Treatment of opioid use disorder (OUD) is now estimated to cost hospitals more than $95 billion a year, according to new data from Premier Inc AI Applied Sciences. That figure approximates 7.86% of all hospital expenditures (data, released first to Axios).

The opioid epidemic has had an enormous human toll, and solving the crisis is critical for patients and for society, but there is economic incentive, as well: Fixing the epidemic can also improve hospital finances.

Although Medicaid and private insurance cover most of the costs for nonelderly adults who are treated for OUD (medication-assisted treatment, counseling, and support services), health systems and hospitals still manage the cost of treating the uninsured and homeless. In addition, many payers are slow to reimburse virtual OUD care at parity with in-person visits.

Although opioid settlements from manufacturers, distributors, and retailers now exceed $50 billion, that sum still represents just over half of hospitals' estimated annual costs for emergency department care for overdoses, among other issues.

Moreover, the addiction crisis has been worsened by the addition and the proliferation of the synthetic opioid fentanyl, which is attracting even more younger people.

Statistics indicate that patients with an OUD diagnosis average 32.5% higher cost per emergency department visit. Overdose patients are at a high risk for multiple organ failure, hospitalization, increased costs due to intensive care unit stays and unplanned readmissions after discharge.

The Premier analysis, which compared data from 2017 and 2022, showed OUD patients were younger than other emergency department patients, were more likely to be male, and Native American or White. The analysis concluded that "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 margin."

Further review of the analysis showed an uneven distribution of OUD emergency department caseload across states. Nationwide, about 2.28% of emergency department inpatient stays were associated with OUD diagnoses. However, New Mexico was highest by 7.09%, followed by New Jersey with 5.54%, while Arkansas and Iowa had the lowest percentage.

In the meantime, federal health officials have laid out guidelines for prescribing opioids for chronic pain, emphasizing that they are not first-line therapy. The Premier analysis points to studies that show 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 better news is that the frequency of patients discharged from emergency department visits with a prescription for an opioid decreased in 2020, compared with 2017-2018, according to recent Centers for Disease Control and Prevention data. However, in the fall of 2022, Joint Economic Committee Democrats released a report estimating the opioid epidemic cost the United States nearly $1.5 trillion in 2020-up 37% from 2017.

Although the human toll takes precedence, the crisis-induced economic shocks to the health care system must be addressed. (See Goldman M. How opioid misuse is costing health systems. Axios Pro: Health Care Policy January 24, 2023. http://Axios.com/Health.)

Adapted from ASA Monitor, January 25, 2023.