Saving Lives and Saving Money: The Case for Harm Reduction in Kanawha County, WV

Read the full report here.

Executive Summary

There is no doubt to residents and policymakers in West Virginia that the state has a drug epidemic problem that is costly in terms of lives lost annually, as well as expenses incurred for medical and mental health treatment, for law enforcement, and for social services provision. In seeking an effective mix of assistance to people with substance use disorders (SUDs) and law enforcement, policymakers both nationwide and in West Virginia have enlisted the help of economists to estimate what SUDs cost communities. The estimates, conservatively calculated in large part due to a lack of available data, are sobering.

For West Virginia (WV), the state with the highest per capita death rate from opioid use in the last decade, the comprehensive opioid cost estimate for 2015 was more than $8.8 billion, or 12.03 percent of the state’s gross domestic product (GDP). As large as this number is, it does not include costs associated with use of non-opioid illicit drugs such as cocaine or methamphetamines which have shown substantial increases in recent years both nationally and in WV.

Very few of these studies focus on costs at the state level, and to our knowledge only one (in New York state) analyzes costs at the county level. This is a critical level of analysis since it is here that many of the costs of illicit drug use are brought to bear and where the vast majority of steps are taken to combat SUDs. Kanawha County, WV sits in the epicenter of the WV drug epidemic. It currently leads the state in the number of deaths from opioids and all overdose deaths. As recently as February 2021, the Centers for Disease Control and Prevention (CDC) identified the outbreak of injection drug use-associated human immunodeficiency virus (HIV) in the county as “the most concerning in the United States.” It is against this backdrop that policymakers are debating the costs and benefits of attempting to manage this outbreak, and those of other viral diseases such as hepatitis B and C, through harm reduction programs that offer free clean syringes to people who inject drugs (PWID).

The goal of this study is to assist the community and the policymakers of Kanawha County, WV by providing data and analysis to inform how they will handle the challenges of the current drug epidemic and its increasingly widespread and costly consequences.

First, we estimate the economic damages from drug-related fatalities and non-fatal causes. The results for 2019, the most recent year for which data is available, are as follows:

• In WV, fatality-related damages are close to $9.9 billion; in Kanawha County, these economic damages are estimated to be nearly $1.5 billion.
• The economic losses associated with non-fatal illicit drug use totaled to $1.4 billion in the state of WV; in Kanawha County, they were approximately $144 million.
• Overall, the total economic damage caused by the drug crisis in West Virginia amounted to about $11.3 billion; in Kanawha County, the total reached $1.7 billion. These amounts represent approximately 15 percent of the state and county gross domestic products, respectively.

The second step the report takes is to examine costs not included in these already sobering estimates. Data on some family- and illicit drug user-related expenses are often not kept in a form that acknowledges that they are associated with drug use or are not included in government surveillance programs. Searching available data sets uncovered costs associated with both the families of people with SUDs and the users themselves. We report significant calculations of expenses related to the health and welfare of Kanawha County families including:

• The estimated costs of meeting the needs of opioid-dependent infants at birth (i.e., born with neonatal abstinence syndrome) was at least $1.3 million in 2017.
• Kanawha County schools may incur an additional $1.6 million for the 13 years of education for the 2018 cohort of children born with neonatal abstinence syndrome alone.
• Estimates of the annual cost of child placements in the foster care system due to drug-related abuse and neglect in 2018 reached almost $40.2 million.

Costs associated with medical conditions often contracted by people with SUDs are similarly large and concerning. In Kanawha County alone:

• To treat the 35 new HIV cases reportedly related to intravenous drug use (IDU) in 2020 will cost nearly $17 million.
• To provide curative treatment for the 635 cases of chronic hepatitis C (HCV) associated with IDU in 2019 is likely as much as $44.5 million.
• The estimated cost of treating the chronic hepatitis B (HBV) cases likely caused by IDU in 2018 is $196,000. While this is a relatively small cost, it would be virtually avoidable with regular HBV screening and vaccinations for drug users at a cost of about $62 per adult.
• Another disease increasingly tied to IDU is infective endocarditis (IE), an infection of the lining of the heart. The 77 IDU-related cases treated at the Charleston Area Medical Center in 2019 cost nearly $4.2 million.

Given these massive cost estimates from loss of life and costs associated with non-fatal illicit drug use in the short and long run, the need to determine cost-effective measures to ameliorate them is urgent. While few studies of the cost savings available from harm reduction programs are available, we outline how several of these programs function, as well as studies on their benefits and costs. Peer-reviewed studies report:

• The availability of various distribution methods of the overdose reversal drug naloxone may decrease deaths by as much as 65 percent over time.
• New users of syringe services programs (SSPs) are five times more likely to enter drug treatment and about three times more likely to stop using drugs than those who don’t use the programs.
• Reductions in HIV and HCV of almost 50 percent are associated with SSPs, according to the federal Department of Health and Human Services.
• Medication-assisted treatments (MATs) are effective in keeping people in treatment and show significant reductions in the risk for overdose, death, HIV, and HCV due to IDU.
• Some of the 120 safe consumption facilities worldwide have reduced fatal overdoses by as much as 50 percent in the long-term. These centers are not yet permitted in the US.

Additional research into the impact of harm reduction programs on crime and law enforcement refutes claims that harm reduction encourages drug use and potential consequences. Among several studies is a 2018 National Institute of Drug Abuse report which finds a return of $4 to $7 from each dollar spent on addiction treatment programs due to the decline of drug-related crime and criminal justice costs. Such results can ultimately benefit all community members by reducing expenditures on law enforcement and increasing spending that improve their quality of life.

The overarching conclusion is simple: Harm reduction and treatment will reduce both the heartbreak families suffer when their loved ones die or are chronically ill and the fatal and non-fatal costs associated with illicit substance use that our communities and state bear. What is more complex is identifying and implementing appropriate steps to achieve harm and fatality reductions. This report recommends three types of action. We advocate for:

• Better data tracking and its more timely distribution. Public policy is best made when decisionmakers have up-to-date information that allows them to conduct cost-benefit analyses of their options. As this report confirms many times, current statistics do not provide this.
• A larger number and wider distribution of harm reduction programs in Kanawha County. With the dramatic increase in HIV and cases of other viral diseases here, time is of the essence. An effective approach might include syringe services programs provided through federally-funded clinics, pharmacies, and HIV treatment sites, as well as mobile services and devoted clinics that build trust and relationships outside of a standard health care setting.
• Structural changes that enhance the social determinants of health — conditions in the places where we live, learn, work, and play that influence a wide range of health and quality-of-life outcomes. Such factors, such as low-income level and limited educational attainment, are associated with increased risk of substance use. They must be improved by providing: a living wage and health care benefits; computer technology and internet access to assist in children’s education; healthy air, water, soil, and homes; and broad access to affordable and safe recreation activities, transportation, and a comprehensive network of social services.

All of this is a lot to ask for. The alternative, however, is unbearably costly to families, businesses, communities, and governments at all levels. It is long past time to make meaningful changes.