Duke 2008 | ASHE | Equity and Efficiency in Health and Healthcare

Prescription opiate use has grown dramatically over the past decade. The United States Department of Justice Automation of Reports and Consolidated Order System (ARCOS) data shows more than a doubling of prescribed Methadone between 2002 and 2005. There has also been a significant rise in prescribed Oxycodone, Hydrocodone, Hydromorphone, and morphine. During the same period prescription cocaine decreased. Diversion and abuse of prescription painkillers has also increased. Healthcare provider fee for service incentives may be driving some of this increase in prescribed opiates. The results from existing cost studies on methadone treatment are biased downward since they take into account only direct patient costs. The excluded costs are significant. This study reviews medical literature to describe how chronic opiate use increases cost and demand for hospital, clinic, and physician services. There are four categories of healthcare costs attributable to prescribed opiates. The first category is costs incurred by the patient. Frequent clinic visits, monitoring by toxicology screens, emergency room visits and inpatient costs are included in this category. The next category is costs from diversion or abuse of prescription pain medications. While overdose costs are recognizable, healthcare costs resulting from patients using diverted narcotics have to be estimated. Toxicology studies on trauma patients show that up to thirty percent have opiates in their systems. The third category of costs is other patient healthcare demand resulting from the prescribed patients' use of narcotics. Examples of these costs are neonatal withdrawal or persons injured in motor vehicle accidents caused by someone taking prescription narcotic medication. The final category of healthcare costs that need to be considered are those of long-term illnesses that are opiate related. In addition to increased trauma costs incurred by those taking prescription opiates, there are effects on nearly every organ system. Cardiac arrhythmias, sleep apnea, renal disease, infection susceptibility, and abnormal lung function have all been related to opiates.

There are significant healthcare costs associated with prescribed methadone, buprenorphine, and other narcotic pain relievers. Cost and Quality of Life analysis needs to consider all the healthcare reimbursed costs and morbidities of prescribing opiates including methadone and buprenorphine. This study adds to the literature by defining more of the healthcare cost associated with prescription opiate use.