In Butler County, experts say the cost of addiction — which has been collectively borne by neighborhoods, families and people in recovery — is mitigated by investing in recovery efforts.

The numbers are staggering. County death data gathered by OverdoseFreePA shows 678 overdose deaths were reported in the county since 2011. According to Butler County’s Chief Detective Tim Fennell, 65 of those deaths occurred last year. The count remained steady with the year previous, as 65 deaths were reported in 2022.

In a 2022 government report published by the U.S. Commission on Combating Synthetic Opioid Trafficking, fatal opioid overdoses were estimated to cost the U.S. economy $1 trillion annually.

Those costs predominantly were related to “lost productivity (the result of early death) and from increases in health care and criminal justice costs,” according to the report.

Mike Krafick, Recovery Hub director for Armstrong-Indiana-Clarion Drug & Alcohol Commission, said he often comes across the fines and costs associated with addiction.

“(Addiction) doesn’t just impact the individual using,” he said. “(Addiction) has a way of consuming and taking over the person’s whole life and can make it hard for people to function day in and day out, maintain employment as drug use progresses. As addiction becomes more severe, it becomes hard to go to work and take care of kids, and impossible to care for loved ones.”

Overdose deaths — along with the rates of unemployment and incarceration associated with addiction — take an economic and emotional toll on a community, said addiction specialist Rachel Shuster.

“The ways in which chaotic substance use affects our community is endless,” she said.

According to Butler County Prison Warden Beau Sneddon, the average cost of incarcerating a person at the prison is about $32,634 a year. That equates to about $89 a day, and does not take into account the cost of medication for opioid use disorder, which treats withdrawal symptoms.

The average cost is calculated using a formula provided by the state and takes into account the prison’s annual budget, population and spending, Sneddon said.

He estimated more than half of inmates struggle with substance use disorder and noted not all inmates have been diagnosed.

Outside of jail, the cost of treatment differs widely and depends on a number of factors, including counseling services, mental health and medical co-morbidities, according to Dr. C. Thomas Brophy, director of the Ellen O’Brien Gaiser Center.

“Oftentimes, county jails are full of people who have a substance use diagnosis who benefit much more by being in treatment than being behind bars,” Krafick said.

Rehabilitation and drug treatment for substance use disorder, in many cases, is also more cost-effective than incarceration.

Executive director Joe Mahoney stated on the less expensive end of the spectrum, medication for opioid use disorder can cost about $147 per injection or dose. On the high end of the scale, the cost can approach $2,000.

“The average person at Gaiser would get Vivitrol or Sublocade injections, and those are the most expensive ones,” Mahoney stated. “It costs close to $1,000 a month (on average), but (there is) great variability on either end of that spectrum.”

It takes a village to rebuild in the wake of an opioid epidemic, Krafick said.

“It can’t just be left to addiction recovery specialists,” he said. “Everybody has a part to play.”

One way Krafick has seen communities make a positive impact is by employers giving people in recovery a second chance.

“Being able to find employment makes a significant difference with the people we’ve worked with,” he said. “Sometimes people just need to catch a break.”

Krafick recalled being able to find employment in 2010 and advance in his role within the Drug and Alcohol Commission made a significant impact on his own recovery. He said the job offered him the opportunity to do meaningful and fulfilling work, and helped him support his family and own a home.

“Recovery is possible and probable — if we give people access to resources they need, treatment when they need it (and) when they want it without barriers, without having to jump through hoops,” Krafick said.

He said if addiction were treated like the chronic disease it is, and if people looked to the results of providing ongoing support to those struggling with substance use disorder, they would realize people thrive and do well in recovery.

“I don’t think we will (eliminate drug use) by making substances harder to access,” Shuster said. "We’ve been doing this since the war on drugs started.“

The opioid crisis is a public and social health issue, she said, and criminalizing addiction hasn’t worked to curb the incarceration rate or number of deaths associated with drug use.

Making naloxone widely available, implementing harm reduction strategies and funding medications for opioid use disorder are more cost-efficient than burdening paramedics, filling jails and racking up ambulance, emergency room and funerary costs, addiction experts agreed.

Krafick argues the costs of recovery are also lower than the costs incurred by every drug-related death.

In 2022, a funeral cost, on average, was $14,478 in Butler County, according to the Pennsylvania Department of Human Services. The funerary cost excludes other prices paid by communities in the face of a person’s death by overdose.

The opportunity to recover, rebuild one’s life and give back to the community is extinguished with every overdose death.

“One of the most cost-efficient ways to prevent devastating losses to communities and to families is ensuring people stay alive,” Krafick said.

In her work as a drug and addiction expert, Ruthane Durso, director of behavioral health at Butler Memorial Hospital, said she has heard claims treatment is “wasted” on those with substance use disorder.

“While people are in active addiction, there is a cost to themselves, their family, their community and the healthcare system,” Durso said. “Just like with any other chronic illness that affects you. And when people get well, they can completely turn their life around.”

“People will say, ‘I don’t even know why we waste time with treatment — let people destroy themselves,’” she said. “When people are in recovery, they are our doctors, lawyers, priests, milkmen, waiters, waitresses. They’re not identifiable. They are functional. They have careers. They are good citizens. They rebuild families, and they have children, grandchildren.”

In recovery, people might not be able to mend every bridge, Durso said. She noted families, marriages and friendships are left broken in the wake of addiction. But new connections can be made, she said.

“A big misconception is that people cannot get well,” she said. “Another misconception is that if somebody has had multiple treatments, they can’t (recover).”

“Just like with any chronic illness, a setback or relapse doesn’t mean treatment is not beneficial,” Durso said. “It’s just the nature of the illness ... setbacks are part of active symptomology.”

Treatment is cumulative, Durso said.

When there is a setback, she said, past recovery efforts aren’t erased.

“You don’t start from beginning,” she said. “You go back to where you left off — we identify the disconnect in the recovery plan and work from there.”

“Just because you underwent more than one treatment, you are not failing or destined to fail,” she said.

Harm reduction strategies — which can range from fentanyl test strips to syringe exchange services — focus on educating people in active addiction about the substances they are using and how to prevent overdoses. They focus on moving people away from risky behaviors. In the process, many choose to go into recovery.

“If we can reach people, they will make these decisions for themselves and reduce the impact to themselves and their communities,” Shuster said.

Shuster said she understands the fear surrounding harm reduction, but research backs it: Not one fatal overdose has occurred at a safe consumption site worldwide, and people who participate in syringe exchange programs, which are not available in Butler County, are five times more likely to enter drug treatment.

“We work with people with a high risk of relapse, and we provide them with those tools to mitigate risks,” Krafick said. “If they’re a daily user, they’re probably not going to dispose of the drugs, but they might use less.”

The most important thing about preventing overdoses is to make sure naloxone is accessible and to dissuade people from using alone, Shuster said.

While naloxone is not considered a harm reduction strategy, a common misconception about both naloxone and harm reduction is they enable drug use.

“The only thing Narcan enables is breathing,” Krafick said.

This article is shared in its entirety as the Butler Eagle kicks off a conversation on addiction and pathways to recovery in our community. To read more from Changing Pathways to Recovery, a six-week series, subscribers can visit www.butlereagle.com/category/changing-pathways.