Fentanyl, Toxicology, Healthcare Costs & Estate Planning: Strange Bedfellows in 2017

Report by Terry Gotham

This week’s edition of “Why We Can’t Have Nice Things” is a look at a couple of different secondary effects of the opiate overdose epidemic that I don’t think are being given enough scrutiny. With Donald John Trump Jr. declaring a “state of emergency” but not promising any tangible resources, I thought it would be best to do the opposite. Dive into the nitty-gritty of two facets of the opiate epidemic that are so far out into the policy weeds that our president has probably never thought about them.

One of the more complex problems caused by the flood of fentanyl and fentanyl analogs is the difficulty in investigating overdose deaths. This is somehwat related to the explosion in complexity that ER staff are forced to cope with when it comes to determining what someone is overdosing from exactly. I spoke about this a while ago but only touched on the difficulties Emergency Rooms and hospitals are dealing with while working with the patient in vivo. But the work doesn’t stop there.

The Daily Herald out of Highland Park, Illinois reported on a story that’s being duplicated in counties all across the country. Toxicologists & coroners in suburban, exurban & rural communities are seeing their testing and evaluation costs spike in the face of the fentanyl analog flood. Anne Majewski of the McHenry County coroner’s office has to almost triple her costs when fentanyl or a fentanyl analog is suspected, with a $185 standard drug screen turning into a complex battery of tests costing near $500.

“It’s a drain for everybody,” says Dr. George Behonick, director and chief toxicologist at AXIS Forensic Toxicology in Indianapolis, one of two labs where suburban coroners typically send their samples. “We don’t want to do anything that’s going to make it even more problematic to get the testing done. Yes, we’re a private entity and we’re there to make money, but not in a way that can cripple the municipal jurisdictions.”
~Why it’s costing more to investigate suburban overdose deaths, Marie Wilson, Daily Herald 8/7/17

These piecemeal cost increases don’t seem like a lot, but in McHenry county, that translated into an increase of  $4500 in 12 months, within an annual budget that saw $40,000 in cuts over that same year. That adds up fast, especially in communities with underfunded health, law enforcement or coroner’s budgets. In addition to costs, complex testing for novel psychoactive substances and fentanyl analogs increases the lag time between a fatality and pronouncement of the exact cause of death. This adds stress and hardship for the grieving family, who may still be unaware of even the general circumstances of a loved one’s passing.

There aren’t any ways to make these tests faster, cheaper or less complex yet. Not only does fentanyl not show up on most standard toxicology screenings, some fentanyl analogs don’t even show up on those. This requires multiple tests to be run, sometimes one after another, delaying the results for weeks as the coroner’s office plays detective with a novel psychoactive substance their department may not have encountered yet.

Thankfully, the coroners & medical examiners aren’t balking at the costs yet, but there are government & law enforcement officials who don’t want to pay for Narcan/Naloxone because of what they believe to be the moral hazard that “overdose reversers” bring with them. Coroners have a more evolved perspective, as they know that the more information they have about what drugs users are actually doing, the more effectively health officials & first responders can create policy and keep their citizens safe.

While some believe that the fight is over once you’ve had your “Intervention” or “Come to Jesus” moment with opiate-dependent family members, the truth is far more complicated and unfortunately, expensive. Ted Sarenski’s family describes how bad it can get in this report from Investment News.

The couple has spent about $200,000 over three years fighting their sons’ opioid abuse. That doesn’t take into account financial losses resulting from their youngest son having stolen from them or the cost of unrefunded tuition when both boys dropped out of college.
~American High, Greg Iacurci & Elizabeth MacBride, Investment News 8/5/17

While opiate addiction & overdose-related medical costs have long been seen to put poor & working class families into bankruptcy, the blow to wealthy families can be surprising. Investment News found 36% of financial advisers have had clients or clients with family members who were “addicted to opioids.” With the exploding rate of dependency affecting families in all income categories, cases like these are blindsiding professionals who may not have the expertise or resources within their own firms to pivot from traditional financial planning like helping a family save for college or elder care, to generating additional income to pay for a second unplanned emergency room visit or third stint in rehab for an immediate family member.

Addiction, unlike dementia, doesn’t always come with decreased financial savvy. With a number of professionals advising clients on how to hide assets or billing statements from dependent family members, it’s not just helping them pay for addiction treatment, it’s also preventing them from draining a bank account or acquiring a credit card to max out. Since 2012, the ranks of those seen as “dependent” have exploded, swelling to 1.4 million privately insured US citizens diagnosed with opioid use disorder in 2016, a 600% increase since 2012. Much like the toxicology & coroner costs, these may not seem big at first. But when top tier private rehab facilities cost $2,000 a day or more, very few families can keep it up for long.

The costs associated with drug addiction are very rarely absorbed by insurance companies, especially when the patient has relapsed repeatedly. This leads to families making rash decisions to meet the stiff costs of private treatment, including raiding 401k funds, mismanaging insurance and even restructuring trust assets. Lastly, because family members in the throes of addiction or recovery aren’t always able to do so while being full-time parents, couples entering their twilight years have been forced to provide for their grandchildren. Being forced to care for 2 generations of children can bankrupt even the most prudent & well-prepared retirees.

It’s important to realize the opiate epidemic is creating additional costs everywhere, affecting members of society who can’t even spell the word, much less describe what they feel like. The tertiary costs explained in this article are just a handful out of hundreds of expenses that are borne at the individual, family, county, state, and country level when opiate addiction is not properly addressed. It’s easy to label this as a problem of the Precariat, a term used to describe those one missed paycheck or emergency expense from bankruptcy. But we can see that even the upper class or well-funded government service departments can be overwhelmed by the issues this epidemic presents modern society. We’re all in this together folks, so let’s get to work.

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