Opioid epidemic tied to sharp rise in hospitalizations, infections, and health care costs

Numerous stories have characterized the human toll of the growing opioid epidemic, but the impact and cost of hospitalizations from opioid abuse haven’t been quantified. Researchers now report that opioid-related hospitalizations and infections rose sharply in recent years, while opioid-related inpatient charges nearly quadrupled, according to findings published in the May 2016 issue of Health Affairs.

“The growing problem of opioid abuse in the United States has been well documented, but our study is the first of its kind to quantify serious infections related to opioid abuse and their impact on the U.S. hospital system and on health care costs,” said co-author Shoshana Herzig, MD, MPH, a hospitalist and Director of Hospital Medicine Research at Beth Israel Deaconess Medical Center (BIDMC), in Boston, MA.

Opioid abuse is associated with a number of potential consequences, including serious infections related to intravenous administration, which can be associated with significant morbidity and mortality, said Dr. Herzig, who is also Assistant Professor of Medicine at Harvard Medical School (HMS).

For this study, the researchers analyzed discharge data from a large, nationally representative sample of U.S. inpatient hospitalizations between 2002 and 2012. They used ICD-9-CM discharge codes of opioid abuse and dependence to identify related hospitalizations, infections, and inpatient charges.

Their findings showed:

• Opioid-related hospitalizations increased 72%, while the total number of all hospitalizations nationally stayed about the same
• Opioid-related hospitalizations with serious infection rose 91%
• Total inpatient charges for opioid-related hospitalizations nearly quadrupled, reaching $15 billion in 2012
• Hospitalizations related to opioid-associated infections accounted for $700 million of that $15 billion.

“The total cost of opioid-related hospitalizations has increased out of proportion to the rate of increase in the number of hospitalizations for these conditions,” said co-author Matthew Ronan, MD, a hospitalist at the VA Boston Healthcare System’s West Roxbury Medical Center and an instructor at HMS.

Medicaid was the most common primary payer for opioid-related hospitalizations as well as those related to opioid-associated infections, the researchers found.

“Further research is needed to investigate the factors underlying the exponentially rising costs associated with these inpatient stays,” Dr. Ronan added.

Recent research indicates that users have shifted from abusing only prescription opioids to abusing both opioids and heroin concurrently. The number of people who reported using heroin nearly doubled between 2003 and 2013, and deaths attributed to opioids and heroin combined totaled more than 24,000 in 2013. Related to this, infections from IV administration of these drugs are associated with significant morbidity and mortality, the researchers noted.

“The downstream consequences of opioid abuse and dependence, including serious infection, are severe—for individual patients and their loved ones, caregivers, hospital systems, and the federal government,” Dr. Herzig said. “A commitment to decreasing access to opioids, early treatment, and preventive strategies will be vital to decrease the burden of disease and cost to the health care system and society.”