The recent, widely reported judgment in the case of Oklahoma vs Johnson and Johnson (which Johnson and Johnson says it plans to appeal) has thrown the problem of the ‘OPIOID CRISIS’ into sharp relief.
This article is intended to broadcast both the benefits of opiate medicines used as prescribed and the risks associated with their misuse, whether prescribed or not.
But first, we need to understand the size of the problem and secondly what are the causes?
What is the size of the opioid crisis?
What is the human impact?
Since the start of the century, more than 400,000 people have died (from opioid misuse) including more than 47,000 in 2017-2018 (US Center for Disease Control and Prevention).
The total number appears to have decreased in 2018 (for the first time since the crisis began), largely attributed to extending the right of dependents to stay on a parent’s health insurance to age 26.
But accidental deaths attributed to opioid overdoses are still even greater than automobile accidents, averaging 130 per day. (The Addiction Centre, ‘What is the Opioid Epidemic?’)
A best-guess estimate is that more than two million US citizens are currently struggling with Opioid Use Disorder (OUD).
Those affected come from all walks of life and all ages: teens, adults, seniors, and veterans. Even more sadly, babies born of opioid abusing mothers may themselves be addicted and suffer instant withdrawal symptoms.
If opioid abuse is common in a neighborhood, or if a loved one is struggling with opioid use disorder, there can be a huge emotional and financial drag.
What is the financial impact?
In 2017 a published report put the annual cost at $500 billion for 2015 (White House Council of Economic Advisors). Their assessment includes the costs borne by us, the taxpayers. We pay for emergency services such as ambulance runs, jail treatment costs, the childcare for minors whose parents who have died from opioid abuse and (indirectly) all the emergency care provided that is not covered by insurance. Also included is the lost productivity.
It is estimated that the annual cost of opioid prescription drug misuse in the USA is $78.5 billion.
What are opioids?
Opioids (or opiates) are drugs either derived from or designed to mimic the effect(s) that opium has on the human brain.
Opioids work by interacting with neurotransmitters in the brain and blocking the (pain) signals that they are sending. This enables opioids to serve as powerful pain killers, but can also cause feelings of intense pleasure, leading to addiction.
Opioid addiction (largely the ‘pleasure’ effect) is one of the most serious problems faced by America today.
Throughout the American Civil War, WW1 and WW2 opium and various derivatives of opium were used as anaesthetics and are essential contributors to modern medical practice. But Opioids are some of the most addictive of all known substances.
Opium was used for recreational (‘pleasure’) purposes throughout Chinese history and there was a clear awareness that (smoking) opium on a regular basis for recreational use was actually dangerous and could lead to physical dependence.
Awareness of the problem spread westward and in 1909, the International Opium Commission was formed to help regulate the shipping, sale and use of opium due to the widely recognized dangers of prolonged use.
These dangers, as well as the benefits and risks, are well recognized in modern medical practice.
- In modern controlled use, Opioids are reliable analgesics (pain relief) for acute (usually traumatic) pain and for pain relief at the end of life (palliative care).
- In some cases (relatively rare) patients may find effective pain relief in the long term especially if the dosage is low and intermittent.
- The risk of harm i.e. long-term dependency is substantially increased by higher dosages.
- If pain remains severe (intolerable) despite treatment with opioids it is an indication they are not effective and treatment should be stopped.
Increasing the dosage will not increase the effectiveness but is highly likely to increase the risk of long-term dependency.
Tapering or stopping high dose or long-term opioid treatment requires careful planning AND co-operation.
The four points (above) illustrate the need for complete transparency between physician and patient.
- Tolerance of pain is subjective
- Resilience to opioid dependency is difficult to predict
- Patients may have prior exposure to prescribed/non- prescribed drugs
- Patients may have existing/previous dependencies e.g. to alcohol
- Determination of the causes of chronic (long-term) pain is complex. Detailed assessment is essential.
The pressures to over demand and oversupply are clear.
Patients wish and expect to be pain-free believing that opioids are the only approach to chronic relief and that ‘more’ is better for acute pain.
Physicians use their knowledge and skills to cure and alleviate.
The ACA offers a link.
Q. What can I do if I think I need substance use disorder services for myself or family members?
Here are three steps you can take right now:
- Learn more about how you, your friends, and your family can obtain health insurance coverage provided by Medicaid or CHIP or the Health Insurance Marketplaces by visiting HealthCare.gov
- Find out more about how the law is expanding coverage of mental health and substance use disorder benefits and federal parity protections
- Find help in your area with the Behavioural Health Treatment Services Locator
Many people take the risk of not having even minimal health insurance on the grounds that they cannot afford it. One of the aims of the Affordable Care Act is to make health insurance affordable to all eligible US citizens. As a result, over 80% of insured Americans receive Premium tax relief or benefit from State or Federal subsidies. In many cases tax relief entirely offsets the cost of premiums and preventative and childcare can be entirely free. Find out if you qualify by contacting your State Health Insurance Exchange or a Private Health Exchange. You must enroll though an Exchange to take advantage of the benefits.
A major factor discouraging citizens from approaching Health insurance exchanges is the concern that their personal details may not be secure and that the advice they receive will not be impartial.
Exchanges, both private and state, act entirely in the best interests of their clients. They are independent of the insurance companies and committed to providing clients with accurate, unbiased information on which to base their decisions.
Talk to your exchange or insurer and discuss your circumstances in confidence. Now is the perfect time to consider how the umbrella coverage of the ACA can protect you, your family and friends.
Open enrollment (November 1st– December 15th) is the opportunity for each of us to decide on our best options.
Don’t wait, make first contact now. Give yourself time to decide!