By Joe Martin
Summer 2018 Catalyst
The opioid crisis in Pennsylvania and throughout the United States is tragic, and has often been described as the greatest health epidemic in modern history. And it is very costly; to families, communities and the economy. The opioid crisis also has a significant impact in two areas not frequently focused on in the media: the workplace and the workforce. Not only is it devastating American families and communities, it's degrading America’s workforce, with the labor force participation rate down 4 percentage points since 2000 despite an increasing population.
According to the Bureau of Labor Statistics, the labor force participation rate in the United States peaked at 67.3 percent in early 2000, and has declined at a more or less continuous pace since then, reaching a near 40-year low of 62.4 percent in September 2015. Work published by the National Bureau of Economic Research confirms that a key reason for this decline in labor is due to opioids.
In a study titled “Where Have All the Workers Gone?,” Princeton University Labor Economist Alan N. Krueger said his research showed that “Nearly half of prime age NLF [not-in-the-labor-force] men take pain medication on a daily basis, and in two-thirds of cases, they take prescription pain medication.” Moreover, “40 percent report that pain prevents them from accepting a job.”
More than 50,000 Americans died of a drug overdose in 2015, of which 63 percent (33,091) reportedly involved opioids. A third of Americans have been prescribed opioid painkillers, and opioids are so addictive that research suggests that 1 in 5 who start a 10-day supply become longer-term users.
Beyond the human toll, the opioid epidemic has created an enormous financial burden and competitive strain on employers of all sizes — in the form of a reduced labor force, lower productivity and higher health care costs. The costs businesses must bear in absenteeism, lower productivity and increased job turnover, retraining and health care are staggering. Not only are these costs driven by the addicts themselves, but also by family members who often bear the biggest share of the burden.
In Pennsylvania, a recent PA Health Care Cost Containment Council report showed that the number of hospital admissions for overdose of pain medication decreased 2.2 percent between 2016 and 2017. There was an overall increase of 12.7 percent in the number of heroin overdose admissions between 2016 and 2017 — the lowest increase seen in recent years, as average annual increases were about 24 percent between 2011 and 2016. These findings continue to stress the alarming impact the opioid problem has on Pennsylvania families.
Nearly 1 in 10 patients hospitalized for a heroin overdose (9.6 percent) died in the hospital — up slightly from 9.3 percent in 2016. For pain medication overdose patients, 5 percent (or 1 in 20) died in the hospital — up from 2.9 percent in 2016.
Hospital admissions for opioid overdose amounted to an estimated $32 million in hospital payments in 2017 — an estimated $16.4 million for heroin overdose and $15.6 million for overdose of pain medication.
On average, heroin overdose patients and pain medication overdose patients stayed in the hospital 3.4 days and 4.4 days, respectively — for a total of 13,642 days in the hospital in 2017.
The average age of patients admitted for heroin overdose was 33. The average age of patients admitted for overdose of pain medication was 53.
Of the 1,753 hospital admissions for heroin overdose in 2017, Medicaid was the anticipated payer for 63 percent, commercial insurance for 18.9 percent and Medicare for 10.3 percent, with 7.7 percent of the patients having no insurance or another type of insurance.
Of the 1,747 hospital admissions for pain medication overdose, Medicare was the anticipated payer for 42.1 percent, Medicaid for 33.6 percent and commercial insurance for 19.3 percent, with 5 percent of patients having no insurance or another type of insurance.
The brief also examines population-based rates over the two-year period 2016 and 2017. Statewide, there were 64.6 admissions per 100,000 Pennsylvania residents hospitalized for opioid overdose (combining both heroin and pain medication overdoses). The rate for lower income residents was 122.0 — almost double the statewide rate. The rate was 113.7 for residents living in areas where less than 10 percent of the population has a bachelor’s degree. Males had a higher rate (77.8) than females (52.1). The rates for black (non-Hispanic), white (non-Hispanic), and Hispanic residents were 67.5, 65.9 and 50.4, respectively. County-level population-based rates are also included in the brief.
There are many ongoing efforts, in both the public and private sectors, to stem the tide of this tragic problem. Employers large and small can make a meaningful difference as well by taking steps to remove the stigma of addiction, educating workers on the dangers of opioids through wellness programs and offering employee assistance programs to help ensure those suffering from or affected by addiction get the counseling and treatment they need.
The brief is available on PHC4’s website at www.phc4.org.
Joe Martin is executive director for the PA Health Care Cost Containment Council.