The Prevention Paradox: Striking a Balance Between Opioid Prevention and Treatment
“We know that prevention works. For every $1 invested in treatment, we save $4 in healthcare costs. That’s a pretty good investment. But we also know that when it comes to prevention, there are some programs that return up to $64 for every one dollar invested. These tend to be programs that are based in schools or in communities.” — Vivek Murthy, former US Surgeon General
In the U.S., there are more than 1,400 facilities actively treating substance abuse and addiction, yet a surprisingly small percentage of people in need of treatment actually receive it. Meanwhile, deaths from accidental overdose have risen from around 35,000 per year to more than 60,000 per year in the last decade. The grim truth is that the opioid epidemic is growing faster and claiming more lives than the healthcare system can realistically treat. Treatment alone cannot solve the problem, but prevention—a critical key to curbing the epidemic—has been largely sidelined.
Treatment and prevention: finding the balance
Current efforts to fight opioid addiction are imbalanced, with a greater focus on treatment than prevention. SAMHSA (Substance Abuse and Mental Health Services Administration) grants are a perfect example of this disparity. While the organization’s mission does promote and implement prevention and early intervention, SAMHSA’s grants focus 80 percent on treatment and only 20 percent on prevention.
Admittedly, allocating resources is tricky. But this imbalance is a paradox that can be found throughout the healthcare industry: while it’s absolutely critical to treat acute cases and save lives, treatment seems to come at the expense of resources that might be used to intervene before acute life-saving treatment is necessary.
In an ideal world, both treatment and prevention would be given unlimited resources. In the real world, a balance must be struck. The good news is that prevention requires far fewer resources than treatment. Compared with the high costs of addiction treatment, prevention programs can be carried out for comparative pennies on the dollar. And the ROI is powerful: SAMHSA reports that for every dollar spent on prevention, there’s almost twenty dollars in savings in healthcare, social, law enforcement, and other public costs.
The case for early opioid prevention
By targeting teenagers—and potentially younger children—with drug abuse education programs before mistakes are made and patterns are set, addiction can be averted. Studies by the National Institute on Drug Abuse (NIDA) have demonstrated that the perception of danger around a behavior reduces the practice of that behavior. Cigarette smoking among teenagers, for example, is at its lowest rate in over 40 years, while marijuana use is up—both practices tracking to public perceptions of the dangers of each. Research-based educational intervention, according to the NIDA, can significantly reduce the early use of illicit substances, including opioids. Considering that that nine out of ten addictions are formed during the teen and young adult years, curbing early use could have massive preventative impact on all future opioid usage.
We’re now in crisis mode, and treatment of existing addiction is crucial for a population already ravaged by an opioid epidemic. But truly stemming this crisis requires a population-level approach to prevention—and that involves education at an early age, before patterns are set, mistakes are made, and the damage is done. When it comes to the question treatment or prevention, the answer is: both.
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