President Donald Trump on Monday sent to Congress a 2019 spending proposal that allocates $17 billion for addressing the opioid crisis, including $13 billion over the next two years for the Department of Health and Human Services to expand “access to prevention, treatment and recovery support services, as well as support for mental health.”

It’s a multibillion-dollar answer to what has been calculated by one leading research group to be a trillion-dollar problem.

The cost of the opioid epidemic in the United States has climbed to an estimated $1 trillion since 2001, and costs related to the crisis are increasing at an accelerating rate, according to a study released Tuesday by Altarum, a not-for-profit health research and consulting institute.

“I expected the projected costs from 2018 to 2020 to be steep, but the number in absolute terms, given the current growth rates of the epidemic, is stunning,” says Corwin Rhyan, the Altarum analyst who conducted the study.

Opioid misuse, substance use disorders, premature mortality and other related costs spiked to $115 billion in 2017 alone, with a growth rate between 2011 and 2016 that was double the previous five years. Based on current use patterns and mortality rates, Altarum projects the opioid crisis to cost another $500 billion by 2020, unless significant measures are taken.

Altarum includes the following in its calculations of opioid epidemic-related costs:

• Individuals’ lost income
• Employers’ lost productivity and healthcare spending
• Governments’ lost tax revenue and additional spending on healthcare, social services, education and criminal justice

Rhyan tells Behavioral Healthcare Executive in an email that swift investment in evidence-based solutions is critically needed and that there is potential for solutions to be cost-effective and cost-saving.

Cost per person

The study notes two shifts over the period analyzed: Those misusing opioids today are younger, and individuals are shifting toward more use of illicit drugs, rather than prescriptions. Based on calculations using an average age of 41 years old for overdose victims, overdose-related deaths account for an estimated $800,000 per person in lost income, productivity for employers and tax revenue for governments.

Healthcare costs related to the crisis—which include emergency room visits, ambulance and naloxone use, related indirect costs associated with an increased risk for other diseases/complications—accounted for $215.7 billion over the period studied.

The Medicaid expansion of 2014 has had two results: Substantially fewer overdoses for uninsured patients, but a disproportionately large percentage of overdose-related costs borne by Medicaid.

“Understanding the largest cost drivers of the epidemic and who bears those costs provides an important perspective on the problem, helps marshal resources towards solutions, and can help point those investments where they are most likely to have the greatest impact,” Rhyan says. “From there, behavioral health professionals can identify where there are gaps in available services and how to build up the resources needed effectively respond to the crisis.”

As part of its study, Altarum released several recommendations for policymakers, including:

• Educating clinicians on the appropriate use of opioids and exploring opioid alternatives to treat pain.
• Monitoring practitioners for high opioid prescribing patterns.
• Encouraging benefit managers to explore drug tiers that create financial barriers to accessing opioids.
• Facilitating access to local support services that aid in recovery.

All figures in the analysis are based on 2016 U.S. dollars.