The Costs of Overdosing on Prescription Painkillers

A couple of years ago, the Centers for Disease Control and Prevention (CDC) quantified the severity of American’s problem with opioid overdoses, and a newspaper investigative report showed how prescribing doctors enabled the problem with these narcotic painkillers.

Now, a new story quantifies the actual cost of prescription drug overdoses based on emergency room patients.

As reported by the Los Angeles Times, prescription drug overdoses are a “substantial” burden on hospitals and the economy, and remain a leading cause of injury deaths in the U.S.

A study published in JAMA Internal Medicine last week analyzed hospital data nationwide from 2010. It found that prescription painkillers were involved in nearly 7 in 10 opioid-related overdoses treated in emergency rooms at an estimated cost of $1.4 billion.

Dr. Andrew Kolodny, a founder of Physicians for Responsible Opioid Prescribing, called opioid overdose deaths “just the tip of an iceberg.”

And the study’s conclusions were hardly surprising to providers on the front lines of the overdose crisis. The Times interviewed Dr. Cesar Aristeiguieta, who runs an emergency room in Houston. “Now we are seeing people can obtain narcotics easier than street drugs – and for free or low cost with insurance,” he said “It’s no wonder we’re in the situation we’re in.”

If there’s any good news here, it’s that only 2 in 100 patients treated for opioid overdose in the ER died. But more than half of those patients had to be admitted to the hospital. And 4 in 100 were transferred to an acute care facility.

Overdose patients who were admitted to the hospital stayed, on average, nearly four days at an average cost of $29,497. The average cost for patients who were released from the ER was $3,640.

Regardless of who pays most of that tab – an insurance company or individual – everyone pays in the long run through higher premiums and copays.

Opioid drugs, which include forms of morphine, methadone, oxycodone and hydrocodone (OxyContin and Vicodin) are powerful painkillers generally meant to address short-term problems, or for palliative care for the dying. That offers patients interventions for comfort, not for treatment. People who take opioids for an extended period risk not only addiction, but a tolerance for the drugs that leads them to take increasingly higher doses, which leads to overdose, and loss of consciousness and the ability to breathe.

Painkiller deaths quadrupled between 1999 and 2011, which paralleled a sharp increase in the number of prescriptions being written for such drugs. “In 2009,” The Times noted, “overdoses involving painkillers pushed drug fatalities past traffic accidents as a cause of death. And in 2011, the U.S. Centers for Disease Control and Prevention declared an epidemic.”

For a long time, the rise in overdose deaths was blamed on pharmacy robberies, teenagers who raided their parents’ medicine cabinets and the black market. But as the 2012 story in the Los Angeles Times demonstrated, physicians were shown to be major enablers of the crisis by prescribing too many painkillers to too many people in too many inappropriate circumstances.

The new JAMA study showed that people with breathing, heart and mental health problems are at higher risk for drug overdoses. One of the contributing authors said doctors who write prescriptions for opioid painkillers must be especially aware of patients who have one of these conditions. They should seriously consider alternative treatments, and discuss frankly the patient’s risk of overdose.