Evaluating the CEA’s cost estimates of the opioid crisis

The President’s Council of Economic Advisors (CEA) recently issued a report stating that the economic costs of the opioid crisis have been greatly underestimated. When previous researchers crunched the numbers, they did not factor in the monetary worth of each life that is lost involving opioids.

According to economists, the value of each decedent’s life is called the “value of a statistical life,” or VSL. Several federal agencies use VSL to inform regulatory decision-making.

{mosads}The CEA recalculated the previously reported economic cost of the opioid crisis so that it now includes a value for each human life lost involving an opioid. For that calculation, the CEA used the figure of 33,091 opioid-related deaths and 2.4 million people with opioid addictions in 2015. The cost was composed of $431.7 billion for the cost of fatalities, and $72.3 billion for the cost of non-fatal abuse and addiction.

In other words, there are now two financial consequences given for opioids: one that includes the loss of human lives (fatalities), and one that does not (abuse and addiction that does not lead to death).

The non-fatal costs are for health care, workplace, drug treatment, and criminal justice costs mostly, lost productivity and crime. Then there are the costs of fatalities.

According to the CEA report, the total cost of opioid-related deaths is estimated at $504 billion in 2015. Divide that by the number of opioid-related deaths — 33,091 — and we see that the CEA has assigned roughly a $15 million value to each life lost.

The CEA’s goal in performing the analysis was to inform policymakers about the economic value of pursuing various potential interventions to curb the problem that has been deemed a public health emergency.

But the latest numbers still leave a crucial element out of the equation, and that is pain. Additionally, the revised calculation oversimplifies the problem.

We commonly blame the opioid crisis on overprescribing for pain. That has been one factor. However, it’s morphed into a problem of primarily illicit and abused prescription opioids. That said, the opioid crisis must be solved without adversely affecting people in pain and leaving them with inadequate treatment options.

The drugs involved in opioid overdose deaths (33,091) fall into different categories: prescription opioids prescribed to people in pain, prescription opioids diverted and used for non medical purposes, and illicit opioids such as heroin and synthetic fentanyl. Each of these categories requires a different type of intervention.

Since the opioid crisis is intertwined with the pain crisis, it is important to recognize that the economic burden of pain is also extremely high. The national price tag for pain is estimated to be between $560 and $635 billion annually for medical costs and lost productivity. This exceeds the total cost of the opioid crisis.

However, those figures for the cost of pain do not include the cost of premature deaths or suicides due to inadequately controlled pain. We must factor in the value of those lost lives, too.

Suicide rates among people with chronic pain are about 3 times greater than those of the normal population. Although it is impossible to know for certain how many opioid-related deaths are actually intentional due to inadequately controlled pain, it is certain that some are. Therefore, a VSL must also be applied to deaths associated with inadequately treated pain if we are to accurately correlate the costs of the opioid crisis with the price of the pain crisis.

The scourge of drug abuse has a long and complicated history, and roots that are far broader than the overprescribing of opioids. This is evidenced by the fact that the majority of drug-related deaths are not associated with prescription opioids. The problem of drug abuse existed long before doctors began to prescribe opioids to manage pain. Interventions must be designed to address the real source of the problem, rather than only what has been projected by imprecise and incomplete data.

Consider that, even though the quantity of opioid prescriptions has declined since 2012, the number of overdose deaths has continued to increase. As deaths from prescription opioids stabilized, overdose deaths from illicit opioids, including heroin and fentanyl, nearly tripled. That changed the nature of the opioid crisis.

The law of unintended consequences always applies when government attempts to solve a problem. Policies that address the opioid crisis may be well intended, but they could exacerbate the pain and/or opioid crises.

Stringently controlling the supply of prescription opioids has not only failed to curb harm, but it has also threatened the well-being of people who require opioids for pain control. In fact, limiting prescription opioids may be contributing to the increased number of deaths and cost. Interventions must be designed to address the real source of the problem, which includes such sociological factors as poverty and hopelessness.

The CEA plans further economic analyses of the opioid crisis to help guide policymakers in determining the best policy options. To effectively do this, they must study the likely negative and positive impact of all interventions — not only for the opioid crisis, but for the pain crisis, as well.

Lynn R. Webster, MD is Vice President Scientific Affairs for PRA Health Sciences. He is a past President of the American Academy of Pain Medicine. In addition, he is a co-producer of the public television, “The Painful Truth.” You can find him on Twitter: @LynnRWebsterMD