The conflicting problems of unrelenting chronic pain and prescription drug abuse cost U.S. taxpayers, insurers and employers more than $323 billion directly and indirectly each year, according to a study by Laffer Associates, an economic research and consulting firm, and the Millennium Research Institute (MRI).
According to this joint study, the $323 billion cost could be reduced in part through the widespread implementation of urine drug tests (UDTs) to assess whether patients are taking their prescribed medications, taking additional non-prescribed medications and/or supplementing their prescription drug regimen with use of illicit drugs or alcohol, potentially leading to a greater risk of adverse physiological interactions or diversion.
The Laffer/MRI study articulates an economic benefit of in office screening and laboratory UDTs of more than three times their cost, resulting in an aggregate net direct and indirect benefit of more than $25 billion, depending on test frequency.
“Our analysis of the data demonstrates a clear correlation between increased UDT and the probability that patients will adhere to their medications,” said Wayne Winegarden, the principal investigator of the study and a principal of Laffer Associates. Adherent results are defined in the study as patients taking medications as ordered, and not supplementing with other prescription medications or illicit drugs.
The study, An Economic Analysis of the Costs and Benefits Associated with Regular Urine Drug Testing for Chronic Pain Patients in the United States, compares the costs and benefits associated with regular UDT and illustrates a positive net benefit. Currently, UDT is the most available form of drug testing to determine whether patients are taking their prescribed medication and/or taking medication that may have adverse interactions.
The study “provides a window into the potential value that evidence-based medicine brings to improving patient outcomes while reducing cost,” noted Kathy Egan City, president of MRI and co-investigator of the research.
Laffer Associates used Millennium Laboratories’ proprietary database to independently examine test results from more than 260,000 individual patient test profiles over a one-year period. Using a logistic regression method, the analysis demonstrates a probability curve where six UDTs per year significantly increase the probability of adherence, reducing the rate of non-adherence by approximately more than 35 percent.
Between 2004 and 2008, visits to emergency rooms for opioid abuse more than doubled. Since 1990, the medical use of opioids has increased by a factor of 10. Deaths from prescription medication overdose now exceed those caused by cocaine and heroin combined, according to the study.
In June 2011, the Institute of Medicine, the health arm of the National Academy of Sciences, released a report stating that more than 116 million Americans suffer from chronic pain at a cost of up to $635 billion. The Laffer/MRI study’s independently derived cost figures suggest that a significant portion of the total cost of pain is related to the challenges of a subset of this population experiencing extreme pain and misusing or abusing opioids.
Easing Back Pain, HR Magazine, April 2008
Chronic Pain Takes Increasing Toll on U.S. Productivity, HR News, March 2007
Rheumatoid Arthritis in the Workplace: Early Intervention Reduces Health Costs, Lost Productivity, SHRM Online Benefits Discipline, February 2006.