Abstract
Objective
Policy makers require evidence-based estimates of the economic costs of substance use-attributable lost productivity to set strategies aimed at reducing substance use-related harms. Building on a study by Rehm et al. (2006), we provide estimates of workplace costs using updated methods and data sources.
Methods
We estimated substance use-attributable productivity losses due to premature mortality, long-term disability, and presenteeism/absenteeism in Canada between 2007 and 2014. Lost productivity was estimated using a hybrid prevalence and incidence approach. Substance use prevalence data were drawn from three national self-report surveys. Premature mortality data were from the Canadian Vital Statistics Death Database, and long-term disability and workplace interference data were from the Canadian Community Health Survey.
Results
In 2014, the total cost of lost productivity due to substance use was $15.7 billion, or approximately $440 per Canadian, an increase of 8% from 2007. Substances responsible for the greatest economic costs were alcohol (38% of per capita costs), tobacco (37%), opioids (12%), other central nervous system (CNS) depressants (4%), other CNS stimulants (3%), cannabis (2%), cocaine (2%), and finally other psychoactive substances (2%).
Conclusion
In 2014, alcohol and tobacco represent three quarters of substance use-related lost productivity costs in Canada, followed by opioids. These costs provide a valuable baseline that can be used to assess the impact of future substance use policy, practice, and other interventions, especially important given Canada’s opioid crisis and recent cannabis legalization.
Résumé
Objectif
Les décideurs ont besoin d’estimations factuelles des coûts économiques de la perte de productivité attribuable à l’usage de substances pour pouvoir mettre en place des stratégies de réduction des méfaits. Partant d’une étude faite par Rehm et coll. (2006), nous avons estimé les coûts en milieu de travail à l’aide de méthodes et de sources de données à jour.
Méthodes
Nous avons estimé la perte de productivité (mortalité prématurée, invalidité de longue durée et présentéisme/absentéisme) attribuable à l’usage de substances au Canada, de 2007 à 2014. Les estimations des coûts liés à la perte de productivité ont été faites au moyen d’une méthode hybride de prévalence et d’incidence. Les données sur la prévalence de l’usage de substances ont été tirées de trois enquêtes nationales d’autodéclaration. Les données sur la mortalité prématurée ont été obtenues de la Base de données canadienne sur les décès (statistiques de l’état civil), et les données sur l’invalidité de longue durée et l’interférence professionnelle, elles, de l’Enquête sur la santé dans les collectivités canadiennes.
Résultats
En 2014, les coûts de perte de productivité attribuable à l’usage de substances totalisaient 15,7 milliards de dollars (environ 440 $ par Canadien), soit une hausse de 8 % par rapport à 2007. Les substances responsables de ces coûts étaient l’alcool (38 % des coûts par personne), le tabac (37 %), les opioïdes (12 %), les autres dépresseurs du système nerveux central (SNC) (4 %), les autres stimulants du SNC (3 %), le cannabis (2 %), la cocaïne (2 %) et les autres substances psychoactives (2 %).
Conclusion
En 2014, l’alcool et le tabac représentaient les trois quarts des coûts de perte de productivité liée à l’usage de substances au Canada, suivis des opioïdes. Ces coûts fournissent un point de référence utile pour évaluer les retombées des politiques, pratiques et autres interventions qui seront mises en place, compte tenu de la crise des opioïdes qui sévit et de la récente légalisation du cannabis au Canada.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Notes
While reduced effectiveness at work is clearly a reduction in labour productivity, and increased LTD can be seen as reduced labour productivity of the working age population as a whole, premature mortality warrants further distinction. While it has the same effect on total output as increased LTD in the sense that output drops because of a reduction in aggregate labour input, it may not be precise to label the effects as “lost productivity.” However, for simplicity, we will refer to the lost output arising from removal from the workforce due to premature mortality as “lost productivity” throughout this paper.
References
Bounajm, F., Stonebridge, C., Theriault, L. (2013). Smoking cessation and the workplace: Briefing 3—Benefits of workplace programs [internet]. The Conference Board of Canada. Available from: http://www.conferenceboard.ca/e-library/abstract.aspx?did=5838
Brealey, R., Myers, S., Marcus, A., Mitra, D., Maynes, E., & Lim, W. (2016). Fundamentals of corporate finance (6th ed.). Whitby, Ont.: McGraw-Hill/Irwin series in finance, insurance and real estate 880 p.
Canadian Community Epidemiology Network on Drug Use. (2014). CCENDU Drug Alert: Increasing Availability of Counterfeit Oxycodone Tablets Containing Fentanyl [Internet]. 2014 [cited 2018 Nov 19]. Available from: http://www.ccsa.ca/Resource Library/CCSA-CCENDU-Oxycontin-Fentanyl-Alert-2014-en.pdf.
Canadian Community Epidemiology Network on Drug Use. (2015a). CCENDU Drug Alert: Fentanyl-related Overdoses [Internet]. 2015 [cited 2018 Nov 19]. Available from: http://www.ccsa.ca/Resource Library/CCSA-CCENDU-Drug-Alert-Fentanyl-related-Overdoses-2015-en.pdf.
Canadian Community Epidemiology Network on Drug Use. (2015b). CCENDU Bulletin: Deaths Involving Fentanyl in Canada 2009–2014 [Internet]. 2015 [cited 2018 Nov 19]. Available from: http://www.ccsa.ca/Resource Library/CCSA-CCENDU-Fentanyl-Deaths-Canada-Bulletin-2015-en.pdf.
Canadian Community Epidemiology Network on Drug Use. (2016). CCENDU Bulletin: Novel Synthetic Opioids in Counterfeit Pharmaceuticals and Other Illicit Street Drugs [Internet]. 2016 [cited 2018 Nov 19]. Available from: http://www.ccsa.ca/Resource Library/CCSA-CCENDU-Novel-Synthetic-Opioids-Bulletin-2016-en.pdf.
Canadian Substance Use Costs and Harms Scientific Working Group. (2018). Canadian substance use costs and harms: 2007-2014 [Internet]. Ottawa, ON: Canadian Institute for Substance Use Research and the Canadian Centre on Substance Use and Addiction. Available from: https://csuch.ca/en/report/.
Degenhardt, L., Whiteford, H. A., Ferrari, A. J., Baxter, A. J., Charlson, F. J., Hall, W. D., et al. (2013). Global burden of disease attributable to illicit drug use and dependence: findings from the Global Burden of Disease Study 2010. Lancet, 382(9904), 1564–1574.
Degenhardt, L., Charlson, F., Stanaway, J., Larney, S., Alexander, L. T., Hickman, M., et al. (2016). Estimating the burden of disease attributable to injecting drug use as a risk factor for HIV, hepatitis C, and hepatitis B: findings from the Global Burden of Disease Study 2013. Lancet Infect Dis, 16(12), 1385–1398.
Degenhardt, L., Charlson, F., Ferrari, A., Santomauro, D., Erskine, H., Mantilla-Herrara, A., et al. The global burden of disease attributable to alcohol and drug use in 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Psychiatry, 2018.
Dobrescu, A., Bhandari, A., Sutherland, G., & Dihn T. The costs of tobacco use in Canada. (2012). Ottawa. The Conference Board of Canada, 2017.
Employment and Social Development Canada. (2019). Canadian Pension Plan (CPP) Disability Benefits by Class of Diagnosis [Internet]. [cited 2019 Jun 18]. Available from: https://open.canada.ca/data/en/dataset/2abf6a97-6c0e-473e-9976-dfa9aba831bf
Evans WE, Montgomery E. (1994). Education and health: Where there’s smoke there’s an instrument [Internet]. Cambridge, MA; (NBER Working Paper Series). Report No.: 4949. Available from: https://www.nber.org/papers/w4949.pdf
Fischer, B., Vojtila, L., & Rehm, J. (2018). The ‘fentanyl epidemic’ in Canada – Some cautionary observations focusing on opioid-related mortality. Prev Med (Baltim).
Government of Canada. (2018). Apparent opioid-related deaths - Canada.ca [Internet]. [cited 2018 Sep 18]. Available from: https://www.canada.ca/en/health-canada/services/substance-use/problematic-prescription-drug-use/opioids/apparent-opioid-related-deaths.html
Greenland, S., Rothman, K. J., & Lash, T. (2008). Measures of effect and measures of association. In K. J. Rothman, S. Greenland, & T. L. Lash (Eds.), Modern epidemiology. Third (pp. 51–70). Philadelphia, PA: Lippencott Williams & Wilkins.
Kehoe, T., Gmel, G., Shield, K. D., Gmel, G., & Rehm, J. (2012). Determining the best population-level alcohol consumption model and its impact on estimates of alcohol-attributable harms. Popul Health Metr, 10(1).
Larg, A., & Moss, J. R. (2011). Cost-of-illness studies a guide to critical evaluation. Pharmacoeconomics, 29(8), 653–671.
Levin, M. L. (1953). The occurrence of lung cancer in man. Acta Unio Int Contra Cancrum, 9(3), 531–541.
Mohapatra, S., Patra, J., Popova, S., Duhig, A., & Rehm, J. (2010 Jun). Social cost of heavy drinking and alcohol dependence in high-income countries. Int J Public Health, 55(3), 149–157.
National Center for Chronic Disease Prevention and Health Promotion (US) Office of Smoking and Health. (2014). The health consequences of smoking—50 years of progress: a report of the surgeon general. Atlanta, GA; 2014.
Northwest Territories Health and Social Services. (2012). Northwest Territories Substance Use and Addictions Survey. Yellowknife: NWT.
Pearce, A. M., Hanly, P., Timmons, A., Walsh, P. M., O’Neill, C., O’Sullivan, E., et al. (2015). Productivity losses associated with head and neck cancer using the human capital and friction cost approaches. Appl Health Econ Health Policy, 13(4), 359–367.
Public Health Agency of Canada. (2019). Special Advisory Committee on the Epidemic of Opioid Overdoses. National report: Apparent opioid-related deaths in Canada (January 2016 to September 2018) [Internet]. Ottawa, Ca; 2019. Available from: https://health-infobase.canada.ca/datalab/national-surveillance-opioid-mortality.html
Rehm J, Baliunas D, Brochu S, Fischer B, Gnam W, Patra J, et al. The costs of substance abuse in Canada 2002. Ottawa: Canadian Centre on Substance Use and Addiction; 2006.
Rehm, J., Kehoe, T., Gmel, G., Stinson, F., Grant, B., & Gmel, G. (2010). Statistical modeling of volume of alcohol exposure for epidemiological studies of population health: the US example. Popul Health Metr, 8(1).
Schroeder, S. A. (2012). Incidence, prevalence, and hybrid approaches to calculating disability-adjusted life years. Popul Health Metrics, 10(1), 19.
Sherk, A., Stockwell, T., Rehm, J., Dorocicz, J., & Shield, K. D. (2017). The International Model of Alcohol Harms and Policies (InterMAHP): a comprehensive guide to the estimation of alcohol-attributable morbidity and mortality. Version 1.0. Canadian Institute for Substance Use Research: University of Victoria, British Columbia, Canada.
Single, E., Robson, L., Xie, X., & Rehm, J. (1998). The economic costs of alcohol, tobacco and illicit drugs in Canada, 1992. Addiction, 93(7), 991–1006.
Single E, Collins D, Easton B, Harwood H, Lapsley H, Kopp P, et al. International guidelines for estimating the costs of substance abuse. Second. Geneva, Switzerland: World Health Organization; 2003.
Statistics Canada. (2014) Canadian Alcohol and Drug Use Monitoring Survey (CADUMS) - Canada.ca [Internet]. 2014 [cited 2018 Apr 4]. Available from: https://www.canada.ca/en/health-canada/services/health-concerns/drug-prevention-treatment/canadian-alcohol-drug-use-monitoring-survey.html
Statistics Canada. (2016a). Surveys and statistical programs - Canadian Tobacco, Alcohol and Drugs Survey (CTADS) [Internet]. 2016 [cited 2018 Jun 21]. Available from: http://www23.statcan.gc.ca/imdb/p2SV.pl? Function=getSurvey&SDDS=4440.
Statistics Canada. (2016b). Surveys and statistical programs - Canadian Community Health Survey - Annual Component (CCHS) [Internet]. Statistics Canada. 2016 [cited 2017 Aug 23]. Available from: http://www23.statcan.gc.ca/imdb/p2SV.pl? Function=getSurvey&SDDS=3226.
Statistics Canada. (2017a). Surveys and statistical programs - Canadian Community Health Survey - Mental Health (CCHS) [Internet]. Statistics Canada. 2017 [cited 2018 Jun 21]. Available from: http://www23.statcan.gc.ca/imdb/p2SV.pl? Function=getSurvey&SDDS=3226.
Statistics Canada. (2017b). Table 051-0001 Estimates of population, by age group and sex for July 1, Canada, provinces and territories, annual (persons) [Internet]. [cited 2017 Aug 23]. Available from: http://www5.statcan.gc.ca/cansim/a26?id=510001
Statistics Canada. (2017c). Table 183-0023 - sales and per capita sales of alcoholic beverages by liquor authorities and other retail outlets, by value, volume, and absolute volume, annual. Statistics Canada: Ottawa, ON.
Statistics Canada. (2017d). Surveys and statistical programs - Vital Statistics - Death Database (CVSD) [Internet]. 2017 [cited 2017 May 17]. Available from: http://www23.statcan.gc.ca/imdb/p2SV.pl? Function=getSurvey&SDDS=3233.
Statistics Canada. (2017e). Table 281-0027 - Survey of Employment, Payrolls and Hours (SEPH), average weekly earnings by type of employee, overtime status and detailed North American Industry Classification System (NAICS), annual (current dollars). Statistics Canada.
Statistics Canada (2017f). Table 282-0087 - labour force survey estimates (LFS), by sex and age group, seasonally adjusted and unadjusted, monthly (persons unless otherwise noted). Statistics Canada.
Statistics Canada. (2017g). Table 326-0021 - Consumer Price Index, annual (2002=100 unless otherwise noted) [Internet]. Statistics Canada [cited 2017 Aug 23]. Available from: http://www5.statcan.gc.ca/cansim/a26?id=3260021
Statistics Canada. Financial market statistics, last Wednesday unless otherwise stated, Bank of Canada. 2019a.
Statistics Canada. (2019b). Changes in life expectancy by selected causes of death, 2017 [Internet]. The Daily. p. 1–6. Available from: https://www150.statcan.gc.ca/n1/en/daily-quotidien/190530/dq190530d-eng.pdf?st=3YgTalQ9
Tsai, S. P., Wen, C. P., Hu, S. C., Cheng, T. Y. & Huang S. J. (2005). Workplace smoking related absenteeism and productivity costs in Taiwan. Tob Control, 14(Suppl 1), i33–i37.
World Health Organization. (2014). Global status report on alcohol and health 2014 [Internet]. Global status report on alcohol. Geneva, Switzerland; 2014. Available from: https://apps.who.int/iris/bitstream/handle/10665/112736/9789240692763_eng.pdf;jsessionid=46539CA2A418DFAAA33D0676CD8607B9?sequence=1
World Health Organization. (2016). International statistical classification of diseases and related health problems 10th revision. Geneva, Switzerland; 2016.
Zhao, J., Stockwell, T., Roemer, A., Naimi, T., & Chikritzhs, T. (2017). Alcohol Consumption and Mortality From Coronary Heart Disease: An Updated Meta-Analysis of Cohort Studies. J Stud Alcohol Drugs, 78(3), 375–386.
Zhao, J., Stockwell, T., Sorge, J. T., Dorocicz, J., Fairbank, J., Hall, B., et al. (2018). Small area estimation of alcohol and other substance use from Canadian substance use surveys: a method to deal with missing data in prevalence estimates. In A paper presented at the 44th Annual Symposium of the KBS Social and Epidemiological Research in Alcohol.
Acknowledgements
The authors would like to thank Alan Diener, PhD, Public Health Agency of Canada, for technical support and review of methods; and Amanda Farrell-Low, Canadian Institute for Substance Use Research, for providing valuable feedback on drafts of this study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
This study was approved by the Research Ethics Board of the University of Victoria (17-068).
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Sorge, J.T., Young, M., Maloney-Hall, B. et al. Estimation of the impacts of substance use on workplace productivity: a hybrid human capital and prevalence-based approach applied to Canada. Can J Public Health 111, 202–211 (2020). https://doi.org/10.17269/s41997-019-00271-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.17269/s41997-019-00271-8