Jan 24, 2023 - Health

How opioid misuse is costing health systems

Share of emergency department inpatients treated for opioid use disorder, by state
Data: Premier Inc.; Chart: Tory Lysik/Axios Visuals

The addiction crisis is increasingly eroding health systems' finances, with the treatment of opioid use disorder (OUD) costing hospitals more than $95 billion a year, new data from Premier Inc. AI Applied Sciences shows.

  • That's 7.86% of all hospital expenditures, according to the data, which was released first to Axios.

The big picture: The opioid epidemic has had an enormous human toll, and solving the crisis is critical for patients and for society. But fixing the epidemic can also improve hospital finances, Premier researchers wrote in a blog post.

  • Medicaid and private insurance cover the lion's share of non-elderly adults who are treated for OUD, including medication-assisted treatment, counseling and support services. But health systems still eat the cost of treating the uninsured and homeless, and some payers have been slow to reimburse virtual OUD care at parity with in-person visits.
  • Opioid settlements from manufacturers, distributors and retailers now exceed $50 billion — but that's still just over half of hospitals' estimated annual costs for caring for overdoses and other issues in emergency departments.

Go deeper: The addiction crisis has worsened due to the proliferation of the synthetic opioid fentanyl, which is attracting more people 40 and under.

  • Patients with an OUD diagnosis average 32.5% higher cost per emergency department visit. Overdose patients often are at a high risk for multiple organ failure, hospitalization, increased costs due to ICU stays and unplanned readmissions after they're discharged.
  • The Premier analysis, which compared data from 2017 and 2022, showed OUD patients were younger than other emergency department patients. They were more likely to be male, and Native American or white.
  • "Collectively, healthcare needs to address [social determinants], OUD and myriad inequities experienced among patient populations to improve health and outcomes, and positively impact hospital and health system margins," the analysis says.

Premier also found that the OUD caseload requiring emergency department care isn't evenly distributed across the states.

  • Nationwide, about 2.28% of emergency department inpatient stays were associated with OUD diagnoses. New Mexico led all states with 7.09%, followed by New Jersey with 5.54%.
  • Arkansas and Iowa had the lowest percentage of ER inpatient stays associated with OUD.

Yes, but: Federal health officials have laid out guidelines for prescribing opioids for chronic pain, emphasizing they're not first-line therapy.

  • Premier notes studies showing that 87% of people with OUD do not receive evidence-based treatment, and there are significant demographic disparities in pain management and development and management of OUD.
  • The frequency of patients discharged from emergency department visits with an opioids prescription went down in 2020, compared to 2017-2018, according to CDC data released last week.

The bottom line: Last fall, Joint Economic Committee Democrats released a report estimating the opioid epidemic cost the U.S. nearly $1.5 trillion in 2020 — up 37% from 2017. 

  • While the human toll often takes precedence, the crisis-induced economic shocks to the health care system can't be ignored.
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