Weighing costs of drug abuse prevention vs. treatment


By Jordyn Grzelewski

jgrzelewski@vindy.com

YOUNGSTOWN

At recent local forums on the opioid epidemic, members of the public submitted questions they wanted the local media to answer in its reporting.

One question was: What are the costs of addiction vs. the costs of preventing it?

The consensus among experts and studies is clear on this question: There are prevention strategies that have been proved to be effective, and the costs of implementing those strategies is drastically less expensive than the cost of responding to substance abuse.

What sometimes goes uncalculated, too, are the costs of addiction that go well beyond treatment and health care expenses.

“When we’re able to prevent the onset of substance abuse, as a society we’re able to benefit from what that individual gives to the community,” said Angela DiVito, executive director of Coalition for a Drug-Free Mahoning County. “They’re able to provide for their families. They’re productive workers who benefit their businesses and pay taxes. They are able to contribute time and creativity and so many positives to the community. We lose those things when we don’t provide prevention and addiction happens.”

THE EPIDEMIC

One of the latest harrowing headlines related to the opioid crisis was that the national epidemic again led to a decrease in U.S. life expectancy.

In 2016, more than 4,000 Ohioans died of unintentional drug overdoses. Although the overdose statistics for 2017 have not yet been finalized, they are widely expected to be worse, and to increasingly be driven by fentanyl, a synthetic opioid painkiller that is 100 times more potent than heroin.

COSTS

For many years, studies have estimated that for every $1 spent on substance-abuse prevention, on average, $10 is saved in treatment costs.

“Multiple studies indicate that every dollar spent on prevention results in an average of $10 in long-term savings. Depending on the study and the approach examined, cost savings have ranged from $2 to $20 for every dollar spent on prevention,” said a 2011 report by the Community Prevention Initiative, a project administered by the Center for Applied Research Solutions.

With the opioid epidemic worsening in recent years, some experts believe the ratio now is closer to $1 on prevention to $18 in treatment savings.

By many measures, the overall cost of substance abuse is significant.

For example, the National Institute on Drug Abuse put the 2013 cost of prescription opioid abuse at $78.5 billion – higher, if taking into account other forms of substance abuse.

PREVENTION

Experts say there are methods of preventing substance abuse that are effective and that the chosen prevention strategy works best when it is tailored to its audience.

“Effective prevention includes delaying the first use of substances and complete future abstinence,” said DiVito. “We know that the brain – the longer we can delay someone from experimenting with drugs, the more time the brain has to grow and the better equipped they are to avoid dependency.”

One resource local experts identified is the Substance Abuse and Mental Health Services Administration’s National Registry of Evidence-Based Programs and Practices, a searchable online database of interventions that studies have found to be effective. Users can search for the characteristics they are looking for, and the database will provide information on programs that match.

DiVito, noting local organizations such as Meridian Healthcare’s PANDA Leaders Club, said peer prevention is a particularly successful method.

“We see great outcomes from those types of programs,” she said.

The Washington Institute for Public Policy, in a database providing cost-benefit analysis on various programs, listed one program for adolescents that has an estimated positive impact of $2,590 per participant and a 97 percent chance of its benefits exceeding costs.

SAMSHA advises that effective prevention requires data-guided decisions and the involvement of community partners. It notes that there are strategies geared toward individuals and strategies that “focus on creating environments that support healthy behavior.

“Research indicates that the most effective prevention interventions incorporate both approaches.”

LACK OF INVESTMENT

Despite the proven effects of prevention, experts say it does not seem to be a national policy or funding priority.

“I don’t think that we focus nearly enough on prevention,” DiVito said. “Prevention budgets over the last three decades have been slashed to almost nonexistence.”

The CARS report notes that “for every federal and state dollar spent on managing the consequences of substance abuse and addiction, 1.9 cents is spent on preventing and treating the problem – with less than 1/4 of that going to prevention.”

“I definitely think we could focus on it more,” said Brenda Heidinger, associate director of the Mahoning County Mental Health and Recovery Board. “When we look at this opiate epidemic, we’re looking at it from the standpoint of we’re never going to arrest our way out of it. We’re never going to treat our way out of it.

“We need to put prevention at the same level as law-enforcement interdiction and treatment of people.”

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