The opioid epidemic cost Massachusetts $15.2 billion in 2017.

That startling tally, a combination of expenses and lost labor, is explained in a report from the Massachusetts Taxpayers Foundation (MTF). It's the first to offer a thorough assessment of the economic damage caused by rising opioid use and deaths in Massachusetts. The authors say it's a conservative estimate because they couldn't find data to measure some considerable costs.

"They're staggering," says Eileen McAnneny, MTF president, of the dollars spent on hospital care, EMTs, early intervention for infants and families, jails and the job productivity forfeited by individuals and employers. "We wanted folks to get a sense of the pervasiveness. It really impacts all major areas: health care, criminal justice, public safety and businesses."

In the state budget alone, the report shows $1.9 billion in spending last year tied to the opioid epidemic across five areas: MassHealth; the departments of Public Health, Mental Health and Children and Families; and the larger criminal justice system.

Employers, the report says, spent an additional $2.1 billion on opioid-related health care in 2017.

The MTF says the spending trends are even more alarming:

Emergency room visits tied to opioid use rose 24 percent every year between 2010 and 2015, the most recent years available.

Wages never paid to the men and women who've died after an overdose topped $1.1 billion for the past two years. That's three times the loss in 2011.

And Massachusetts' gross state product is $64 billion short of where it would be, if not for the opioid epidemic.

The largest single yearly cost identified in the report is lost productivity. The $9.7 billion total includes wages lost to absence, long-term impairment or injury and death. The faces behind these numbers are in every neighborhood of the state.

Personal Cumulative Losses

Take Michael, a big, bearded 33-year-old from Rockland who cleaned the hoods and grease ducts above kitchen stoves in Boston's best restaurants until about three years ago. The combined damage of heroin and methamphetamines have left him too unstable to climb ladders.

"It was good money and I loved the work but I just can’t go back to it," Michael says. "My balance is completely off."

We’re only using Michael’s first name because one way he makes money now is on small drug deals, buying more than he needs and selling what’s left at a higher price. He supplements that income with odd jobs.

"I hope it’s a bad winter," Michael says with a laugh. "I got regular shoveling clients and I make good money doing that."

Kurt, a veteran who injured his back in Iraq, works on and off — the same routine for the past 15 years. He builds swimming pools and drives a forklift.

"It’s all been laboring type of stuff," Kurt says, "stuff that ain’t really any good for my back. So often times I want to do something to help me with the pain."

Kurt works until the addiction takes over or his back gives out. "Then," he says, "I stop."

The thousands of drug users in recovery talk about their personal cumulative losses. Mike, who works in finance in Boston, was out of work or only partially employed for five years, starting soon after college.

"That’s a lot of time," says Mike, "especially in your 20s."

Instead of making money, building his resume and professional network, and saving for a home, Mike was losing contacts and spending his parents' savings on treatment. Now, at 33, Mike says most of his friends are making at least twice what he is and have started a family.

"And I wonder, how long will it take to get back on top, so to speak, or just back in a position where I’m not playing catch-up?" Mike says.

Mike says he knows he’s lucky to be alive. Gerry DiPierro’s daughter, Aleesha, is somewhere in the MTF report's line item labeled "foregone income due to fatalities." She overdosed in 2014 at age 28.

"By the time we got her to the hospital, she already had brain damage," DiPierro recalls. "She lasted about five or six months and then passed."

The opioid epidemic also haunts DiPierro at his business, DiPierro Construction. When he picks up the phone for this interview, a veteran carpenter has just left DiPeirro's office after giving notice. The man told DiPierro he’s addicted to opioid pain pills and is checking into a rehab program. Another employee left to seek opioid addiction treatment a few months ago.

"I’m in a mess," DiPierro says. "You’ve got the guy working a job, he’s already been trained here, and then he’s gone. But I mean I feel bad because it affects their families, kids, you know, it’s just bad, it’s bad, it’s bad."

Other employers describe difficulties finding and holding onto qualified employees, increased overtime to compensate for missing workers, and more reliance on temporary workers.

'We May Need More Revenue'

The report lists some of the costs of the epidemic it did not calculate: future expenses tied to children placed in state care, the pain and suffering for families of those addicted to opioids, and the untold costs of opioid use that is not reported.

There have been other attempts to calculate the economic impact of the opioid epidemic, but these are largely national reports, not state-specific estimates. The MTF says it hopes other states use and adjust this analysis to understand their own costs derived from the epidemic, because we're all paying for it.

In a statement, state Attorney General Maura Healey says “this comprehensive report brings a unique look into the economic and fiscal impacts of this devastating crisis on our state, and shows that while our efforts are making a difference — we have much more work to do."

The findings may be used in the AG's complaint against Purdue Pharma, which alleges the company's marketing of the opioid Oxycontin violated Massachusetts consumer protection law.

The MTF says it hopes the report will add urgency to current attempts to fight the opioid epidemic, especially among employers.

While the number of opioid overdose deaths has dipped in recent quarters, there's no indication that the epidemic at large has slowed.

So if the state will lose roughly $15.2 billion to the epidemic again this year, should it be spending that much to prevent addiction or treat the disease?

"I think we absolutely have to use the resources available more wisely," says MTF president McAnneny. "And we may very well need to spend more revenue."

McAnneny says the report, which was funded by a grant from RIZE Massachusetts, will generate discussions about the best ways to spend public money and contributions from employers. The taxpayers foundation launches those talks at an event later this week.

Gov. Charlie Baker, who will speak at that event, said in a statement: