The price of drugs, al­co­hol hits home

State loses $2B an­nu­ally to sub­stance abuse

The Commercial Appeal - - Front Page - Holly Fletcher Nashville Ten­nessean USA TO­DAY NET­WORK - TEN­NESSEE

abuse an­nu­ally costs Ten­nessee more than $2 bil­lion — more than half of which is at­trib­uted to lost in­come from peo­ple who have fallen out of the the la­bor mar­ket, ac­cord­ing to an econ­o­mist.

The sub­stance abuse epi­demic — most no­tably in­volv­ing opi­oids — raises ques­tions about ac­cess to treat­ment, how to stem the il­licit use of pre­scrip­tion painkillers and staunch the use of il­le­gal drugs.

But the eco­nomic im­pact is less un­der­stood and not gen­er­ally a com­poSub­stance nent of pol­icy dis­cus­sions.

Teresa Wa­ters, chair of pre­ven­tive medicine at Univer­sity of Ten­nessee Health Sciences Cen­ter who leads a pol­icy re­search group, dug into the costs as­so­ci­ated with sub­stance abuse.

The $2 bil­lion cost to Ten­nessee in­cludes:

❚ $46 mil­lion for ba­bies born in the state with neona­tal ab­sti­nence syn­drome,

❚ $422.5 mil­lion for hos­pi­tal­iza­tions as­so­ci­ated with opi­oid abuse, and

❚ $138 mil­lion for hos­pi­tal­iza­tions with al­co­hol listed as the first di­ag­no­sis.

But, at $1.29 bil­lion, the lost in­come from hav­ing an es­ti­mated 31,000 peo­ple, or 1 per­cent of the work­force, out of jobs is the big­gest com­po­nent.

Wa­ters ex­pected the eco­nomic im-

pact to be siz­able but was still sur­prised by the fi­nal tally — es­pe­cially given the de­ci­sion to take a con­ser­va­tive ap­proach to the anal­y­sis.

“When I put it all to­gether, I was like, ‘wow.’ It’s strik­ing. It’s a wake-up; call that this is not just a sad story. This is an eco­nomic story,” said Wa­ters.

Epi­demic brings higher med­i­cal, jail costs and de­flates work pro­duc­tiv­ity

Wa­ters started her anal­y­sis af­ter talk­ing with Dr. David Stern, vice-chan­cel­lor for clin­i­cal af­fairs for the Univer­sity of Ten­nessee’s Col­lege of Medicine and the Univer­sity of Ten­nessee Health Sciences Cen­ter.

Stern wants to cre­ate a pro­gram for new physi­cians to be trained in ad­dic­tion medicine, and wanted to put the cost of his pro­posal in con­text with what abuse costs the state.

Wa­ters said she took a con­ser­va­tive ap­proach to the anal­y­sis so the over­all eco­nomic im­pact and state spend­ing is likely higher. In fact, she didn’t in­clude costs as­so­ci­ated with sub­stance abuse over­doses be­cause of de­bate over how to es­ti­mate eco­nomic im­pact from early loss of life.

“I don’t think this is com­pletely com­pre­hen­sive. It’s re­ally the most ob­vi­ous ar­eas,” said Wa­ters.

Na­tion­ally, the opi­oid epi­demic cost the U.S. econ­omy more than $504 bil­lion in 2015, the White House’s Coun­cil of Eco­nomic Ad­vis­ers pro­jected in a Novem­ber study.

In most states there is a dearth of qual­i­fied physi­cians with train­ing in ad­dic­tion medicine — and there are ex­pen­sive ram­i­fi­ca­tions, said John Don­ahue, CEO of Ax­ial Health­care, a start-up in Nashville that works with in­sur­ers to iden­tify over-pre­scrip­tion and peo­ple at risk for ad­dic­tion.

Pa­tients that Ax­ial has iden­ti­fied as high risk for opi­oid abuse use 300 per­cent more health care ser­vices than pa­tients who are seek­ing opi­oids, Don­ahue said. The spend­ing comes down when peo­ple get into treat­ment.

Wa­ters spends a lot of her time look­ing at health care fi­nanc­ing and the cost ef­fec­tive­ness of med­i­cal treat­ment.

She’ll be leav­ing Mem­phis soon to be the chair of the depart­ment of health man­age­ment at pol­icy at Univer­sity of Ken­tucky Col­lege of Pub­lic Health.

The dis­con­nect be­tween treat­ments for phys­i­cal and men­tal health is an im­ped­i­ment to get­ting peo­ple help, said Wa­ters.

She wants peo­ple to un­der­stand the nexus be­tween health and econ­omy — the costs it brings to the state.

In a sep­a­rate anal­y­sis, Wa­ters es­ti­mates that the state spends $273 mil­lion an­nu­ally on ef­fects drug and al­co­hol-re­lated health prob­lems and crimes. When com­bined with lost sales tax rev­enue, the cost is $513 mil­lion to the state bud­get.

❚ Ten­nCare spent $41.4 mil­lion on in­cre­men­tal costs re­lated to ba­bies born with NAS, ac­cord­ing to a 2017 re­port — a fig­ure that’s been on the rise over the last sev­eral years.

❚ Hos­pi­tal­iza­tions as­so­ci­ated with opi­oid abuse cost Ten­nCare $76.9 mil­lion, per 2015 data.

❚ Adult in­car­cer­a­tion for drug and al­co­hol re­lated of­fenses cost nearly $123 mil­lion in 2015.

‘Sub­stance use dis­or­der is killing our fu­ture’

With 1 per­cent of the work­force out of work due to sub­stance abuse, the state loses out on $239.4 mil­lion in an­nual sales tax rev­enue.

And Wa­ters thinks there are prob­a­bly more peo­ple out of work be­cause of sub­stance abuse, or at least work­ing at lower lev­els of pro­duc­tiv­ity.

Hav­ing peo­ple in the prime of work years, ages 20s through their 40s, out of work brings long-term con­se­quences for the state and fam­i­lies.

“These folks are los­ing their ed­u­ca­tion, los­ing their abil­ity to work pro­duc­tively,” said Wa­ters. “That’s a huge, huge loss.”

Wa­ters hopes the eco­nomic im­pact of the epi­demic drives more state law­mak­ers to think of the is­sue as more than tragedy for fam­i­lies but as a road­block to a healthy state in the com­ing years.

“It’s re­ally our fu­ture. Sub­stance use dis­or­der is killing our fu­ture. We want to bring in more jobs to Ten­nessee. We want to have a stronger work­force,” said Wa­ters.

“If we want to at­tract Ama­zon, these big com­pa­nies, we have to have a strong work­force.”

Reach Holly Fletcher at hfletcher@ten­nessean.com or 615-259-8287 and on Twit­ter @hol­lyfletcher.

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