Author: Molly Sequin, MA

Healthcare utilization patterns among persons who use drugs during the COVID-19 pandemic

The COVID-19 pandemic has changed the way individuals access the healthcare system. For example, recent studies suggest high-risk populations may be foregoing necessary care out of fear of entering healthcare facilities and contracting the virus. A new study by Sean Murphy, PhD, associate professor of population health sciences at Weill Cornell Medicine and director of the methodology core and of consultation services at the Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV (CHERISH); Jyotishman Pathak, PhD, Frances and John L. Loeb Professor of Medical Informatics and chief of the Division of Health Informatics within Weill Cornell Medicine’s Department of Population Health Sciences; and Weill Cornell Medicine colleagues, James Yoder, and Jonathan Avery, MD, explores the effect the pandemic has had on healthcare utilization of persons with drug use disorder.

Individuals with a drug use disorder tend to face an increased risk of severe COVID-19 complications, and thus may be avoiding healthcare facilities, which can serve as critical touchpoints with the system, offering providers the opportunity to connect these patients to evidence-based treatment. Research has established that no, or inadequate, treatment for drug use disorder is associated with higher risk of drug overdose and overdose deaths, HIV/HCV infections, and suicidal behavior, as well as increased utilization of high-cost healthcare resources, particularly those of an emergent nature, which often result in an inpatient stay. In fact, preliminary national estimates indicate that drug overdoses (fatal and nonfatal) increased by 18%, 29%, and 42% in March, April, and May 2020, respectively, relative to the same period last year.

Although pandemic responses from the Drug Enforcement Administration (DEA), Substance Abuse and Mental Health Services Administration (SAMHSA), and others have lowered access barriers to ensure individuals receiving evidence-based treatment for drug use disorders continue to do so, very few persons with a drug use disorder initiate treatment, and among those who do, the majority struggle to adhere to that treatment, due to the chronic, relapsing nature of substance use disorders.

After reviewing preliminary data from four large New York City hospitals, Drs. Murphy, Pathak, and colleagues found that addiction consults in the hospitals decreased by half during March, April, and May 2020 when new cases of COVID-19, and related hospitalizations and deaths, were peaking in New York City. New referrals to treatment also fell substantially in March, April, and May, compared to the period of October 2019 through February 2020. However, the hospitals made no changes to the staffing or operations of the addiction team during this time. The number of consults returned to baseline in June and July of 2020.

To avoid an increased severity of drug use disorders and the associated health complications from becoming more prevalent, the researchers suggest that identifying persons with drug use disorder who may be foregoing treatment, and connecting them to evidence-based addiction treatment using methods that minimize the risk of COVID-19 transmission, should be a top priority during the COVID-19 pandemic. For example, utilizing “real-world” data from electronic health records (EHRs) can aid in the recognition and phenotyping of persons with drug use disorders to allow providers to better identify both new and existing patients.

According to Dr. Murphy, “Persons with drug use disorders are an underserved and stigmatized population who face exacerbation of these issues due to COVID-19. Our preliminary evidence indicates it is likely that many individuals in this population have avoided potentially necessary care in healthcare facilities due to their increased risk of severe COVID-19 complications. If so, not only can this worsen the specific condition they would have sought care for, but it also eliminates an opportunity to for them to get linked to evidence-based care for their drug use disorder, and in-turn reduce their risk for associated adverse outcomes.”

The Cost of Opioid Use Disorder and the Value of Aversion

According to a new study, the total annual cost of opioid use disorder (OUD) to U.S. society in 2018 was $786.8 billion. This figure includes costs associated with excess healthcare expenditures, criminal justice resources, lost workplace and home productivity, and premature mortality. Of the $786.8 billion, $89.1 billion was attributed to additional healthcare expenditures. The study was conducted by Sean M. Murphy, PhD, associate professor of population health sciences at Weill Cornell Medicine and director of consultation services at the Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV (CHERISH). He estimated the annual taxpayer burden of OUD, which consists of the additional healthcare costs incurred by public insurers and on behalf of those who are uninsured, as well as costs to the criminal justice system, to be $93 billion. Dr. Murphy further calculated that approximately three-quarters of the annual costs associated with OUD can be attributed to people in their mid-twenties to late forties.

Quantifying the cost associated with OUD is an important step to addressing the opioid crisis, as these figures can increase public interest and, in turn, the dedication of scarce resources. However, robust economic evaluations of interventions for the treatment and prevention of OUD that include measures of both cost and effectiveness are necessary to inform optimal resource allocation. To support these economic studies, Dr. Murphy also estimated the value of preventing an OUD, overall and by age. The mean value of preventing an OUD across all ages in the U.S. was estimated to be $2.2 million for society, $325,125 for taxpayers, and $244,030 for the healthcare sector.

Dr. Murphy’s estimates are substantially higher than previous ones due to his innovative approach and ability to include costs associated with the recent increase in overdose deaths due to synthetic opioids such as fentanyl. In comparison to Dr. Murphy’s estimate of $786.8 billion, a 2016 study estimated the societal economic burden to be just $84.6 billion (2018 USD), while a 2017 study estimated $535.3 billion (2018 USD) in societal burden.

Dr. Murphy’s analysis used 2018 data from the National Survey on Drug Use and Health, and the CDC WONDER Database on all U.S. persons at least 12 years old, with an OUD, or who died of opioid-related overdose. The age- and stakeholder-specific values, which had not previously been calculated, will allow for more robust and targeted economic evaluations of interventions to reduce the burden of opioids.

Dr. Murphy concludes, “The opioid crisis continues to take an enormous toll on the personal, public, and economic health of the United States. This study estimates the economic burden incurred by the U.S. healthcare sector, U.S. taxpayers, and U.S. society, as a result of opioid use disorder and opioid overdose deaths. The findings highlight the continued need for resources to address the opioid crisis and provide critical inputs for the economic research needed to determine how best to use those resources.”