OVERVIEW
The statistics are fearsome:
- After 10 days of opiate use – even legitimate use like post-surgical pain management – 1 in 5 people will become addicted
- It is approximately 2.5 years between the onset of opioid addiction and death
- For every death, there are 850 others caught up in the opioid addiction death-spiral
- Each and every day, 95 people in the U.S. die from an opioid overdose
Recent analysis shows that the situation is getting worse, not better, and at an increasingly rapid rate:
The chart above shows the epidemic’s three waves – driven by a procession of legal and illicit opioids alike – abuse has ricocheted across the country, creating a scenario in which Americans now are more likely to die from an opioid overdose than a car crash.
- From 1999 through 2006, the death rate rose steadily with the expanded use of prescription opioids, which exacerbated a long-smoldering heroin problem
- Starting in 2007, the death toll rose at a slower pace as knowledge about prescription- fueled addiction grew and legal action targeted the pharmaceutical industry
- In 2014 and the years since, as more lethal opioids – particularly the synthetic substance fentanyl – became increasingly accessible, the death toll began soaring to tragic new heights. In 2017, the age-adjusted opioid death rate reached 14.9 per 100,000 people, up from 2.9 in 1999.
WHAT IT IS
One of the reasons opioid prescription use has grown is because these are effective drugs for reducing pain. Prescription opioids can be used to help relieve moderate-to-severe pain and are often prescribed following a surgery, a physical injury, or for certain health conditions. These medications can be an important part of treatment, but also come with serious risks. Recently, the Centers for Disease Control and Prevention (“CDC”) updated opioid prescribing guidelines to address under what circumstances, in what numbers, and for how long opioid prescriptions should be prescribed.
Because of the risks inherent with opioid use, the medical community is increasingly recommending alternatives. The good news is that reducing surgical opioid use need not compromise patients’ quality of care. In fact, the more we learn about the risks and benefits of opioids after surgery, the more it becomes clear that, just as in non-surgical settings, we’ve tended to overestimate the benefits of opioids while underestimating their risks. Patients and surgeons have many tools to choose from, and the time for such discussions is before an operation.
Some patients achieve adequate pain control with ibuprofen or a topical pain reliever right after an operation. Yet others may benefit from regional anesthesia, where an injection using a medicine like Novocain is placed close to a nerve to relieve the discomfort. Longer term, others may benefit from additional non-pharmacologic therapies such as physical therapy, massage or acupuncture.
If you are contemplating surgery or facing a medical situation which is going to involve pain management, it is important that you have a conversation with your physician about his/her potential recommendations for treatment.
HOW IT GOES WRONG
For many members, addiction starts with a medical condition or a sports injury. Maybe a fall from a bicycle or a minor surgery precipitates the prescribing of pain control medication. No question about it: opioid medications are one of the most effective pain killers on the planet.
From the moment a patient takes the first pill, he/she feels the endorphins being squeezed from their brain. It’s a rush of one of the most powerful feel-good chemicals that exist in the body. Before long, you become physically dependent on the opioid medication and you are unable to stop using it.
And then the prescription is gone. A patient may be able to convince their physician to give them another prescription, but that is all. Once this gets close to gone, the patient finds themselves considering all kinds of thoughts about how to get more of the drug. The inability to stop using the opioid medication despite knowing the harmful effects it has on you, your ability to perform your work, or to meet family obligations signals addiction. Addiction can occur in as soon as just a few days.
Initially, patients recognize that the ideas they are entertaining are irrational. Most people tell themselves that they are not a drug addict, that they are different because they have a fine home, kids, a good paying job. You could quit if you wanted, but these pills make you feel so good. You tell yourself you could quit if you want to… but you don’t want to.
Typically, patients in the early stages of addiction will seek out another physician to give them another prescription, but that only works so long, and then the doctors start to get suspicious. After an unsuccessful try at “doctor shopping,” the patient is now desperate — the drug owns them. They begin frequenting unhealthy environments in search of anything that can satisfy their craving.
The patient seeks out the drug on the street, sometimes substituting heroin or fentanyl for the opioid prescription.
At this point the patient feels their drug use must be kept secret at all costs; there are outward appearances to be maintained. Obtaining treatment regardless of the initial cause of your addiction is out of the question. The most important thing – other than obtaining drugs – is to keep it secret… from your family, your co-workers, everyone.
Addiction doesn’t play favorites: it hits street people, and CEOs, and successful people from every walk of life, and ordinary people who go to work and try to make ends meet. One of the first obstacles to getting over opioid addiction is to drop the shame so that you can ask for help. Often this is the most difficult part of the process.
OPIOID INTERACTION WITH COMMONLY USED DRUGS
In addition to addiction issues, opioid prescriptions can interact with a lot of commonly prescribed drugs that can result in life-threating outcomes. Review all of your medications with your doctor so that you can reduce the risks of serious drug-drug interactions with opioids.
According to the Mayo Clinic, drugs that may interact with opioid medications include:
- Alcohol
- Anti-seizure medications, such as carbamazepine (Carbatrol, Tegretol, others)
- Certain antibiotics, including clarithromycin (Biaxin)
- Certain antidepressants
- Certain antifungals, including itraconazole (Onmel, Sporanox), ketoconazole and voriconazole (Vfend)
- Certain antiretroviral drugs used for HIV infection, including atazanavir (Reyataz), indinavir (Crixivan), ritonavir (Norvir) and others
- Drugs for sleeping problems, such as zolpidem (Ambien, Intermezzo, others)
- Drugs used to treat psychiatric disorders, such as haloperidol (Haldol)
- Muscle relaxers, such as cyclobenzaprine (Amrix)
- Other opioid medications
- Sedatives, such as diazepam (Valium)
Opioid medications affect your brain and may make you sleepy. Mixing these medications with alcohol or other drugs that can heighten these effects, leading to slowed breathing, decreased heart rate and a risk of death.
Signs of an emergency include:
- Very small pupils that don’t change size when a light is quickly shined in your eye
- Losing consciousness or going into a deep sleep from which you can’t be wakened
- Very slow breathing
- Fingernails or lips that appear purple or blue
Call 911 or your local emergency number if you or someone you know is experiencing these signs.
WHAT THE PWGA IS DOING
We have asked our pharmacy benefit partner to review our prescription records to see if there are medical personnel prescribing opioid medications out of proportion to their fellow professionals. The sad truth is that one reason for the explosion in opiate use is that opioids can be resold at a high profit. Other times, the physician is simply not sensitive to the addiction issue. We are taking steps to prevent opioid misuse by medical providers and to increase opioid education and addiction awareness.
We have also been reviewing our relationships with various drug rehabilitation centers and we will be happy to provide you with a list of in-network care centers.
WHAT TO DO IF YOU OR A LOVED ONE HAVE A PROBLEM
There is a saying in the drug addiction community, “If you think you might have a problem… You have a problem.” If you or a loved one has an opioid addiction problem the most important thing you can do is acknowledge it and seek treatment.
The good news is that if you or your dependents are participants in this Plan you can get access to substance abuse treatment, which is covered under your PPO Plan. Furthermore, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is a federal law that requires group health plans (like this one) to provide substance abuse benefits at the same level as medical/surgical benefits. So if you or your dependent need substance abuse treatment please contact your doctor to help arrange it.
In the movie Ben’s Back, the character played by Julia Roberts saves her son’s life with an opioid blocking agent called naloxone that is easily available as an injection or nasal spray. It is used as a treatment for overdoses; it blocks or reverses the effects of opioids and is often carried by first responders. Some states permit retail pharmacies to provide naloxone over-the-counter to patients.
We’re not doctors. We can’t make medical recommendations. As the author of this article, I can tell you that when my brother was having his opioid-related issues, I made sure I had the drug on hand just in case. Fortunately, I never needed it. The most important thing is to seek help. If you are struggling with addiction, or even just think you might have a problem, we urge you to reach out to your medical professionals and get help. Without that help, the statistics – as you’ve seen here – are not pretty.