Paying for Pills: How Prescription Drug Abuse Hits Us All

It doesn’t take many addicts to run up a big bill.

"It’s not unusual for us to see clients utilizing 20, 30, 40 pharmacies to obtain their medications."

That’s Sherry Bozoian.

She investigates fraud for New Hampshire Medicaid.

When Bozoian’s department spots a Medicaid recipient going from pharmacy to pharmacy to buy drugs, they restrict that person to a single drugstore.

It’s called a lock-in program, and it’s designed to clamp down on the abuse and sale of medications paid for with Medicaid dollars.

Bozoian’s auditor has identified less than one percent of all Medicaid clients as doctor shoppers.

But in its overuse of the medical system, that tiny group costs the state a lot of money.

By locking in about 70 people a month between January and May of this year, Bozoian figures the state saved $132,000.

In an earlier story we introduced a young man we called Bill, the college student who was addicted to opioids.

He went to an ER seeking drugs.

"So I went to the ER one night and just said my stomach’s killing me; they gave me a shot of morphine."

Then the doctors gave Bill a test.

Today, he can’t remember whether it was a CT scan, an MRI or just an X Ray.

So we looked at the figures for what that single scam could have cost an uninsured patient in New Hampshire.

Just to walk into the emergency room, the bill would range from $600 at the least expensive hospital to about $2300 at the most expensive.

That test, depending on what hospital Bill went to, could have cost anywhere from $350 to $3500 dollars.

And most ER physicians, and many pain specialists, say they see at least one doctor shopper on each shift.

Multiply the cost of Bill’s ER visit by thousands of abusers and what’s the cost to NH’s health care system?

"Many many millions."

That’s David Strang, an ER doctor in Franklin.

"If you consider not only how much is being spent on these substances that are then being diverted, but add up all the health care dollars that go into signing into the emergency room to see someone like myself and the x rays that go along with that, that don’t need to be taken; the nursing time; the ambulance expense in going to the ER for the injury that doesn’t exist, that’s millions and millions of health care dollars that are being burned up right there."

Insurance companies are beginning to take notice.

Cigna, one of New Hampshire’s big three insurance providers, began identifying abusers in early 2007.

Addicts are funneled into treatment programs, and people suspected of selling their prescriptions are investigated for insurance fraud.

In the process, the insurance company cuts down on what it says are unnecessary prescriptions, and doctor and ER visits.

The company, which operates in several states, figures that it has saved $27 million so far.

But that’s hardly where the costs end.

It’s no surprise that many addicts turn to crime to pay for pills and other drugs.

Consider Katy, the recovering addict I met at a Dover restaurant.

She had escalated from pain pills to heroin, which gives the same high but is cheaper.

At one point, she was spending $340 a day on heroin.

"I was stealing. I got caught, a lot. I got convicted, a lot.
And she spent time in jail – a lot."

"I went to jail for the last time because I robbed an Exxon. That was probably the best thing that could have happened to me. That started my bottom. Like I had nothing. Nobody would send me money in jail, my mom wouldn’t write me letters. And finally the state of NH decided that I had a drug problem, and they mandated me to SE NH Services in Dover, and I stayed there for 11 months."

Jail time costs around $24,000 a year.

And while an addict’s in jail, she’s not getting better.

Ray McGarty is executive director of Southeastern New Hampshire Services.

"They’ll get no treatment or extremely inadequate treatment and once they’re out they’ll be off and rolling again."

That’s exactly what happened to Katie.

She’d get out of jail and begin using, and stealing, right away.

Until she received long-term treatment, that is.

A year at Southeastern costs about $11,000, McGarty says.

Today, Katy is sober, working full-time and hoping to go to college.

But she’s not yet a full-time mom to the little boy she had when she was 19.

And that’s where yet more costs are escalating.

"Our population has switched mostly to women in treatment and most of them have children."

McGarty says many of those kids are in foster care.

That’s expensive, too.

So says Lorraine Bartlett of DCYF.

About 900 New Hampshire kids are in foster care right now, at costs ranging from $18,000 to $70,000 annually.

Then, says Bartlett, there’s the cost you can’t count.

"I don’t think that you can put a dollar figure on the emotional costs to a child and a parent when they’re separated from each other and then the continued emotional cost for a child who’s waiting for a parent to have that substance abuse issue addressed to the point where they’re able to safely and effectively parent their child."

But there isn’t nearly enough treatment for those who need it – despite both the emotional and economic consequences of untreated addiction.

According to HHS, about 60,000 people need treatment for substance abuse, including alcoholism.

But only 10% get it.

The state spends less than $12 million on substance abuse treatment, and a fraction of that on prevention.

For NHPR News, I’m EG.