It’s the most fundamental principle of public health policy: An ounce of prevention is worth a pound of cure. That well-established truth is essential to keep top of mind as our nation starts spending more than $50 billion in settlement dollars to address the opioid epidemic.
Primary prevention focuses on intervening before harms occur. A simple vaccination can prevent serious disease; a healthy diet can prevent obesity, diabetes, or a heart attack.
Nowhere is the value of prevention more evident than in substance use. This approach can not only prevent harm and even death but also save lots of money.
While most health care spending has a certain “Monopoly” quality – seemingly unlimited piles of money of uncertain origins — opioid settlement spending is different. $50 billion is a lot of money, but it’s a limited source that will be doled out over 18 years. When it’s gone, it’s gone. There will be no second chance to get it right.
One of our organizations helps states and local governments determine how to spend the settlement funds in their regions. They are deciding how to balance expensive, high-intensity treatment with less-costly harm reduction and primary prevention.
Of course, these three priorities aren’t mutually exclusive, but each dollar spent in one area won’t be available for the other two. And, even with this much money, the challenge is far more extensive than the funding available.
To be sure, we are true believers in treatment. One of us, Dr. Costello, is in long-term recovery, and that recovery started in a treatment center. Dozens of studies show that addiction treatment is cost-effective and, in many forms, even cost-beneficial for society. This is especially true in high-prevalence settings like jails and prisons.
But we’re here to advocate for primary prevention funding as a significant component of opioid settlement spending.
- It is an extremely cost-effective way to spend limited funds.
- It will benefit our entire society for generations.
- It can improve a range of outcomes for a broad and diverse portion of our society, including adults. The Prevention Institute describes primary prevention as “a key strategy for eliminating inequities in health.”
We know what some of you may be thinking when it comes to youth drug prevention: “But DARE didn’t work!” And, by some study outcomes, you’re correct.
But don’t let DARE poison your view of prevention. Comprehensive, evidence-based prevention programs consistently demonstrate incredible returns.
In fact, a 2009 study sponsored by the Substance Abuse and Mental Health Services Administration concluded that effective substance abuse prevention programs could save an estimated $18 for each dollar invested if implemented nationwide.
A more recent review by the Washington State Institute for Public Policy shows at least 18 youth prevention programs produce benefits of at least $10 for every dollar invested. That said, this same review demonstrates the importance of choosing the right program and maintaining fidelity, since a dozen such programs may generate negative returns.
When based on evidence-based best practices, prevention demonstrates the most durable benefits of any type of intervention. While numerous articles have warned against the opioid settlement following in the tobacco settlement’s footsteps, that caveat ignores the huge strides our nation has made in limiting the toll of tobacco.
Since the mid-1960s, smoking has steadily decreased, from 42.4% of the population to 13.7%, with nearly 40% of that decrease coming after the tobacco settlement of 1998.
Among youth, this drop has been even more precipitous. Around 40% of high school seniors smoked in 1976; according to the CDC, 28% still smoked in 2000. But in 2022, only 2% smoked, although vaping has replaced much of this decrease through unchecked marketing to youth.
Imagine now if we could accomplish the same success in reducing opioid addiction and overdoses that the United States has accomplished in limiting tobacco use.
Defined broadly, opioid settlement prevention efforts would support a huge swath of society, adults included.
- Primary prevention focuses on stopping harm from ever occurring. This would encompass efforts to limit young people from becoming dependent on or even experimenting with opioids, which is especially important given the lethality of fentanyl.
- Primary prevention need not be limited to youth. While prevention efforts for adults are sparse, the best-known such intervention, Screening, Brief Intervention, and Referral to Treatment, generates $5.16 in benefits for every dollar spent per Washington State Institute for Public Policy’s analysis. Some form of this intervention is now standard in virtually every primary care setting.
- Secondary prevention focuses on reducing harm by early intervention. Brief interventions have been demonstrated effective in a range of settings, including primary care, colleges, and hospitals.
Secondary prevention would include treatment and support for those harmed by the opioid epidemic. They deserve this support from funds extracted from the companies that recklessly perpetuated the crisis.
While communities should tailor their opioid settlement spending strategies to their local needs, we should embrace basic, population-focused prevention strategies. Prevention efforts can turn the tide of addiction for decades to come. And they are where we’ll get the biggest bang for our buck.
Photo: Gearstd, Getty Images
