For anyone suffering from chronic pain, often the only relief comes in the form of powerful opioid painkillers. But the use and abuse of opioids by some patients drives up the average annual cost of their healthcare by tens of thousands of dollars, according to a study funded by Ameritox, one of the nation’s largest urine drug screening companies.
The study, published in the American Journal of Managed Care examined data from 18 million people enrolled in health care plans from 2005 to 2008. The average annual cost of health care for patients not on opioid therapy was just under $5,000.
Costs rose dramatically for the 1.3% of patients that researchers identified as chronic opioid users. Those who were prescribed opioid painkillers for at least 120 days over a six month period had an average annual health bill of $23,049 – over four times higher than nonusers. They also had a greater frequency of alcoholism, drug abuse, and significantly more hospital visits.
The news was even worse for opioid users who did not take their drugs as instructed. The average cost of their health care jumped over $3,000, to $26,433 annually. Non-adherence included taking too much of the prescribed medication, diverting medication to other individuals, self-medicating with non-prescribed or illegal drugs, or taking medication inconsistently.
The management of pain is a common reason for people to seek medical attention. But while acute pain usually goes away when an injury heals, chronic pain can persist for over six months. According to the Institute of Medicine, over 100 million Americans suffer from chronic pain.
“Total medical spending on chronic opioid users is likely to be substantial in most managed care plans,” wrote leader author Harry Leider, MD, chief medical officer for Ameritox. “Chronic opioid users had elevated healthcare resource use and incurred substantially greater healthcare costs than nonusers. Furthermore, some chronic opioid users generated higher costs than others and these excess costs were associated with indicators of non-adherence determined by urine drug monitoring.”
Leider and colleagues say the data helps build a case for regular urine drug testing – although their association with Ameritox hardly makes them uninterested observers.
“Urine drug testing can identify patients who are likely to be non-adherent and have significantly higher healthcare costs,” they said. “In particular, patients with urine drug levels that were higher than expected using a proprietary algorithm were predicted to have significantly higher costs than patients whose test results were within an expected range. Improving adherence could reduce costs incurred by patients with chronic pain.”
But critics of urine drug screens say there is little evidence the tests can help identify opioid abusers. And a recent report by the California Workers’ Compensation Institute (CWCI) found urine drug screens raised the cost of health care substantially. Insurance companies and employers in California paid nearly $100 million for drug tests in 2011, almost 200 times what they paid eight years earlier.
“This study confirms a viral-like growth rate in the volume of drug testing and in the amounts billed and paid for these services,” the CWCI report said. “Data analysis and anecdotal evidence from managed care specialists suggest an implied strategy of serial testing at the point of service for many opioid prescriptions and refills. This creates an environment in which tests must continually be conducted to determine the presence or absence of specific pharmaceuticals, which according to experts and treatment guidelines, often should not have been prescribed in the first place.”