By Avalere Health

In 2022, over six million people in the United States reported having an opioid use disorder (OUD). Past research has not yielded comprehensive estimates of the full societal burden of OUD or the impact of OUD treatments in limiting associated costs. To evaluate the costs of OUD and the benefits and cost savings associated with OUD treatment, Avalere Health conducted secondary research and modeled the costs as well as the savings associated with treatment of OUD, nationally and by state. This research (1) characterized the prevalence of OUD, (2) modeled the costs of OUD, and (3) modeled the net cost impact of four ambulatory OUD treatments: (a) behavioral therapy alone, (b) behavioral therapy plus methadone, (c) behavioral therapy plus transmucosal buprenorphine, and (d) behavioral therapy plus longacting injectable (LAI) buprenorphine. Key findings: 1. OUD prevalence: OUD cases per capita (the percentage of individuals per state with OUD) ranged among states from 0.75% to 2.99%. New Hampshire, Nevada, Massachusetts, and Kentucky had the highest rates of OUD (greater than 2.5%), while Wyoming, Hawaii, Washington DC, and Minnesota had the lowest (less than 1.0%). 2. Cost burden of OUD: The average annual total cost per OUD case OUD is approximately $695,000 across all stakeholders analyzed. The annual cost per OUD case, excluding the patient burden to the individual with OUD, is approximately $163,000, spread across public and private stakeholders. Including lost quality and length of life, the patient burden of OUD is approximately $532,000 per year. 3. Costs to external stakeholders: The costs to the federal government, state/local government, private businesses, and society are driven by lost productivity for employers ($438 billion), employees ($248 billion), and households ($73 billion). Health insurance and uninsured costs were $111 billion, criminal justice costs are $52 billion, and other substance use treatment costs are: $12 billion. 4. Treatment benefits of OUD: Medications and behavioral therapy to treat OUD are associated with significant average cost savings per case. Estimated annual per-case savings net of treatment cost from ambulatory treatments are estimated to be: • $144,000 for behavioral therapy alone • $271,000 for behavioral therapy plus methadone • $271,000 for behavioral therapy plus sublingual buprenorphine • $295,000 for behavioral therapy plus LAI buprenorphine

Washington, DC: Avalere Health, 2025. 21p.

By Kyle Johnson, Felipe Botero, Mariana Botero, Andrés Aponte and Lina Asprilla

Governance by illegal armed groups and criminal actors has increasingly been identified as a serious problem for communities and states in Latin America. This is particularly true in Colombia, where President Gustavo Petro’s government has implemented a policy known as “Paz Total” (“Total Peace”), which aims to negotiate with all illegal armed groups and numerous criminal organisations in the country. Contrary to initial expectations, the development of simultaneous negotiations has not progressed as quickly or effectively as anticipated, leading to the unintended consequence of increasing the capacity of armed and criminal groups to govern the territories involved in the Total Peace Process (TPP). This has prompted some think tanks, opinion leaders and experts to argue that the policy is strengthening both rebels and criminals, including enhancing their ability to govern the territories, neighbourhoods and communities where they operate. This paper explores the argument and demonstrates that this trajectory is not generic: it depends on the armed and criminal actors, the specific areas and the populations involved. Through case studies from three regions (Buenaventura, Arauca and Tumaco) where armed and criminal actors of different natures operate (including Los Shottas and Los Espartanos in Buenaventura, the Frente Domingo Laín (Domingo Laín Front) in Arauca and the Segunda Marquetalia (Second Marquetalia) in Tumaco), we provide evidence that governance models and territorial control vary significantly. These variations occur within distinct hybrid political order contexts. By examining the differences in governance between these three cases, as well as how governance has evolved over time, the paper highlights an understudied aspect of criminal and rebel governance. This comparison explores not only which aspects of life are governed, but also how they are governed. The research concludes with several key findings: criminals and rebels exercise control over different dimensions of life in their areas of influence, a capacity that has been amplified during the implementation of the TPP; ceasefires have facilitated this process; hybrid political orders have contributed to this trajectory; and the timing and sequencing of the peace process are crucial. The paper stresses the importance of considering the on-the-ground effects of initiating negotiations with the rebel and criminal actors who control these territories. By incorporating violence reduction and confidence-building measures into the incipient peace process, the research highlights potential perverse effects that need to be anticipated and mitigated. Additionally, it highlights the importance of breaking the links between criminal and rebel groups and local armed forces or state institutions to undermine criminal and rebel governance. Finally, it suggests that zones of dispute and strategic competition between illegal armed organisations should be treated differently from zones of hegemonic control in terms of public policy

SOC ACE Research Paper 34.

Birmingham, UK: University of Birmingham , 2025. 67p.