This blog was guest written for WVCBP by Jill Kriesky, former associate director of the Southwest Pennsylvania Environmental Health Project and author of our upcoming report on the cost of the addiction epidemic in Kanawha County.
Someone, let’s say your sister, partner, or friend, gets hooked on opioids or stimulants, or a combination of both. We might view this as a personal tragedy, but it also has economic consequences. What is the cost to the person with a substance use disorder, their family, and the broader community?
The West Virginia Center on Budget and Policy is preparing a report on the economic costs of the addiction epidemic in Kanawha County, which is set to be released in January 2021. Here we offer a sneak peek at some of our findings.
Using data provided by the West Virginia Department of Health and Human Resources (DHHR), our research reveals that fatal overdoses from all drugs dipped 15 percent in West Virginia between 2017 and 2019. However, in Kanawha County, the fatal annual losses have remained high and steady, with 151 fatalities in 2017, 152 fatalities in 2018, and 152 fatalities in 2019.
Kanawha County’s contribution to the state numbers is significant. If one removes Kanawha County from the statewide data sets, the remaining counties record an 18 percent reduction over the past two years. Since 2015, Kanawha County families have lost at least one loved one, on average, every three days.
Based on more conservatively-constructed overdose fatalities data sets using the Center for Disease Control and Prevention’s (CDC) WONDER database, our forthcoming report calculates the value of the statistical lives (VSLs) of the Kanawha County residents lost to drug overdoses in 2018 at $1.268 billion dollars. VSLs are determined by using actuarial principles to estimate what deceased individuals would have earned from their age of death until retirement had they lived. One way to understand this number is to consider how the incomes generated by individuals would have been used, had they not died. They most likely would have been spent on basic necessities – housing, utilities, food, child care, and transportation – for the individual and their family. When the person who overdosed is gone, so is that source of income, which shifts the burdens of these expenses to surviving partners, parents, children, and friends.
In recent years, two health conditions largely caused by reusing needles to inject drugs have emerged as major concerns for this community. The first, Hepatitis C (HCV), is currently most commonly transmitted via sharing needles or other drug use equipment, according to the CDC. HCV can ultimately lead to cirrhosis of the liver, liver cancer, or liver failure.
Between December 2015 and March 2018, the Kanawha County Health Department (KCHD) administered a syringe services program that supplied sterile needles to people who inject drugs. During the final full year of this harm reduction program, 2017, 458 chronic HCV cases were diagnosed. This was the lowest number seen since 2012. In 2018, a year when KCHD’s program only operated for nine months, the number rose to 1,114. In 2019, the number declined to 635. While it is an improvement over the previous year, it still represents a 38 percent rise since the final year of the syringe services program. Between 2018 and 2019’s total new cases, approximately one percent of Kanawha County’s population was diagnosed with chronic Hepatitis C.
HIV is another condition suffered by an increasing number of people who inject drugs without access to sterile equipment. While KCHD’s Dr. Sherri Young reports that Kanawha County used to witness an average of two new cases of HIV per year related to injection drug use, 2019 saw a massive spike, with 14 new cases in this category. As of mid-October 2020, the 22 new HIV cases related to drug use registered in Kanawha County represent a 57 percent spike compared to 2019, with more than two months of data left to report.
There are several other diseases that result from engaging in drug use practices that also have high, long-term medical costs. Infective endocarditis and neonatal abstinence syndrome (NAS) are two that we will outline in our final report in early 2021. In the meantime, let’s put an approximate price tag on the two diseases outlined above.
According to peer-reviewed research, the lifetime cost of treating a patient with HCV, conservatively estimated, is $64,490. Using this estimate, the low-end lifetime costs of treating the new Kanawha County chronic HCV cases in 2019 would be $40,951,150. The CDC’s estimate of the lifetime cost of treating an HIV case is nearly $450,000. To treat just the most recent year, Kanawha County’s 14 new cases will cost $6.3 million. The total lifetime costs incurred for these two conditions diagnosed in Kanawha County alone for 2019 is $47,251,150. These costs are not borne by the health care industry alone, but are also passed on in the form of elevated health insurance costs, increased hospital treatment costs, and an economy which suffers from a sicker workplace.
What’s the strategy for reducing these costs? Of course the answer is complex. But one of the answers is clear: accessible syringe services programs (SSPs). The Kanawha County Health Department program, when it was allowed to function, and Solution Oriented Addiction Response’s (SOAR) outreach into the community, are examples of evidence-based programs that over time, across the country and the world have proven to reduce HCV and HIV. According to the CDC:
“Nearly 30 years of research has shown that comprehensive SSPs are safe, effective, and cost-saving, do not increase illegal drug use or crime, and play an important role in reducing the transmission of viral hepatitis, HIV and other infections.”
Of key relevance, CDC research found that SSPs are associated with an approximately 50 percent reduction in HCV and HIV incidence. And these programs are incredibly cost effective as well. A syringe costs about 10 cents when bought in bulk through medical suppliers. One could easily run a broadscale, low-barrier harm reduction program that serves all of Kanawha County every year for much less than the lifetime treatment cost of one person with HIV (let alone the 14 Kanawha County residents who were diagnosed with HIV in 2019 for lack of an accessible 10 cent syringe).
For many engaged in responding to the overdose crisis, syringe services programs are part of a compassionate response. These programs meet people where they’re at and help save lives through syringe and naloxone distribution. These programs also help build relationships that make it more likely that clients will enter recovery, while reducing the harms, pains, and diseases associated with addictive behaviors.
What our research is revealing is that syringe services programs are also an economic answer. If Kanawha County is dedicated to reducing health care costs, it does not make sense to add on over $47 million in expenses to address just two preventable diseases over one year of their respective unchecked spread. We can do better, and the solutions are right in front of us.
