News & Commentary

Opioid Abuse Fuels Lots of Hospital Cost


The opioid abuse epidemic increased dramatically from 2002 to 2012, with the number of abuse-related hospitalizations increasing from about 300,000 to more than 520,000 during that decade, according to a study in Health Affairs. In addition, said researchers at Harvard Medical School, the number of patients who abused opioids and who also experience associated serious infections, such as endocarditis or septic arthritis—often because of intravenous drug use—grew from 3,421 to 6,535 during a period when hospitalizations overall remained stable.

Hospital costs associated with these developments soared as well, said the study, which was published in the May issue of the journal. Inpatient charges for opioid abuse nearly quadrupled, rising from $4.57 billion to $14.85 billion. The cost for treating associated infection more than tripled, increasing from about $190 million in 2002 to about $700 million 10 years later.

Those increases remained significant, even accounting for inflation, noted the authors, Matthew V. Ronan and Shoshana J. Herzig: $11.64 billion in 2012 represented in 2002 dollars; and $549.01 million in 2012 represented in 2002 dollars, for hospitalizations and associated infections respectively.

Researchers conducted a retrospective cohort study using data from the Agency for Healthcare Research and Quality’s Nationwide Independent Sample, the largest inpatient database in the United States.

The costs may be on the low side because they do not include costs incurred after discharge, which can be considerable. Ronan and Herzig noted that a larger proportion of those with a serious infection required further care in a skilled nursing facility. They may have also needed home health care.

Medicaid shoulders most of the burden. Just 20% of hospitalizations for opioid abuse and 14% of hospitalizations for associated infections were covered by private insurance, the study stated. Twenty-three percent of those with associated infections are uninsured and probably can’t get the care they need.

The researchers noted that patients with complex histories (medically and psychosocially) often can’t get care at skilled nursing facilities. As a result, they wind up staying in the hospital longer, so the cost of their care goes up.

These patients, in a way, are given the hot-potato treatment, with no hospital or health care system willing to take on the costs.

“The potential lack of ‘ownership’ of the patient’s care may exacerbate the already troubling issues related to access to care and ability to follow through on follow-up care demonstrated by others,” wrote the Harvard researchers.