Cost of opioid medication abuse with and without tampering in the USA

Figures & data

Figure 1 Disposition of the respondents.

Notes: Figures marked with an asterisk (*) were used to calculate prevalence of prescription opioid abuse, and figures with a dagger (^†) were used to calculate the prevalence of tampering in abuse in Vietri et al.¹⁵ Reproduced with permission from Vietri J, Joshi AV, Barsdorf AI, Mardekian J. Prescription opioid abuse and tampering in the United States: results of a self report survey. Pain Med. 2014;15(12):2064–2074, by permission of Oxford University Press.¹⁵
Abbreviation: NHWS, National Health and Wellness Survey.

Table 1 Per-service costs applied to each service in estimation of direct medical costs

Services	Opioid related	Source	Amount ($)
Medical services
Outpatient visit	N	TMS	$108.01
Outpatient visit	Y	TMS	$116.21
ER	N	TMS	$552.86
ER	Y	TMS	$633.11
Hospitalization	N	TMS	$10,891.64
Hospitalization	Y	TMS	$5,644.75
Drug rehabilitation services
Group therapy	Y	ADSSCS	$13
Individual therapy	Y	ADSSCS	$125
Partial hospitalization program	Y	ADSSCS	$15
Detoxification	Y	ADSSCS	$102
Inpatient rehabilitation	Y	ADSSCS	$102
Outpatient rehabilitation	Y	ADSSCS	$15
Methadone	Y	ADSSCS	$17

Note: Values are 2011 dollars.

Abbreviations: ADSSCS, Alcohol and Drug Services Study Cost Study; ER, emergency room; N, no; TMS, Truven MarketScan; Y, yes.

Table 2 Demographic and health characteristics of the sample

	Use of prescription opioids
	Current survey (N =1,206)*						NHWS		p-value
	Abuse with tampering (n=107)		Abuse without tampering (n=118)		Medical use only (n=981)		Non-opioid control (n=19,679)
	%	n	%	n	%	n	%	n
Demographics
Age, years (mean, SD)	36.51	11.97	39.77	11.96	52.21	15.61	50.42	15.83	<0.0001
Female	44.9	48	51.7	61	57.2	561	58.0	11415	0.0222
Race/ethnicity
White	41.1	44	58.5	69	80.2	787	80.1	15762	<0.0001
Black	16.8	18	11.9	14	9.2	90	8.1	1587
Hispanic	20.6	22	15.3	18	4.7	46	5.1	996
Asian	20.6	22	11.9	14	3.2	31	4.6	901
Others	0.9	1	2.5	3	2.8	27	2.2	433
Married/living with partner	55.1	59	57.6	68	59.6	585	62.2	12242	0.1225
Annual household income
<$25,000	24.3	26	14.4	17	22.4	220	14.8	2906	<0.0001
$25,000–$49,999	21.5	23	31.4	37	29.4	288	26.2	5154
$50,000–$74,999	16.8	18	23.7	28	19.4	190	21.2	4179
≥$75,000	33.6	36	28.0	33	20.4	200	26.8	5267
Decline to answer	3.7	4	2.5	3	8.5	83	11.0	2173
Employed	75.7	81	68.6	81	44.5	437	55.8	10982	<0.0001
Health insurance	70.1	75	68.6	81	87.5	858	85.6	16837	<0.0001
Health characteristics
Currently smoke cigarettes	27.1	29	39.8	47	20.5	201	13.1	2577	<0.0001
Currently drink alcohol	70.1	75	80.5	95	59.0	579	63.5	12502	<0.0001
Currently exercise	73.8	79	60.2	71	52.4	514	64.9	12762	<0.0001
BMI categories
Underweight	4.7	5	1.7	2	1.6	16	1.9	379	<0.0001
Normal	46.7	50	40.7	48	26.8	263	31.9	6274
Overweight	28.0	30	26.3	31	27.5	270	32.2	6331
Obese	18.7	20	30.5	36	42.3	415	31.8	6252
Decline to answer	1.9	2	0.8	1	1.7	17	2.3	443
CCI (mean, SD)	0.40	1.11	0.28	0.77	0.76	1.33	0.34	0.85	<0.0001
Abuse >2 times/week	80.4	86	41.5	49	0.0	0	0.0	0	<0.0001

Notes:

* Thirty-six of the 1,242 respondents were excluded for unintelligible open-ended responses (n=8) or tampered with the medication but did not report abuse (n=28). Reproduced with permission from Vietri J, Joshi AV, Barsdorf AI, Mardekian J. Prescription opioid abuse and tampering in the United States: results of a self report survey. Pain Med. 2014;15(12):2064–2074, by permission of Oxford University Press.¹⁵

Abbreviations: BMI, body mass index; CCI, Charlson Comorbidity Index; NHWS, National Health and Wellness Survey.

Table 3 Estimated 3-month indirect costs by use of prescription opioids

	Use of prescription opioids
	Current survey (N = 1,206)*									NHWS
	Abuse with tampering (n=81)			Abuse without tampering (n=81)			Medical use only (n=433)			Non-opioid control (n=10,922)
	Mean	SD	Median	Mean	SD	Median	Mean	SD	Median	Mean	SD	Median
Absenteeism	$1,861a	$3,021	$672	$675b	$1,853	$0	$518b	$1,996	$0	$155c	$974	$0
Presenteeism	$1,824a,b	$2,477	$947	$2,276a	$3,252	$918	$1,645b	$2,445	$513	$754c	$1,676	$0
Total	$3,614a	$4,072	$2,133	$2,938b	$3,729	$1,479	$2,166c	$3,182	$890	$910d	$2,029	$0

Notes: Sample size is reduced as analysis restricted to employed respondents not on vacation the week prior to the survey; means in the same row that do not share the same subscript letter (a–d) are different at p<0.05 using the Fisher’s LSD test.

* Thirty-six of the 1,242 respondents were excluded for unintelligible open-ended responses (n=8) or tampered with the medication but did not report abuse (n=28).

Abbreviations: LSD, least significant difference; NHWS, National Health and Wellness Survey.

Table 4 Estimated 3-month direct medical costs by use of prescription opioids

	Use of prescription opioids
	Current survey (N = 1,206)*									NHWS
	Abuse with tampering (n=107)			Abuse without tampering (n=118)			Medical use only (n=981)			Non-opioid control (n=19,679)
	Mean	SD	Median	Mean	SD	Median	Mean	SD	Median	Mean	SD	Median
Non-opioid related
Physician	$545a	$891	$108	$217b	$396	$108	$258b	$357	$108
ER	$708a	$1,164	$0	$173b	$394	$0	$103b	$311	$0
Hospitalization	$12,927a	$31,244	$0	$1,846b	$5,924	$0	$1,765b	$5,580	$0
Total	$14,180a	$32,245	$553	$2,236b	$6,433	$108	$2,126b	$5,837	$216
Opioid-related
Physician	$693a	$1,084	$232	$163b	$502	$0	$62c	$129	$0
ER	$870a	$1,346	$633	$290b	$2,121	$0	$6c	$86	$0
Hospitalization	$7,227a	$11,881	$0	$1,770b	$4,022	$0	$1,047b	$3,176	$0
Total	$8,790a	$13,546	$1,679	$2,223b	$4,813	$0	$1,116c	$3,196	$0
Overall (non-opioid related + opioid related)
Physician	$1,238a	$1,904	$448	$380b	$790	$116	$320c	$390	$216	$170d	$254	$108
ER	$1,578a	$2,339	$633	$463b	$2,166	$0	$109c	$332	$0	$27d	$155	$0
Hospitalization	$20,155a	$38,602	$0	$3,616b	$9,141	$0	$2,813c	$7,849	$0	$299d	$1,860	$0
Drug rehabilitation	$358a	$578	$49	$55b	$204	$0	$7c	$126	$0	$0d	$0	$0
Overall total	$23,328a	$41,672	$4,019	$4,514b	$10,434	$216	$3,248c	$8,215	$224	$495d	$1,993	$108

Notes: Means in the same row that do not share the same subscript letter (a–d) are different at p<0.05 using the Fisher’s LSD test.

* Thirty-six of the 1,242 respondents were excluded for unintelligible open-ended responses (n=8) or tampered with the medication but did not report abuse (n=28). Non-opioid control data are from NHWS, which do not allow for differentiation of opioid-related costs.

Abbreviations: ER, emergency room; LSD, least significant difference; NHWS, National Health and Wellness Survey.

Figure 2 Adjusted 3-month direct and indirect costs for US adults abusing prescription opioids.

Notes: Values are least-squared means from a generalized linear model at the mean of the covariates. Error bars are standard error of the mean. Covariates included in the model were age, sex, annual household income, race, employment status, CCI, self-reported psychiatric illness, obesity, alcohol consumption, smoking, exercise, use of an opioid in the NHWS, and possession of health insurance.
Abbreviations: CCI, Charlson Comorbidity Index; NHWS, National Health and Wellness Survey.

VietriJJoshiAVBarsdorfAIMardekianJPrescription opioid abuse and tampering in the United States: results of a self report surveyPain Med201415122064207424931057

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