America’s opioid crisis likely cost more than $500 billion in 2015, much higher than previous estimates, according to a new analysis from President Donald Trump’s Council of Economic Advisers.
Previous estimates tended to look through the lens of institutions the crisis affects, from the health care and criminal justice systems to employers.
But there’s a larger human cost at play that also needs to be factored in, argues the new report.
Sounds simple enough. But behind the revised figure, an important existential question looms: What is the value of a human life?
Getting the number right is important “because that number informs how much we should invest in solving the problem,” said Dr. Anupam Jena, an associate professor at Harvard Medical School. If estimates “are six times lower than what they truly are, we are at risk of investing six times less into combatting the problem than we should.”
America’s opioid crisis dates back to the 1990s, when pharmaceutical companies pushed prescription pain treatments, saying that they weren’t addictive. Today, the U.S. consumes more opioids — a category that includes prescription painkillers like Vicodin and OxyContin and illegal drugs like heroin and the potent synthetic opioid fentanyl — than any other country.
The Council of Economic Advisers report makes the case that other opioid-crisis estimates “vastly underestimate losses by undervaluing the most important one — the fatalities resulting from overdoses that involve opioids.”
But that’s where it gets tricky. Government economists use a measure called the “value of a statistical life” (VSL) to examine how important reducing risk of death is, but in other health analyses that figure has ranged widely, between $1.4 million and $8.9 million.
Guidance also varies by agency involved. The Department of Health and Human Services prefers a VSL of $9.4 million, while the Environmental Protection Agency favors $10.1 million.
The new report’s preferred method is to use a VSL that varies with age, which may sound harsher to the general public than it does to economists. (Most individuals who die from an opioid overdose are between age 25 and 55, and research suggests the younger individuals in that range have a higher value, according to the report.)
That age-adjusted approach values opioid overdose deaths, combined with the non-fatal costs of opioid abuse — including health care costs, costs to the criminal justice system and reduced productivity — at $504 billion, more than six times higher than a 2016 analysis.
However, a non-age-dependent calculation suggests the total could be either a lot lower or a lot higher, with a range between $294 billion and $622 billion (using VSL estimates of $5.4 million and $13.4 million, respectively).
Experts on the opioid crisis largely agreed with the report’s conclusions in correspondence with MarketWatch.
The report “convincingly demonstrates that existing cost estimates have far understated the loss from the epidemic largely due to ignoring the value of lives lost,” said Michael Barnett, an associate professor at the Harvard T.H. Chan School of Public Health. “The value of lives lost is highly dependent on the assumptions one makes, but clearly is enormous financially and from a humanitarian perspective.”
The cost of the crisis might be even higher, Jena said, because estimates “miss the impact on families and the economic value of lost life to them,” though they would be admittedly hard to quantify.
In any case, what comes next is most important, said Dr. Stefan Kertesz, a professor at the University of Alabama at Birmingham School of Medicine. The report comes about a month after Trump declared the crisis a “public health emergency,” falling short of the “national emergency” status he previously promised, which would come with additional funding.
“Several costly collective failures” contributed to the current crisis, including overprescribing of opioids, failure to promote evidence-based care of addiction and failure to implement comprehensive systems of care for people who have pain, Kertesz said.
“The problems with such an analysis is not the dollar figure,” he said. “This report tends to reinforce a narrow view that the culprit for today’s problems and the target for fixing it will be focused on one chemical: opioids.”
Society needs to invest in better solutions, but “that’s not happening in most states,” he said.
“If this report helps us address a comprehensive failure to render needed care, then it’s helpful,” Kertesz said, but it’s not “if it turbocharges what amounts to a single-chemical battle.”