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Opioid costs: high and rising

Opioid abuse is an epidemic in the U.S. Opioids are a class of drugs that include the illegal drug heroin, as well as legal prescription pain relievers like oxycodone, hydrocodone, codeine, morphine, fentanyl and others.1 The fact that millions of Americans have routine access to these powerful painkilling drugs has created a tremendous problem with many costs.2

Physical costs

While all prescription drugs have some risk of misuse, prescription opioids have high abuse potential. Opioids, whether taken alone or in combination with other drugs, can lead to abuse, addiction and to life-threatening adverse events.1

Over the last two decades, drug overdose has overtaken automobile accidents as the leading cause of accidental death in the U.S., with 47,055 lethal drug overdoses in 2014.1 Of these 47,000 deaths, almost 19,000 were related to prescription pain relievers, plus another 10,574 overdose deaths related to heroin.1

Financial costs

In addition to the disastrous numbers of premature deaths, ruined lives and broken families, we must also reckon the financial cost of this widening epidemic. This graph shows one way of allocating the various ways opioids affect the economy:

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Year-over-year national aggregated charges for private insurance claims for opioid abuse and dependence diagnoses


At the individual level,(chart below), note the vastly different amounts paid by insurance companies for ordinary (non-opioid-abusing) patients ($3,435) compared to the average $19,333 for patients with an opioid abuse or dependence diagnosis. Notice also that the cost to treat patients suffering from opioid dependence or abuse is already over 450% higher than for ordinary patients. And treatment costs are rising fast, up over 25% between 2013 and 2015.3

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Average allowed claims for all patients vs. patients with opioid abuse or dependence diagnosis (private insurance)


In addition to the direct medical costs, opioids make up one-quarter of all workers’ compensation prescription drug costs. In fact, workers who take opioids for longer than three months usually don’t return to work at all, due to dependence or other side-effects.4 In all, prescription painkiller abuse is costing employers an estimated $25.5 billion a year in missed workdays, lost productivity, and lost earnings from premature death.4

Finally, we all pay for things like increased costs to the criminal justice system. A recent study estimated these costs to be over$5 billion in a recent year, including $4 billion just for new prisons and additional police.5

Future costs

Unfortunately, the increased spending may only just be getting underway. For one thing, prescription and illegal use of narcotics may still be increasing.6 We have learned that when the authorities have taken steps to limit the use of opioids, people simply switch to cheaper alternatives like heroin. This happened in 2014 when the FDA re-classified opioids to a more restrictive drug schedule.7

Another important factor we need to remember is that there are probably now more than 10 million people in the U.S. who are receiving daily, long-term treatment with opioid drugs.8 Treatment experts use clinical prevalence estimates to extrapolate from there that the total number of Americans suffering from opioid addiction may exceed 5 million people.8

Now let’s look back up the page at the average per-patient cost for treating someone with an opioid abuse diagnosis ($19,333). Rounding that up to $20,000 yields a simple back-of-the envelope estimate: Treating just the 5 million or so addicted persons we have now would cost around $100 billion dollars.

With increased media attention on drug dependency, new anti-opioid workplace campaigns, and heightened management strategies such as are being designed by OptumRx, we can expect the number of patients seeking treatment for opioid problems to continue to grow.6


The opioid crisis is having a profound economic impact on individuals, employers and other groups that sponsor health insurance plans, as well as on the care delivery system. Costs associated with opioid abuse have increased dramatically in recent years, including drug abuse treatment services and lost productivity.

OptumRx is collaborating with its sister companies across Optum to attack the opioid epidemic. Our plan takes a tightly integrated approach to preventing and controlling the spread of opioids, while also supporting those who need help overcoming any problems with abuse.

Look for additional details, coming soon.

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  1. American Society of Addiction Medicine (ASAM). Opioid Addiction: 2016 Facts & Figures. [PDF].
  2. Johns Hopkins Bloomberg School of Public Health. The Prescription Opioid Epidemic: An Evidence-Based Approach. Nov. 2015. Accessed at: on 05.02.2016.
  3. FAIR Health Study: The Impact of the Opioid Crisis on the Healthcare System: A Study of Privately Billed Services, September 2016. Accessed at:
  4. HR Today. Combatting the Prescription Drug Crisis. March 1, 2016. Accessed at: on 09.23.2016.
  5. Pain Medicine 2011; 12: 657–667. Societal Costs of Prescription Opioid Abuse, Dependence, and Misuse in the United Statespme_1075 Pain Medicine 2011; 12: 657–667
  6. Kaiser Health News. Study: Health Spending Related To Opioid Treatment Rose More Than 1,300 Percent. Sept. 12, 2016. Accessed at:
  7. Mother Jones. Drugs Kill More People than Cars or Guns. Sep. 19, 2016. Accessed at: on 09.23.2016.
  8. Annual Review of Public Health. The Prescription Opioid and Heroin Crisis: A Public Health Approach to an Epidemic of Addiction. Vol. 36: 559-574 (March 2015). Accessed at: 0n 09.28.2016.
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This article is directed solely to its intended audience about important developments affecting the pharmacy benefits business. It is not intended to promote the use of any drug mentioned in the article and neither the author nor OptumRx has accepted any form of compensation for the preparation or distribution of this article.