How Does the Opioid Crisis Affect Public Health?

In 2016, Vivek Murthy, US Surgeon General, recommended that the country needs to start treating addiction more effectively, “Not as a moral failing, but as a chronic illness that must be treated with skill, urgency, and compassion. The way we address this crisis is a test for America.”

A public health crisis can be defined as a situation that impacts the wider society far more profoundly than the challenges faced by the individuals affected or their immediate friends and family. The opioid epidemic certainly meets this description, as it has led to problems in all aspects of life including the economy, workforce, healthcare, and addiction. As a result of this addiction, “the life expectancy in the US has decreased since 2014 for three consecutive years.”

What is the opioid epidemic?

During the late 1990s, pharmaceutical companies assured healthcare providers that opioid pain relievers did not cause addiction, thus causing a rise in opioid prescriptions. In the wake of more opioid prescriptions, both prescription and non-prescription opioids were misused until it was found that they could actually be highly addictive.

Finally, in 2017, HHS declared a public health emergency and released a 5-Point Opioid Crisis Strategy.

How Does the Opioid Crisis Affect Public Health?

Economic Impact

As a result of failing to address substance abuse properly, our country suffers substantial financial losses. Alcohol misuse and illicit drug use result in a yearly economic impact of $249 billion and $193 billion respectively, based on a 2015 Surgeon General's report. In the criminal justice system, opioids cost $14.8 billion.

Moreover, the cost of incarceration generally falls on taxpayers, since incarcerated individuals cannot work and pay taxes. According to the Federal Bureau of Prisons, about 45 percent of the people in American prisons were incarcerated for drug offenses. Approximately 64,000 inmates are currently serving time instead of working and contributing to society. When people leave the penal system, they are little more knowledgeable about their addiction and no farther along in their recovery than when they first arrived.

By investing in addiction treatment, criminal justice costs, drug-related crime, and theft are reduced by $4-$7 per dollar invested.

Healthcare Failing

The likelihood of substance abusers receiving treatment is lower than that of patients with another condition affecting a similar number of people.

As the Surgeon General reported, “Few other medical conditions are surrounded by as much shame and misunderstanding as substance use disorders. Historically, our society has treated addiction and misuse of alcohol and drugs as symptoms of moral weakness or as a willful rejection of societal norms, and these problems have been addressed primarily through the criminal justice system. Our health care system has not given the same level of attention to substance use disorders as it has to other health concerns.”

In addition, opioids have cost the health care system $35 billion. A patient overdosing on opioids costs the U.S. healthcare system $1.94 billion annually.

Declining Life Expectancy

From 2019 to 2020, life expectancy at birth in the United States decreased by 1.5 years to its lowest level since 2003, according to the CDC.

“The decline in life expectancy between 2019 and 2020 can primarily be attributed to deaths from the pandemic, as COVID-19 deaths contributed to nearly three-fourths or 74% of the decline,” notes the CDC. “An estimated 11% of the decline in life expectancy can be attributed to increases in deaths from accidents/unintentional injury." Over one-third of accidental injuries, deaths are caused by drug overdoses, and NCHS reports that over 93,000 overdose deaths will occur in 2020, an all-time high.

Workforce Obstacles

When an individual has undergone substance abuse treatment, they generally have more control over potential employers learning about their history, even if the circumstances are otherwise identical to that of someone who has received justice. If a substance misuse history is considered a public health issue, rather than a criminal offense, a worker is less likely to find his or her employability impacted.

A worker who undergoes treatment instead of incarceration is less likely to suffer a relapse and lose their employment, as treatment has also been found to be more effective at addressing substance abuse. The freedom from a disruption in employment is beneficial to both the employer and the employee.

Additionally, opioid overdoses, misuse, and dependence have resulted in $92 billion in lost productivity. Losses stem from premature deaths as a result of overdoses, lost "productive hours" due to opioid use disorder and incarceration.

Children’s Education

Researchers have focused much of their research on those with opioid addictions most directly affected by the epidemic, write Rajeev Darolia and John Tyler for the Brookings Institution.

“Our research agenda focus has been less proximate as we ask: What is the effect on children’s learning of being embedded in a community where the opioid epidemic has taken hold?” the authors add.

“In this case, we have focused on the collateral damage that impacts children and potentially manifests in measurably reduced learning results.” Although our findings are only correlational, they suggest that education outcomes of children may be adversely affected by the opioid epidemic.

For simplicity, this report examined only one education outcome: third-grade test scores. “However, it is certainly possible that detrimental educational effects of exposure to the opioid epidemic vary depending on the age and developmental stage of the exposed individual,” states Darolia and Tyler. “Moreover, exposure to the epidemic is likely to impact important education outcomes other than test scores, such as attendance, probability of school disciplinary action, graduation, or college enrollment. We are exploring a broader set of outcomes in forthcoming work.”