Guest MINDSETTER™ Fine: What Does Drug and Alcohol Use Cost Rhode Island?

Thursday, March 17, 2016

Guest MINDSETTER™ Michael Fine, M.D.

Too many Rhode Islanders are using drugs and alcohol. What does all this cost us?

There are no good recent Rhode Island specific numbers about the cost of drug and alcohol use. People who make cost estimates nationally look at losses in workplace productivity , health care expenses, and other costs due to a combination of criminal justice expenses, motor vehicle crash costs, and property damage.

Here are a variety of estimates, made using a variety of methodologies for various years from 2007 until 2015, reported here because these estimates provide a feel for the cost though none likely provides us with the precise cost. In 2007 (before use exploded), the estimated cost of prescription drug abuse in Rhode Island was $108 million. The yearly cost of opiate poisoning alone is estimated to be $115 million -- but that includes only medical costs, absenteeism, and lost future earnings due to early death, and not lost productivity, government costs, or the costs due to alcohol, marijuana or other drugs. (This estimate is based on a national cost estimate made in 2009 and adjusted for the difference between per capita use in Rhode Island and the national average of per capita use and then adjusted for inflation). Another cost estimate made in 2009 that includes both resource costs and productivity costs of both drugs and alcohol use puts the cost to Rhode Island at $2.3 billion. In 2015, the total indirect cost to the state budget attributed to substance use disorders was reported to be $513 million, a figure which does not include direct Federal Government expenditures or the cost of lost productivity or the cost of economic damage to families and communities or the cost of substance use associated health care expenditures made by private health insurance plans or individuals.

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The $513 million spent from the state budget is perhaps the saddest number of all that I cited. It means that instead of spending $513 million on schools, on recreation programs, on community building and the other kinds of activities that might prevent substance use, we spent that money on law enforcement, prisons, and treatment. We have squeezed the wrong part of the balloon.

The costs of treatment alone are also significant. About 7000 people were treated for substance use disorder in Rhode Island in 2013. About 4000 people were treated with methadone (which costs about $4000 per person per year),1000 people were treated with suboxone (which costs about $6000 per person per year), and 2000 people were treated with behavioral therapies (costs too variable to estimate). So we spend at least $22 million of treatment of substances that are not alcohol. If all 6000 people treated for alcohol use in 2013 received inpatient treatment, which costs about $25,000 per treatment, then we spent about $150 million on that. And if we are able to reach every Rhode Islander with active dependence and addiction - over 100,000 people - then the costs quickly become half a billion to a billion dollars or more.

The cost data cited are estimates, not dollars. No one knows how much we could save by preventing drugs and alcohol use because prevention also costs money. And there is economic activity – from alcohol sales, from drug and alcohol treatment, from health care, from corrections and law enforcement – that would shrink if we could reduce the number of people using. Remember that even drug dealers create economic activity – they buy cars and take their families out to dinner – so reducing drug and alcohol use is likely to have a mixed economic impact, saving some money by preventing the damage the drug trade causes, but costing some money because we would employ fewer people as a result of that trade. The net economic impact of drug and alcohol use is hard to estimate with any precision. But the human cost is more significant than the economic consequence.

Two hundred thousand Rhode Islanders using. How that impacts our students and their performance, our workers and their performance, our teachers and their performance, our businesses and their successes and failures, our lawyers and law enforcement professionals and judges and our other public servants is hard to imagine, and difficult to bear. But as we think about drug overdose death as well as Rhode Island’s academic, economic, and civic successes and our failures, we have to look these numbers in the face, own them, and change.

Treatment is available, which is a good thing. But prevention is better. We are much better served if there are no Rhode Islanders or perhaps only a few hundred or a few thousand Rhode Islanders using, dependent, or addicted, instead of close to 200,000.

Guest MINDSETTER™ Fine: What Does Drug and Alcohol Use Cost Rhode Island?

Related Slideshow: Rhode Island Doctors Getting the Most Drug Company Money

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