The cost of addiction
The price of this epidemic -- in medical care, rehabilitation, emotions, early mortality, broken relationships, lost productivity and more -- is unprecedented, devastating and rising
Roxxanne Newman began using drugs as a teenager.
Daughter of young parents who had their difficulties, she spent much of her childhood living with her grandmother and cycling through group homes. She experienced turbulent emotions daily.
Chemicals provided relief from the trauma and stress, at first.
“I just loved the feeling, the escape from all the anger and sadness and insecurities,” she said. “It was really fun for a long time.”
Until it wasn’t.
-- $128.4 million --
Medicaid costs in Rhode Island for inpatient treatment of opioid-use disorder, or OUD, from the second half of 2013 through June 2019.*
Gleeful highs from oxycodone, ecstasy and alcohol became daily injections of cocaine and heroin. Newman was addicted, her life controlled by the fix.
“Everything that I made for money went toward using. I was doing massive amounts of drugs and then I couldn’t pay my bills anymore. Eventually, I ended up homeless on the streets of Providence and that's when I started to go in and out of prison and in and out of rehab.”
During a six-year period in her 20s, Newman overdosed, was incarcerated and was hospitalized many times, at significant expense. Her body and mind were wilting.
“I was on this spiral of determination basically to eventually die from drugs. I had no hope, didn’t plan on surviving. I was just using until I thought I would inevitably die.”
-- $26.4 million --
Medicaid costs of emergency-department visits for treatment of OUD from the second half of 2013 through June 2019.*
And then came what she describes as the “really rough year” of 2011.
“One day, I just woke up in a house, a drug den essentially, with all intention of continuing to use,” she said. “And I went outside and I was like, I just don't want to do this anymore. It's just so tiring.
“I had nothing. I had no clothes. I was wanted [by the police] and I was a probation violator.
“I had no food. I had no resources, no home.
“Nothing. Just this drive to not want to live this way anymore.”
After one final relapse, she didn’t. She cast the needle aside and began her recovery.
Today, Newman is a mother of a young girl with another daughter due next year and is pursuing a master’s degree in research psychology at Rhode Island College. A leader in the recovery movement, she seeks to unravel the reasons some people like her become addicted while others do not -- and what interventions might save lives.
-- $71.2 million --
Total of federal grants to Rhode Island to address the opioid crisis from 2015 through this year.*
In its darkest essentials, the story of Newman is the story of many at this time when substance use and debilitation and death from overdose constitute an epidemic in Rhode Island and America. The costs -- in medical care, rehabilitation, emotions, early mortality, broken relationships, lost productivity and more -- are unprecedented, devastating and rising.
Dr. James McDonald, medical director for the Rhode Island Department of Health, knows this as well as anyone.
“There are the healthcare costs and direct patient care costs for someone being admitted to an emergency department,” he said. “Then you have the cost of being admitted to a hospital and discharged from a hospital. Then you have the medicines that people need and you have the doctor visits.”
Also, McDonald said, the costs of treating HIV, hepatitis and other diseases substance users are at risk of contracting. And for substance users “who survive an overdose but don't get back to a normal cognitive state,” McDonald said, there are long-term treatment costs. Addicts who now require expensive 24-hour care in a facility or home, for example.
Added to these are costs that are less easily quantified but “much larger to the epidemic,” McDonald said. “Things like the employment that people missed,” the lost individual earnings and loss of productivity that also would have benefited the community, in the form of taxes paid and stability for children who otherwise might follow a parent’s path.
“Another cost is what the family loses: the relationship with someone who's now got a chronic disease,” McDonald said. “I don't know how to measure the cost for Mom or Dad when their adult child suffers from abuse disorder and they've lost that relationship.”
Nor the costs to other relatives and friends, and the cost to self, he said.
-- $37.7 million --
This year’s spending in the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals’ Behavioral Health Division, which addresses addiction.*
Calculating the tangible costs of addiction is virtually impossible since no agency tracks every measure and many treatment centers do not report expenditures.
Still, some numbers provide insight.
According to the state Executive Office of Health and Human Services, Medicaid costs of emergency-department visits for treatment of opioid-use disorder, or OUD, were $26.4 million from the second half of 2013 through June 2019. Medicaid inpatient costs for the same group over the same period totaled $128.4 million. Federal grants to Rhode Island to address the opioid crisis from 2015 through this year added up to $71.2 million, according to EOHHS.
A significant portion of the $463 million budget for the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, or BHDDH, is devoted to addiction-related programs: $37.7 million for the Behavioral Health Division.
But the starkest numbers tally accidental drug overdose deaths: from 2014 through 2018, 1,504 fatalities were recorded in Rhode Island, according to the Health Department.
The majority occurred in Providence, Pawtucket, Warwick and Cranston. But no community was untouched. The fact that the cause cannot be, or is not, determined for every death means the true numbers, as for suicide, are likely higher.
-- $327.4 billion --
Cost of addiction-related mortality in the U.S., a measure that includes lost lifetime wages, from the second half of 2013 through June 2019.*
Nationally, the costs are staggering.
According to “Economic Impact of Non-Medical Opioid Use in the United States,” an October report on the opioid crisis by The Society of Actuaries, the total cost from 2015 through the middle of this year is $819.3 billion, almost a trillion dollars. The analysis was based on data from the Centers for Disease Control and Prevention, the White House Council of Economic Advisers and the federal Department of Health and Human Services, among other sources.
The society broke down costs by mortality, a measure that includes lost lifetime wages, $327.4 billion; healthcare, $269.7 billion; lost productivity, $123.7 billion; criminal justice costs, $50.9 billion; child and family assistance costs, $41.1 billion; and education, for federal spending on primary and secondary school program costs, $6.5 billion.
“The extent to which future costs will rise or fall will be dependent on our ability to reduce the incidence of OUD and to support those currently living with OUD working toward recovery,” the society wrote. “Important work remains to develop and disseminate effective interventions to address OUD, and stakeholders across the economy may find that engaging in that work presents an opportunity to reduce both the human and economic costs of the crisis.”
-- $269.7 billion --
Costs of addiction-related healthcare in the U.S. from the second half of 2013 through June 2019.*
In Rhode Island, much of that work falls to BHDDH, which oversees “a comprehensive statewide system of mental health and substance abuse prevention intervention, treatment activities and recovery supports,” according to the department website.
“This department is so recovery-oriented,” said Lori Dorsey, senior public health promotion specialist at BHDDH and a recovering addict who lost a son in 2017 to an overdose. “Everything we do is recovery-oriented.”
That is the direction set by department head Rebecca Boss, who in a recent conversation about the considerable costs of addiction emphasized what might be called the flip side: the value of recovery, which can bring employment, stability, and a payback to society in the form of wisdom and support from people like Dorsey.
“We're working on the prevention end,” Boss said, on endeavoring to “get kids not to misuse substances to start with and not have this problem 10, 20 years down the road, regardless of what the drug du jour is, whatever the drug of the time is.”
That, she said, involves providing children and adolescents “the skills and resiliency to be able to cope with life and its stressors, and some of the despairs that have been talked about without substance use. And giving them opportunities to live a meaningful and purposeful life and not become involved in substances.”
She calls recovery “the other end.” Naloxone, also called Narcan, can save lives, she said, and medically assisted treatment, 12-step programs and other interventions can help maintain sobriety -- but housing, community and employment, among other factors, are critical, too.
“If there's no opportunity for somebody, then it's really easy to think about 'Why am I doing this if I don't have a place to live, I don't have a job to go, I don't have any meaning or connection,'” Boss said. “'Why am I going to bother to be in recovery when life was better when I was using?'
“You've got to make life in recovery equal to or better than a life of substance use.”
-- $123.7 billion --
Addiction-related lost U.S. productivity from the second half of 2013 through June 2019.*
Health Department medical director McDonald depicts the drug crisis in broad strokes.
“We have to be careful how we look at the addiction epidemic,” he said. “What I would suggest is that it's a symptom of something larger,” something that transcends opioids.
“We're really becoming a ‘substance culture,’ ” he said. “Cocaine's on the rise. Vaping hit the news recently. Tobacco has been around for as long as we can remember. Alcohol has always been a large issue in our culture…
“The opioid epidemic is a symptom of larger cultural issues that aren't completely understood yet.”
Childhood trauma and toxic stress, such as what Roxxanne Newman experienced, McDonald said, are implicated. That assessment is shared by Benedict F. Lessing, president and CEO of Woonsocket-based Community Care Alliance, which provides a variety of services for people living with mental-health and addiction issues.
Certain groups are disproportionately affected, Lessing said.
“If it's an African American or a Latino or people that live in the margins,” he said, “then they're not only dealing with the stigma of addiction or mental-health issues, they're dealing with the stigma of poverty and everything that comes with that.
“Low-income people in this country are not well-regarded. They’re regarded as people who are ‘leeches on the system,’ and so forth.
“We have not figured out yet or have not had the political will to say that if we did right by our fellow human beings, particularly those on the margins, there would be all kinds of benefits in terms of improved communities, greater productivity, people maintaining themselves in employment, all kinds of things.”
-- $50.9 billion --
Addiction-related U.S. criminal justice costs from the second half of 2013 through June 2019.*
Rhode Island College president Frank Sanchez counts himself among Roxanne Newman’s admirers.
“Roxxanne’s incredible story is a testament to both the power of recovery and the value of education,” Sanchez told The Journal. “She is an inspiration in the many roles she’s played at Rhode Island College: as a student, a researcher, a leader of the student organization RICovery, and now as a graduate student and teaching assistant…
“I am humbled by what she continues to accomplish. Both our college and our state are lucky to have her.”
In another building at RIC, Newman one recent day was mentoring undergraduate Jessica Zurawel, who is double majoring in psychology and chemical dependency/addiction studies. Managing stress, Newman said, is a critical part of avoiding relapse. So-called “recovery capital,” she said, is a management tool.
“You’re going to have stress no matter what, there’s nothing you can do,” Newman said. “When I think about how stressful I am at the moment and I think this stress is causing me to want to use or give everything up, I think, well -- I have my network, I go to school, I have my daughter I have a home, I have all these things.”
“That’s your recovery capital,” Zurawel said.
“My personal recovery capital. So that makes me feel like even though I’m stressed out, I don’t have to use. I can do this.”
-- $41.1 billion --
Addiction-related child and family assistance costs in the U.S. from the second half of 2013 through June 2019.*
These are techniques Newman began to adopt shortly after her last relapse. Twelve-step programs have helped, too, as have cognitive behavioral therapy; membership in Anchor Recovery Community Center, founded by the late recovery pioneer Jim Gillen; and the support of fellow recovering addicts.
With her daughter and a second daughter due early next year, “I'm blessed,” Newman said. “I started on this journey for myself, but now that I have two little people that depend on me, I look at them and I just can't give up. I have to hang on.”
Newman tears up.
“I drove my daughter to preschool today. It’s quiet, we’re listening to the radio, and she picks a song that she likes. And just out of nowhere, she says, you know, ‘Mommy, I love you,’ and it's like she really believes I'm the whole world, that I do nothing wrong.
“And so I don't want to let her down.
“I don’t want to let either one of them down.”
For confidential and non-judgmental help with addiction or mental-health issues, contact BHLink, on the web at bhlink.org; by 24/7 telephone, (401) 414-5465; or by visiting the 24/7 walk-in triage center, 975 Waterman Ave., East Providence. In an emergency, dial 911.
On Twitter: @gwaynemiller
*SOURCES: The state Executive Office of Health and Human Services, the state Department of Behavioral Healthcare, Developmental Disabilities and Hospitals. National data from, “Economic Impact of Non-Medical Opioid Use in the United States,” Society of Actuaries, a 93-page study, October 2019.