The economic costs of the opioid epidemic include direct costs, funds that must be allocated for purchase of any and all goods and services above that which we would normally allocate for these items were there no opioid epidemic, and indirect costs arising from the need to treat health complications related to opioid misuse, the loss of worker productivity and the long-term negative impact on the children and dependents of individuals with opioid use disorder. The opioid epidemic has significantly increased the financial burden on the criminal justice system as governments must now cover the costs for increased law enforcement, the judiciary, corrections, probation services, and parole. Medical costs directly related to the treatment ofopioid use disorder include inpatient and outpatient addiction treatment, the costs for methadone, buprenorphine, and naloxone. In this chapter we look at the specific areas in which the opioid epidemic has had a very real, and very negative effect on the world economy.

Our response to the opioid epidemic has been reactionary, however preventing future addiction saves lives and money. Methods to prevent opioid misuse and addiction are frequently placed in one of three categories: universal, selective, or indicated. Universal prevention addresses an entire group of people without respect to any factors that might predispose someone to addiction. Most school-based curricula and education for prescribers fall under this category. Selective interventions are geared towards a subset of a population indentified as a higher risk for opioid use disorder, for example programs developed for children who have experienced traumatic events. Finally, indicated prevention focuses on individuals who are already using opioids but do not yet meet criteria for a clinical diagnosis of opioid use disorder. No matter the type, all strategies have the potential to postiively impact individuals and communities through reduced rates of addiction, overdose, and death.

Chronic opioid misuse puts people at significant risk for developing multiple health problems, caused either by decreased access to preventative care, exposure to blood-borne or sexually transmitted diseases or as a direct result of chronically elevated levels of exogenous opioids. People with opioid use disorder often suffer from chronic pain and mental illness at rates much higher than in the general population and are at significant risk for financial ruin, homelessness, overdose, and death. While it may not be possible to make opioid use completely safe, if we can, we should make it less dangerous. Illicit opioids are often impure and adulterated after production. They must be procured illegally and are often injected with unsterile equipment in an unsafe and unsupervised environment. All of these factors can and should be addressed as part of a comprehensive strategy to fight the opioid epidemic. Only by challenging the beliefs that underlie the stigma surrounding opioid use disorder and directly addressing the factors that contribute to the increased morbidity and mortality associated with chronic opioid misuse can we turn the tide of the epidemic.

Harm reduction refers to a set of strategies aimed to limit the negative consequences associated with drug use, but without requiring complete abstinence. Some harm-reduction strategies aim to reduce the risk of overdose, such as the use of naloxone rescue kits, fentanyl testing strips, and implementation of Good Samaritan laws. Other strategies lower the risk of overdose but also the likelihood of contracting infectious diseases such as HIV and hepatitis. Syringe services programs, also referred to as needle exchange programs, and supervised consumption facilities all fall under this category. Medications for opioid use disorder (MOUD), which include methadone, buprenorphine, and naltrexone, have been proven to lower the risk of overdose, improve the likelihood of maintaining sobriety, and therefore lower rates of disease transmission. Finally, harm reduction is utilized in criminal justice system through the use of drug decriminalization, police diversion programs, and drug treatment courts.

Relapse is a common phenomenon, and therefore relapse prevention plays a signficant part in addiction treatment. To effectively prevent relapse, it is important to understand how relapse happens and who is most susceptible to it. We now recognize relapse as a multi-stage process occuring over time, rather than a singular event. Multile intrapersonal and interpersonal factors have been identified that influence the risk of relapse. When creating a relapse prevention plan, these factors must be taken into consideration in order for the individual to be successful.