This week's release of a report detailing the cost of opioid use disorder to Missouri taxpayers has reinforced lawmakers' efforts to counter the epidemic.
In the report, research conducted by the Hospital Industry Data Institute finds the total economic cost of the crisis in the state was $12.6 billion in 2016.
The institute used methods from the White House Council of Economic Advisers to calculate the number, said Mat Reidhead, who authored the report.
"It's a staggering number," Reidhead said. "What the White House found was that the total cost nationwide was $540 billion — with a 'B' — in 2015."
Reidhead, vice president of research for the Missouri Hospital Association, said fatalities accounted for 96 percent of the economic burden to Missouri. In December, a month after the White House data was released, the U.S. Centers for Disease Control published 2016 data that show deaths associated with opioids grew by 29 percent over 2015, another number Reidhead said was dumbfounding.
But that was nationwide.
It was worse in Missouri.
"We were significantly higher — 35 percent in Missouri, which was 6 percent higher than the nation," he said. "We saw that and realized it really called for a study."
Joy Sweeney, director of the Jefferson City-area Council for Drug Free Youth, shook her head at the numbers.
"The cost factor is through the roof," she said. "The cost in lives can't even be measured."
The growing epidemic has prompted CDFY and other organizations — including the Jefferson City Police Department, the Cole County Sheriff's Office, the Cole County Health Department, St. Mary's Hospital, Capital Region Medical Center, Compass Health, Missouri Recovery Network and others — to begin development of an opioid task force.
"We really have a massive amount of capacity, as far as partnerships goes," Sweeney said.
The report and effort come as the state grapples with identifying fault in the epidemic.
In June, Missouri Attorney General Josh Hawley filed a suit against three pharmaceutical companies — Purdue Pharma, Endo Health Solutions and Janssen Pharmaceuticals. The suit alleges the companies carried out a multi-year campaign to misrepresent the addictive risks of opioids, resulting in thousands of patients receiving opioid prescriptions to treat chronic pain.
In October, Hawley widened the investigation and demanded drug distributors provide documents associated with their investigation.
"It has become clear that opioid distributors had opportunities to stem the tide of the opioid crisis, but instead chose to look the other way while making millions of dollars in profit," Hawley said in a news release.
Although the suit does not solve the crisis going forward, it attempts to hold the people and companies who caused it responsible, state Rep. Jay Barnes, R-Jefferson City, said.
"The facts that are in the public square are pretty damning for these companies," Barnes said. "They started selling these drugs with no testing that showed they were safe or non-addictive. And no testing that showed they were more effective in helping with pain-management over the long term than non-opioid prescriptions combined with physical therapy."
Then, the companies formed groups to pitch the products as miracle drugs to family doctors nationwide, Barnes said.
The rate of fatalities from opioid overdoses has almost doubled in Missouri since 2012, Reidhead said. He cited CDC data that show opioid overdoses in 2012 accounted for 8.5 deaths for every 100,000 people in the state. In 2013, the rate was 10.14; 2014 was 11.41; 2015 was 11.24. The rate in 2016 was 15.12 for every 100,000 deaths.
"The stuff is heroin," Barnes said. "It is heroin in a pill. They are selling heroin, and they pitched it as something that would be non-addictive to be used in the management of common pain."
Barnes and other legislators have filed bills designed to regulate opioid prescriptions and to help people dispose of unused opioids.
House Bill 1310, sponsored by state Rep. Crystal Quade, D-Springfield, would require the Department of Health and Senior Services to create regulations for all health care professional with the authority to prescribe opioids, according to the bill summary. Regulations must meet CDC guidelines for prescribing opioids for chronic pain.
HB 1927, sponsored by state Rep. Becky Ruth, R-Festus, requires HSS to develop a voluntary non-opioid form to allow a person to refuse the administration or prescription of opioids.
Barnes already has filed two bills connected to opioids, including HB 2120, which would fund substance abuse treatment for women for up to two years after they have had a child. Another, HB 1618, would establish a controlled substance take-back program to allow certain health care entities to accept unused drugs for safe disposal.
"The drug take-back program is something that many other states have done," Barnes said. "These opioids — you're not supposed to flush them down the toilet because they get into the groundwater. Are you supposed to throw them away?"
Some pharmacies are offering recipients methods of destroying medications. Some give or sell DisposeRX to customers. When mixed with water and prescriptions, the product makes opioid inert, according to its website. It can then be dropped in the trash or taken to a medications take-back.
Because Missouri doesn't have a take-back program, people wishing to return their medications don't have that option.
"That does not make sense," Barnes said. "If you've got unused prescription drugs, (you should be able to) take them back to the pharmacy and get rid of them.
"We need a way for people with excess prescription drugs to hand them back in so they don't get into the hands of people who would abuse them," he said.
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