Importance It is important to understand the magnitude and distribution of the economic burden of prescription opioid overdose, abuse and dependence to inform clinical practice, research and other decision makers. Decision makers choosing approaches to address this epidemic need cost information to evaluate the cost effectiveness of their choices. Objective To estimate the economic burden of prescription opioid overdose, abuse, and dependence from a societal perspective Design, Setting and Participants Incidence of fatal prescription opioid overdose from the National Vital Statistics System, prevalence of abuse and dependence from the National Survey of Drug Use and Health. Fatal data are for the U.S population, nonfatal data are is a nationally representative sample of the U.S. civilian noninstitutionalized population ages 12 and older. Cost data are from various sources including health care claims data from the Truven Health MarketScan® Research Databases, and cost of fatal cases from the WISQARS™ (Web-based Injury Statistics Query and Reporting System) cost module. Criminal justice costs were derived from the Justice Expenditure and Employment Extracts published by the Department of Justice. Estimates of lost productivity were based on a previously published study. Exposure Calendar year 2013 Main Outcomes and Measures Monetized burden of fatal overdose and abuse and dependence of prescription opioids. Results The total economic burden is estimated to be $78.5 billion. Over one third of this amount (is due to increased health care and substance abuse treatment costs ($28.9 billion). Approximately one quarter of the cost is borne by the public sector in health care, substance abuse treatment, and criminal justice costs. Conclusions and Relevance These estimates can assist decision makers in understanding the magnitude of adverse health outcomes associated with prescription opioid use such as overdose, abuse, and dependence.

State prescription drug monitoring programs are promising tools to rein in the epidemic of prescription opioid overdose. We used data from a national survey to assess the effects of the programs on the prescribing of opioid analgesics and other pain medication in ambulatory care settings at the point of care in twenty-four states from 2001 to 2010. We found that implementation of a prescription drug monitoring program was associated with more than a 30 percent reduction in the rate of prescribing of Schedule II opioids. This reduction was seen immediately following the launch of the program and was maintained in the second and third years afterward. Effects on overall opioid prescribing and prescribing of nonopioid analgesics were limited. Increased utilization of these programs and the adoption of new policies and practices governing their use may have contributed to sustained effectiveness. Future studies are needed to evaluate the comparative effectiveness of these policies.

This study suggests exposure to parental incarceration in childhood is associated with health problems in young adulthood. Extant literature suggests underlying mechanisms that link parental incarceration history to poor outcomes in offspring may include the lack of safe, stable, nurturing relationships and exposure to violence. To prevent poor health in offspring of the incarcerated, additional studies are needed to (1) confirm the aforementioned associations and (2) assess whether adverse experiences and violence exposure in childhood mediate the relationship between parental incarceration history and offspring health problems.