Objective: To provide per-patient estimates of the economic burden for opioid medication abuse with and without tampering.
Patients and methods: Adults in the US who participated in the 2010 and/or 2011 National Health and Wellness Survey were resurveyed to provide information on use and abuse of prescription opioids in the previous 3 months. Participants (N=20,885) were categorized as those who abused and tampered (n=107), abused without tampering (n=118), those who reported using of opioids as prescribed (n=981), and non-opioid controls (n=19,679). Average wages from the Bureau of Labor Statistics and health care unit costs from the Truven MarketScan database were applied to self-reported work impairment (absenteeism, presenteeism, and overall work impairment) and health care resource utilization (health care provider visits, emergency room visits, hospitalizations, and drug rehabilitation) to estimate indirect and direct medical costs, respectively. Estimated mean costs for these groups were compared using analysis of variance, and generalized linear models were used to compare costs adjusted for confounders.
Results: Those who abused and tampered had significantly higher mean indirect (work impairment: $3,614 vs $2,938, p<0.05) and direct (health care use: $23,328 vs $4,514, p<0.001) costs over 3 months than those who abused without tampering. This included higher mean incremental costs for non-opioid-related medical visits ($14,180 vs $2,236, p<0.001), opioid-related medical visits ($8,790 vs $2,223, p<0.001), and drug rehabilitation ($358 vs $55, p<0.001). Increased total direct costs were associated with tampering after adjusting for confounders (p<0.001). Median incremental costs were also higher among those who tampered.
Conclusion: Tampering with prescription opioid medications is associated with significantly increased medical costs compared to abuse without tampering. Reducing tampering may provide net health care savings.
Keywords: abuse deterrent; direct costs; health care resource utilization; indirect costs; medication tampering; opioid abuse; work impairment.