone for people who made their own bad choice to start using drugs? Naloxone is just another way to coddle drug addicts. They'll just go back to using drugs, anyway.

Answer:

Your questions about opiate addiction and the use of naloxone to treat overdose are valid and reflect the concerns of many citizens. However, substance use and addictions, as well as national, state and local efforts to curtail use and its impacts on society, are complex subjects and not amenable to easy or quick analyses or answers. It's a problem that we will all have to live with for a long time as a society, so let's get acquainted with some of the facts so we can together as a nation develop thoughtful and effective approaches to a serious and growing problem.

I'd like to start with the notion of "choice" in addictions. Indeed, individuals do make the decision to "pick up" a drug for the first time and the many times that might follow, with addiction to one or several drugs being a possible outcome after repeated use. Although patterns of drug use are varied (not everyone who uses drugs becomes an addict), many of the people for whom substance abuse becomes a chronic illness have underlying emotional and physical problems that have contributed significantly to continued use.

Childhood sexual and physical abuse, depression and bipolar disorder, overwhelming stress and anxiety, unbearable physical pain are all reasons that people might begin and continue to use drugs – even if they adversely impact the quality of a person's life. The desire to minimize or eliminate emotional and physical pain is a powerful and understandable human impulse, and if healthier options are not available or known to someone who is suffering in mind or body, using drugs becomes a way of coping and getting on with a difficult life.

I say this NOT to imply that people who use drugs have no responsibility for their actions – all of us are obligated to consider how our choices affect us personally, affect those we love and affect our larger community. But the social and psychological and biological forces that drive addiction are difficult to unravel and to overcome, and our solutions to drug abuse in America will only be as good as our ability to understand this phenomenon in all its (frightening) depth and complexity from a very individual, personal perspective.

There is, however, some good news in the addictions picture: addiction – like diabetes and hypertension – is a treatable chronic disease. Treatment programs across the country, using approaches based in medical research, have the capability to help people stop using drugs and to return to productive lives. As with any other chronic disease, relapse with addictions is expectable (40% across all drugs of abuse), but comparable to Type I diabetes (30%), hypertension (50%) and asthma (50%). Relapse from opiates can be considerably higher.

So being addicted to drugs – even opiates, which are among the more difficult substances to stop using – is not a life sentence. Many addicts want desperately to quit and resume a normal life, and will go through the hard mental and physical work of multiple relapses before they successfully achieve long-term recovery.

There is no question that opiate addiction is a huge national and worldwide problem. In 2012, it was estimated that 2.1 million people in the United States suffered from substance use disorders related to prescription opioid pain relievers, with an additional 467,000 addicted to heroin. The total number of opioid pain relievers prescribed in the United States has skyrocketed in the past 25 years; and globally, prescriptions for products like hydrocodone and oxycodone have escalated from around 76 million in 1991 to nearly 207 million in 2013.

And the easy availability of opioid prescribed drugs has been accompanied by increases in negative consequences. For example, emergency department visits for the recreational use of opioid pain killers increased from 144,600 in 2004 to 305,900 in 2008. More alarming is the increase in overdose deaths due to prescription opioid pain relievers – they have more than tripled in the past 20 years, escalating to 16,651 deaths in the United States in 2010.[9]

Which brings us around to Naloxone. Although the cost of Naloxone has increased in recent years, it still remains a relatively inexpensive alternative for saving the life of a person who has overdosed on opiates. It costs between $20-$40 dollars for a full naloxone kit, which includes everything a person would need to reverse an overdose. So money spent distributing naloxone provides tremendous value for every dollar spent. Consider the alternative: each overdose death costs taxpayers about $30,000. Let's do the math: with about 16,600 overdose deaths from prescription opioids in 2010 (this does not include deaths from heroin), the cost to society for losing these people to drugs is about $500 million. By contrast, the cost of Naloxone kits to save those same lives is about $664,000.

Finally, I want to address the idea that we are coddling drug users by saving lives and providing treatment. There is no question that drug addiction brings a great burden to all of us in terms of increased crime, increased health care costs, lost work productivity and the loss of loved ones and neighbors; and that tough law enforcement efforts are a necessary part of the overall picture of curtailing substance use in this country. But would decreasing the availability of Naloxone to treat opiate overdoses be the answer to the opiate addiction epidemic?

In Howard County, from 2011-2012, prescription opioid-related deaths increased 600%. Ask any parent of a child who has died from an opiate overdose: if your child had a second chance to live, no matter how difficult they had made their life, your life and the lives of those around them, would you deny them the one medicine that in their moment of crisis could keep them alive? Would you deny them the one chance that, after many hard attempts at recovery, might allow them to pursue a happy, productive and normal life? No matter how devastating and frightening and incomprehensible substance abuse may be to the rest of us, in the final analysis we are bound by the values of this country and of our shared humanity to honor the sanctity of life and to give everyone – no matter how troubled, how fallen, or how seemingly burdensome – the right to live and try again.


PART 2

 


The Cost Of Overdose Deaths

by Rick Silver, MD

In my last article on the use of Naloxone to treat people who had overdosed on opioids such as heroin or pain pills, I said that "Each overdose death costs taxpayers about $30,000." An alert reader wondered "why or how people who die of an overdose present a [financial] COST to society."

Naloxone has the ability to reverse the life-threatening effects of opioids. When it is administered and has the desired effect, the person who has overdosed survives, thus reducing any further costs that would have been incurred had the naloxone not been available.

At this point I'd like to reframe the reader's query a bit by asking not what the cost of the death itself is, but what the costs are if we fail to revive someone with Naloxone. In other words, if we are trying to judge the financial benefit of widely distributing naloxone for use by emergency personnel in the field, we have to look at the post-overdose costs. (I will note of course that the cost of human suffering from drug use and from overdose deaths is inestimable).

A key financial impact of Naloxone is that it makes the need for emergency room and hospital visits less necessary. The article How Costly Can An Overdose Be?, published in a 2016 newsletter by the BLVD Treatment Centers in Los Angeles (https://www.blvdcenters.org/blog/costly-can-overdose), describes these approximate costs in detail:

  • A trip to the emergency room in an ambulance requiring life support: $1200
  • Treatment in the emergency room followed by release to the community: $3,640
  • Getting your stomach pumped (gastric lavage): $1,000 to $6,000
  • A stay in the hospital (the average stay is 3.8 days): $29,497
  • If the overdose leads to death, a funeral costs about $8,000; direct cremation is $2,700

These additional figures from an article in the Journal of the American Medical Association are also quite sobering:

  • Emergency room visits for drug overdoses reached 5 million in 2011, a 100 percent increase from 2004.
  • About 1.25 million of those visits were due to illicit drugs.
  • From 2001 to 2014, overdose deaths increased from nearly three-fold for prescription drugs to six-fold for heroin.

The opiate epidemic in America is very real and very costly in human and financial terms. If a simple intervention like Naloxone – which costs about $40 – can save lives, reduce suffering and significantly reduce health care costs, it is well worth it for communities across the country to adopt this as a key weapon in our fight against the devastating impact of drug abuse.