By: Mark Rembert, Michael Betz, Bo Feng, and Mark Partridge
Opioid addiction, abuse, and overdose deaths have become the most pressing public health issue facing Ohio. Ohio leads the country in drug overdose deaths per capita, a rate that continues to rise, overwhelming families, communities, and local governments across the state. In this policy brief, we aim to contribute to the understanding of this unfolding crisis and highlight insights that can inform policymaking.
One important motivation for us to consider this topic is its significant costs. We estimate that there were likely 92,000 to 170,000 Ohioans abusing or dependent upon opioids in 2015, resulting in annual costs associated with treatment, criminal justice, and lost productivity of $2.8 billion to $5.0 billion. Additionally, we estimate that the lifetime lost productivity of those who died from an opioid overdose in 2015 to be $3.8 billion, for an annual total cost of opioid addition, abuse, and overdose deaths ranging from $6.6 billion to $8.8 billion. To put this into perspective, Ohio spent $8.2 billion of General Revenue Funds and Lottery Profits money on K-12 public education in 2015, thus, the opioid crisis was likely as costly as the state’s spending on K-12 education.
The emergence of the opioid crisis has been unevenly distributed across the state. We consider the relationship between drug overdose deaths in 2015 and several county level economic, demographic, and health factors. We find that areas of the state experiencing lagging economic growth and low economic mobility had higher drug overdose death rates. We also find that overdose deaths were strongly linked to educational attainment. In 2015, the drug overdose rate for those in Ohio with just a high school degree was 14 times higher than those with a college degree. Finally, we note the link between prescription opioids and overdose rates, finding that counties that had higher levels of prescription opioids per capita in 2010 also had higher overdose death rates in 2015.
Research has shown that the most clinically and cost effective method for reducing opioid addiction, abuse, and overdose death is medication-assisted treatment. We consider the prominent treatment options, and discuss their availability across the state. We estimate that in the best-case scenario, Ohio likely only has the capacity to treat 20-percent to 40-percent of population abusing or dependent upon opioids. We find distinct geographic disparities in access to treatment, especially between urban and rural areas of the state. Many people in rural areas of Ohio have extremely limited access to medication-assisted treatment. This is a particularly critical issue in the rural areas of Southwest Ohio where opioid abuse rates are high but local access to treatment is limited.
We conclude by offering two policy recommendations based on our analysis. In the near term, the state should prioritize expanding access to treatment in underserved areas. This would require working with physicians and hospitals in underserved areas to encourage providers to obtain the waiver required to prescribe opioid treatments to their patients. We note that Vermont offers an excellent model for expanding access to opioid treatment. In the long term, the state should focus on improving the labor market outcomes of residents in areas severely impacted by the crisis. Specifically, we recommend that the state focus on improving educational investments in as a way of deterring drug abuse and overdose, particularly noting the substantial evidence linking early childhood interventions on improved employment outcomes later in life.
The full report can be found at: https://aede.osu.edu/sites/aede/files/publication_files/Swank%20-%20Taking%20Measure%20of%20Ohios%20Opioid%20Crisis.pdf