Tobacco and opioid addictions cost Indiana more than $8.2 billion annually, and the state should do more to address these problems, according to two studies released today by the Fairbanks Foundation and conducted by IUPUI’s Richard M. Fairbanks School of Public Health.

The toll from tobacco alone comes to $6.8 billion, taking into account health-care costs, costs incurred from secondhand smoke and lost productivity due to smoking-related diseases and smoking on the job. Opioid overdose deaths cost Indiana $1.4 billion in 2014 in terms of medical costs and lost lifetime earnings, the study found.

Then there’s the loss of life. Opioid overdoses killed more than 1,000 people in 2014, and tobacco was responsible for more than 10 times that number of deaths, the studies say.

Fairbanks Foundation officials hope that showcasing the economic and human costs of these addictions will galvanize people statewide to act.

The studies provide “a really close examination not only on the human toll … but also the economic impact and how much we as taxpayers are having to bear the burden,” said Claire Fiddian-Green, president and chief executive officer of the Richard M. Fairbanks Foundation.

The foundation, which has an annual grant-making budget of about $14 million, will focus on tobacco and opioid addiction, both of which are major contributors to poor public health in Indiana, Fiddian-Green said. The state ranks 41st in health in national studies, making it a less appealing to businesses considering coming here.
While few in public health would call the studies surprising, their publication represents increasing attention being paid to these issues, some say. An HIV outbreak in Scott County linked to intravenous drug use also helped shine the spotlight on how prevalent it is in some communities, said Kim Manlove, director of the Indiana Addictions Coalition.

“For the first time in the past decade, I think we’re seeing an awareness of these issues and a willingness to actually do something about it that we haven’t seen,” he said. “I don’t know frankly that it shows anything new. I’m just grateful that they have joined the fray.”

Next week the Fairbanks Foundation will host a summit to bring together funders and experts in tobacco and opioid addictions to discuss potential solutions.

While the two addictions appear to differ greatly from one another — tobacco use, for instance, is legal — they have several features in common, said Paul Halverson, founding dean of the Fairbanks School of Public Health. The school has received grants from the foundation but is not connected to it otherwise.

Both addictions are health behaviors that can be prevented, Halverson said. In addition, they both have major health impacts. Tobacco addiction is the largest cause of preventable death, while opioid use is “one of the fastest growing scourges on our state” in terms of human lives and economic costs, he said.

Finding interventions that are scientifically proven to work is critical, he said.

“It’s really important to understand that these are addictions that are really tough to beat on their own,” Halverson said.

Ben Gonzales, 25, understands that now. Two and a half years ago, Ben was in the throes of heroin addiction. The Purdue graduate, who had dabbled in recreational drug use during college, started using heroin regularly the summer after he graduated and a relationship dissolved.

Eight months later, his parents, in whose northeast-side home he was living, learned of his addiction. Gonzales entered therapy and received a Vivitrol shot to block heroin’s effect on him. But as the long-acting medication wore off, Gonzales used again, overdosed and crashed his car. Paramedics revived him with Narcan, and he reiterated his resolve to quit.
He spent four months sober and then in August 2014 he used again, this time at home. He overdosed once more, and the paramedics once more revived him. This time, he went into a 90-day inpatient treatment program. He’s been sober for two years and works in addiction treatment.

The more people talk about addiction, he said, the greater the chance of finding a solution.

“I think this study is great. I think it brings awareness,” he said. “Unless we talk about how we change, we’re not going to get anywhere.”

The system also needs to place a higher priority on recovery, adding it into the continuum of care, Manlove said. Many people who enter recovery relapse, and treatment plans need to reflect that reality, approaching addiction as a chronic disease much the way diabetes or heart disease may be.

Historically, addiction has been treated like an acute disease, in which the person is stabilized, detoxed and then dispatched to a 12-step group or the equivalent, Manlove said. Only about 15 to 20 percent of those who enter such groups wind up staying.

“We can’t continue to look at addiction and people’s failure to get into recovery as a personal failing. We’ve got to realize this is a chronic relapsing disease,” Manlove said.

People may also blame smokers for their inability to quit, Halverson said. On average, it takes a person 11 times of trying to quit before he or she succeeds.

But one of Indiana’s main obstacles is the sense that there’s little the state can do, Halverson said. Many people he meets seem resigned to the numbers.

The Centers for Disease Control and Prevention recommends that Indiana spend almost $80 million on tobacco cessation plans; instead, the state has about $7 million allocated.

“We don’t have to accept the fact we’re 44th in smoking. … We’re spending $6.8 billion in costs related to tobacco, and in some ways, this is like a hidden tax we’re all paying because we’re not taking actions that will change that for our state,” Halverson said. “This is not something we just have to accept. This is something we have to do something about.”