‘Closer to home’ – the cost of the opioid epidemic may be the tip of the iceberg

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Heroin is cheap. But the epidemic is expensive - and that's just the tip of the iceberg. (Photo by Benjamin Schachtman)
Heroin is cheap. But the epidemic is expensive – and that’s just the tip of the iceberg. (Photo by Benjamin Schachtman)

Author’s Note: This series began with a look at the numbers of the opioid crisis, from arrests to overdoses to the number of prescriptions. Those numbers are stark. They make clear what some would still deny: the opioid crisis is real, it is serious and it is getting worse.

Addressing the cost of the epidemic, things aren’t as clear. As we conclude our series, we need only look back on what we were told by law enforcement, by health care professionals and by users and survivors of the epidemic themselves: the opioid crisis it the tip of the iceberg.

Part XI – The cost of the opioid epidemic

As with any other social issue, people – that is, voters and taxpayers – are understandably going to ask: “what is it going to cost us?”

On the law-enforcement front, it is true that heroin has driven gang-related and property crimes that have taxed police resources. But few in law enforcement seem to think that eradicating heroin would – or should – have an impact on public spending on law enforcement, according to Brunswick County Sheriff John Ingram and Wilmington Deputy Police Chief Mitch Cunningham.

“The gangs and the trafficker adapt so very quickly,” Ingram said. “These are some of the same people who were selling crack, who were selling powdered cocaine. And when heroin has run its course they will find the next thing and we’ll still be in this fight.”

Likewise, Cunningham said, “I’m sure it would be good to have a number, a bottom line you could hit people with. But that’s not the way it works. If we got rid of all the heroin, drug dealers would start selling something else, and there would still be crime.”

New Hanover's Sheriff's Office costs residents about a quarter a year. Throw in a penny or two for the crime lab and it's clear - law enforcement is not the main cost of the opioid epidemic. (Photo Benjamin Schachtman)
New Hanover’s Sheriff’s Office costs residents about a quarter a year. Throw in a penny or two a day for the crime lab and it’s clear – law enforcement is not the main cost of the opioid epidemic. (Photo by Benjamin Schachtman)

Cunningham said that the Wilmington Police Department (WPD) has added detectives to the narcotics task force, as well as officers and intervention specialists to their drug-related gang unit.

WPD has also inherited an expensive crime lab. More than $200,000 in grant funding for the lab has dried up, according to Chief Evangelous, who asked the state to take control of the lab. But the cost of all of this to the county would be less than a penny per day for everyone in New Hanover County.

The New Hanover court system has struggled to handle the case-load of the opioid crisis, according to District Attorney Ben David. But funding itself has not been  to the county’s primary battle. According to the adopted fiscal year budget for 2016-2017, the court system made nearly double in revenue from fees what it spent on operation. Even factoring in the cost of the entire Sheriff’s Office, residents in New Hanover County pay about 25 cents a year for law and order.

“Are the people of Wilmington and New Hanover County paying for these investments? For the police force and the courts and all that? Yes,” Cunningham said. “But it’s a drop it the bucket compared to the real costs of the epidemic.”

As Representative Holly Grange said recently, “people only recognize the cost, the real cost, of the epidemic when it impacts them. When it hits closer to home than just being on the news.”

There is no question of the cost of the epidemic to anyone who has been the victim of drug-related crime, who has lost a loved one or seen a family torn apart by addiction. But for many it seems that the tragedies remain anecdotes, removed from their own lives.

So, what is the cost of the epidemic to the average person?

The big-picture cost

Ten years ago, the total societal costs of opioid abuse in the United States were $55.7 billion, according to a 2011 study conducted by the American Academy of Pain Medication. About half of that was workplace costs, including lost earnings from sickness, firings and death. The another half was mostly healthcare costs, with only a small portion (less than 10 percent) made up by criminal costs, including law enforcement and prison costs.

For every one overdose, there are over 700 opioid abusers. (Data from SAMHSA, courtesy of North Carolina Public Health Department.)
For every one overdose, there are over 700 opioid abusers. (Data from SAMHSA, courtesy of North Carolina Public Health Department.)

That means that, in 2007, the epidemic costs every man, woman and child about $183 per year – not quite staggering. However, though there are no exact figures, it is worth considering that the number of overdoses have doubled since 2007 in New Hanover County and continue to rise, both in southeast North Carolina and nationwide.

Another way to approach the big-picture cost is to take overdoses as statistical indicator of a the larger number of people struggling with addiction.

A study performed by the Substance Abuse and Mental Health Services Administration, based on numerous data sets, identified the number of ER visits and other medical costs that occur on average for every one overdose. The 2010 study indicates there about $4,350,000 in healthcare costs for every one overdose; for New Hanover County – with 45 opioid overdoses in 2015 – that means nearly $200 million.

That’s about a $1,000 per person every year in healthcare costs. Whether opioid abusers have private insurance or not, that money has to come from somewhere, driving up insurance premiums, draining state funding and exhausting private donations.

(An important note: not everyone is hurting – the epidemic is big business. The proliferation of private treatment centers has become a cottage industry in Wilmington. Despite years of public outcry, pharmaceutical companies continue to make billions of dollars from opioid medication as 75 percent of doctors continue to ignore state resources to track over prescription, according to North Carolina Attorney General Josh Stein.)

Closer to home

Whether you ask Brunswick County Sheriff John Ingram or Coastal Horizons Clinical Director Kenny House, the opioid epidemic is a mental health problem, not a law enforcement issue. The “real costs,” as Deputy Chief Cunningham alluded to, are the costs of treating the epidemic.

A single overdose costs about $17,000, according to Robert Childs, director of North Carolina Harm Reduction. In many ways, that price tag is just the tip of the iceberg.

Data presented to local and state representatives by Kenny House of Coastal Horizons. (Photo Benjamin Schachtman)
Data presented to local and state representatives by Kenny House of Coastal Horizons. (Photo Benjamin Schachtman)

Claire Parker, spokeswoman for New Hanover Regional Medical Center, declined to give an official estimate for how much an overdose could cost. She said, “there is no ‘normal’ overdose. Every patient is different, and we see patients treated and released, or kept for several days. We often see multiple drugs in a person’s system, and we also see other medical conditions, like diabetes or liver problems. So it’s impossible to say how much an overdose will cost.”

NHRMC received 103 overdoses in 2016 and at least 150 emergencies visits every month for opioid related issues. According to Blue Cross Blue Shield of North Carolina, the average emergency room visit cost $1,233. Taking that figure, and Childs’ OD estimate, that means 2016 saw $1.75 million in overdose costs, and $2.2 million in ER visits in 2016.

According to Parker, some of these patients are covered by private insurance, but many rely on the hospital’s private fund to cover their costs.

The Harbor, a detox and crisis center, treated about 700 opioid cases with funding from Trillium, the government-funded hub for health services funding in the 24-county southeastern region of North Carolina. Trillium’s 2016-2017 budget of $444.7 million budget includes $2.2 million from New Hanover County, and $377.9 million from state and federal funds.

Trillium said any figure on the cost of the opioid crisis would be “difficult.” This is in part because both the funding for and the occurrence of substance abuse and mental health so commonly go together. As Jennifer Mackethan, spokeswoman for Trillium, told Port City Daily:

“Individuals are not treated in isolation for one disorder versus another, so it would be really difficult to tell this information. For example, a person may have a substance use disorder and major depressive disorder; whichever is billed for first would be the primary diagnoses … if the depression was entered first then the billing would reflect that, but certainly the provider is addressing both.”

In a very real sense, when we talk about the cost of the opioid crisis we’re talking about the part of the iceberg getting serious media attention. Below the waterline, the epidemic is inseparable from drug addiction, including alcoholism, and at the deepest level, a national crisis of untreated mental health issues.

Taking into consideration only a fraction of those issues considered “severe,” mental health generates a cost of about $1,000 per person nationwide. A recent report by the National Institute of Mental Health, “conservatively estimates the total costs associated with serious mental illness, those disorders that are severely debilitating and affect about 6 percent of the adult population, to be in excess of $300 billion per year.”

According to a 2011 CDC report, nearly half of the population on the United States will experience a mental health issue in their lifetime. One in two – it doesn’t get too much more close to home than that.

Read more from our opioid series

Part V – The power and potential risk of harm reduction

Part VI – Opioid demand, the fear of detox and the path to treatment

Part VII- ‘Killing with kindness’ – where are prescription opioids coming from?

Part VIII – Taking babies from mommies – Opioids’ impact on families

Part IX – ‘Do the right thing,’ local and state government response

Opioids: An appendix for readers