Prescription opioid dependency, abuse, and misuse are commonly encountered issues in the mental health profession and are observed with greater frequency among specific populations, including those with criminal backgrounds (Kopac, Hurt, Proctor, & Hoffman, 2016; Peters, Young, Rojas, & Gorey, 2017). While the prevalence and expense associated with opioid issues is generally understood as pertaining to the individual, little was known about the impact the opioid epidemic had on the American society. The following examines a 2011 study in which Birnbaum et al. examined the societal costs of prescription opioid misuse. A summary provides key information, and strengths and weaknesses of the research are presented. Suggestions for future research are offered, and a personal reflection upon the article concludes.
Birnbaum et al. (2011) conducted a study to gain an understanding of the cost incurred to the American society due to opioid misuse, abuse, and dependency. The authors referred to previous research performed by organizations including the Centers for Disease Control and Prevention, the Food and Drug Administration, the Office of National Drug Control Policy, and the National Center on Addiction and Substance Abuse that had all reported a substantial cost associated with drug abuse; however, these studies had not revealed the economic burden imposed upon the public.
Birnbaum et al. (2011) sought to expand upon the prior research to include the costs associated with reduced workplace productivity components, criminal justice issues, and caregiver responsibilities brought about due to prescription opioid abuse. Key points of the article revealed that workplace costs accounted for nearly half (45.9%) of all societal costs, while health care costs were nearly equal, comprising 44.9% (Birnbaum et al., 2011). Criminal justice costs contributed 9.2% of the cost (Birnbaum et al., 2011).
A part of the article the authors did well was initially referring to prior research from which to extend. The information gleaned from the research is also very relevant in the substance abuse counseling profession, as it could be used to help obtain funding for specific, cost-effective rehabilitation programs and prove the impact of opioid abuse on not only the afflicted individual but also on others who may potentially have no connection to the person (Birnbaum et al., 2011). The authors also pointed out the disparity between the economic burden of prescription opioid abuse and the financial commitment of societal funds for opioid misuse prevention and research efforts.
Birnbaum et al. (2011) successfully completed their objective in that they determined the societal cost of prescription opioid dependency, misuse, and abuse incurred by the American public, $55.7 billion, and were able to divide the total into major categories comprising the expense: absent workplace productivity ($25.6 billion), healthcare costs ($25 billion), and the criminal justice system ($5.1 billion) (Birnbaum et al., 2011). The title is clearly written and appropriately matches the information revealed in the article. The purpose of the study is explained multiple times throughout.
As for elements of the research process, Birnbaum et al. (2011) described the methods in detail, listing 25 sources of data, including a sufficient review of previous literature, information obtained from other secondary sources such as publicly available reports of various government agencies, and data regarding administrative claims pertaining to diagnoses verified in the International Classification of Diseases and processed through insurance, including a generous study sample of nine million individuals covered by Florida Medicaid (Birnbaum et al., 2011). Birnbaum et al. (2011) also examined claims made by opioid abuse individuals with private insurance and by caregivers of these individuals. They employed a “prevalence-based estimation approach” (Birnbaum et al., 2011, p. 660) to identify the overarching categories of major expense and further examined cost analysis via the quantity method, apportionment method, and human capital approach.
Despite the numerous strengths present in the study, a few weaknesses are apparent. The authors acknowledged a discrepancy across the prior literature in the definition of prescription opioid dependence and abuse. They also recognized that the results may not be accurately reflective of the true societal cost of opioid misuse as their study could only account for patients with a substance abuse diagnosis, omitting any individuals with an undiagnosed condition (Birnbaum et al., 2011). Furthermore, although comparisons were made with control groups, specific validity and reliability values were not offered. Birnbaum et al. (2011) stated the limitations to their study: 1) due to lacking prior information, growth in the opioid problem could not be precisely determined; 2) despite the large sample of Florida Medicaid participants, this sample does not accurately reflect the national population; and 3) much of the research was dependent upon secondary sources that each have their own distinct variability and limitations.
Birnbaum et al. (2011) suggested future studies analyze other societal burdens imposed by events caused by or linked to opioid misuse, to include worker’s compensation claims and vehicular accidents. Further research may also consider the connection between opioid abuse and comorbid mental disorders to determine which condition occurred first and if there is a cause and effect relationship between the two (Birnbaum et al., 2011). Finally, other studies could examine illicit versus prescription opioid abuse or attempt to discover individuals at risk of developing an opioid use disorder (Birnbaum et al., 2011). Depending on the study performed, a variety of clients could benefit from further research, ranging from those at risk of opioid abuse to those affected by others’ use to those who have experienced significant loss due to opioid misuse, abuse, or dependency.
I was surprised to learn that only 9.2% of the societal cost of opioid abuse came from the criminal justice system because previous research demonstrated a strong positive correlation between substance use and involvement with the criminal justice system (Kopac et al., 2016; Mannerfelt & Hakansson, 2018; Peters et al., 2017). However, I hypothesize that this amount is related to one of the weaknesses acknowledged, in that only prescription opioid users with a diagnosed disorder were considered in this study. The results and limitations were thought-provoking, relevant to the field of substance abuse counseling, and inspired me to consider additional studies that examine societal costs of illicit substance use among individuals without a diagnosis. I would expect the values to be considerably higher. Still, in any study surveying substance abuse, it may be difficult to obtain accurate figures, as there will be participants that decline to provide admission of illicit drug use.
I appreciate the authors’ attempt at obtaining a large sample for the study, and I feel that the secondary sources are ample for the primary objective. Because the study was quantitative in nature, the data do support the authors’ conclusions. Finally, one important “take-away” I gained from the article is the significance of having quantifiable data upon which an argument can be based. The American Counseling Association (2014) explained that counselors have an ethical obligation to advocate for their clients and profession. Advocacy can only be effective with the use of research, and studies like Birnbaum et al. (2011) exemplify using facts to create a compelling case for critically urgent issues like substance abuse.
References
- American Counseling Association (ACA). (2014). 2014 ACA code of ethics [PDF file]. Retrieved from https://www.counseling.org/resources/aca-code-of-ethics.pdf
- Birnbaum, H. G., White, A. G., Schiller, M., Waldman, T. Cleveland, J. M., & Roland, C. L. (2011). Societal costs of prescription opioid abuse, dependence, and misuse in the United States. Pain Medicine, 12(4), 657-667.
- Kopac, A. M., Hurt, S., Proctor, S. L., & Hoffman, N. G. (2016). Clinical indicators of successful substance use treatment among adults in the criminal justice system. International Journal of Mental Health and Addiction, 14(5), 831-843. doi:10.1007/s11469-016-9644-8
- Mannerfelt, C., & Hakansson, A. (2018). Substance use, criminal recidivism, and mortality in criminal justice clients: A comparison between men and women. Journal of Addiction, 2018, 1-9. doi:10.1155/2018/1689637
- Peters, R. H., Young, M. S., Rojas, E. C., & Gorey, C. M. (2017). Evidence-based treatment and supervision practices for co-occurring mental and substance use disorders in the criminal justice system. American Journal of Drug and Alcohol Abuse, 43(4), 475-488. doi:10.1080/00952990.2017.1303838
