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