The use – and abuse – of opioids in the U.S. has reached unprecedented levels. Slightly less than five percent of the world’s population lives in America, and yet 80 percent of all opioid prescriptions are written within its borders. And the impact on society has also been without precedent. In 2016, 65,000 U.S. citizens died of overdoses related to opioid abuse. To put that figure into context – it’s more than prior peak car accident deaths per year, and more than the total number of American lives lost during the Vietnam War.
The issue is complicated: The opioid crisis extends far beyond illegal drugs, such as heroin. An estimated 2.1 million U.S. citizens suffer from substance use disorders related to prescription opioid pain relievers — more than four times the number addicted to heroin in the same year. The growing crisis was declared a “national health emergency” by the White House in October 2017.
What are the origins of this crisis? What is the full extent of its impact? And what role can organizations play to help tackle it?
History Of The Opioid Crisis
The roots of the current opioid crisis begin in the 1990s, when an increasing number of doctors began prescribing strong opioids to treat pain. “Over the last 20 years, physicians have prescribed more opiates year over year,” says Dr. Neal Mills, Senior Vice President and Medical Director, Aon Health & Benefits.
Dr. Mills explains that the roots of this practice can be traced back to the medical training of a generation of doctors. “The increased opioid prescriptions are partially because of training physicians received in medical school.”
In addition to body temperature, body pressure, heart rate and breathing rate, Dr. Mill explains that pain was seen as the fifth critical vital sign. “As a result, when physicians dealt with patient pain, they felt obliged to prescribe more opiates.”
In effect, as part of pain treatment, physicians began to unwittingly contribute to the growing problem.
Opioid painkillers are highly addictive, and using them for even just a few days can lead to dependency. “Starting on day three of a new opiate prescription, there is a certain percentage of the population that will go on to develop opiate dependence,” says Dr. Mills. “For people who have been on opiates for 30 days, around 20 to 25 percent will still be on opiates one year later.”
In America alone, 92 million Americans are thought to have used opioid painkillers in 2016 – greater than the number who used tobacco.
“Ninety-nine percent of the world’s hydrocodone, an opioid, is prescribed in the U.S., and yet as a country it represents less than five percent of the world’s population,” explains Dr. Mills.
By the end of the 2000s, health care providers and regulators began to realise the problem and put limits in place around opioid prescriptions – including cracking down on “pill mills,” a term for clinics illegally selling prescription drugs. Unfortunately, by this point millions of Americans had already become dependent on opioids. And when legal opioids became more controlled, a black market filled the gap with stronger, illegal substances like heroin and fentanyl, creating deeper problems. One study by the Journal of the American Medical Association found that 75 percent of heroin addicts started on painkillers.
“While we have begun to control the number of prescription painkillers, the number of emergency department visits caused by people taking heroin is still on a vertical climb,” says Dr. Mills – and the crisis is strongly focused on the U.S.
The Impact Of Widespread Opioid Addiction
The opioid crisis is one of the gravest public health issues ever faced by the U.S. On top of the 65,000 annual deaths linked to opioids, 2.1 million U.S. citizens were found to have an addiction to either prescription or illegal opioids in 2016.
The crisis has had a substantial impact on the U.S. economy. In 2013, the economic burden of prescription painkillers alone was estimated at $78.5 billion, and around a third of that sum was attributed to higher health care and drug treatment costs. A significant amount of the economic burden falls on businesses, and broadly across sectors. “The number one prescription by volume for most employer groups I have served is opioids,” says Dr. Mills.
While the stereotype conjured by the word “addict” doesn’t normally lend itself to someone at work – the definition is evolving. “Because of the sheer volume of prescriptions written, many of those suffering from opioid addiction are employed by U.S. businesses,” Dr. Mills explains.
Up to 70 percent of U.S. employers say their workplace is affected by prescription drug abuse. People suffering from opioid addiction are particularly prevalent in industries with a high chance of physical strain or injury, such as food, recreation, or construction.
In addition to the human impact, these figures also highlight significant consequences for workplace productivity. It’s estimated that preventing opioid overdoses, deaths and substance abuse disorders across 2016 could have potentially saved the U.S. economy $95 billion.
Solving The Opioid Crisis
While the U.S. government declared last year that mass opioid addiction constituted a “national health emergency,” the funds required to effectively fight it are estimated to run into the tens of billions of dollars. Given the scale of the problem, employers are facing up to the fact that they will need to be aware of the issues surrounding it and play an active role if they are to manage its impact on their organization and the wider workforce.
Among the most effective ways of treating opioid abuse is prescribing medication to help addicts manage their condition. “The relapse rate for heroin users without medication-assisted treatment is 90 percent,” says Dr. Mills. “It’s like a very serious chronic condition. But if you enlist medication-assisted treatment, that relapse rate immediately falls to 50 percent.”
How can the private sector pursue ways to combat opioid addiction within its employee population? In addition to employers ensuring the clinicians available to their employees follow the CDC’s (Centers for Disease Control) opioid prescribing guidelines, there other approaches to consider.
Dr. Mills suggests that employers can begin or continue to:
Demystify And Identify Opioid Addiction For What It Is
Finding a way to manage and defeat the opioid crisis will not be easy. However, demystifying the medical condition, and identifying and helping the groups most at-risk will be key steps.
“The most fundamental concept people need to remember is that this is a chronic brain disease – just like asthma is a chronic lung disease, and just like diabetes is a chronic disease of the pancreas,” says Dr. Mills.
And as with other diseases, Dr. Mills reminds employers that there is effective treatment. “We just need to learn how to identify at-risk groups, and help them find the right treatment at the right time.”
“[The opioid crisis] is so prevalent and so widespread that you know someone who is affected by this” – Jim Merritt, Indiana Senator serving on Governor’s Task Force on Drug Enforcement Treatment
“Consider the amount of standard daily doses of opioids consumed in Japan. And then double it. And then double it again. And then double it again. And then double it again. And then double it a fifth time. That would make Japan No. 2 in the world, behind the United States” – Keith Humphreys, Professor, Psychiatry and Behavioral Sciences, Stanford University & Senior Policy Advisor, White House Office of National Drug Control Policy, 2009 – 2010
The Opioid Epidemic, Explained – Vox, December 21, 2017
The Opioid Crisis Comes To The Workplace – The Atlantic, December 21, 2017
Authorities Are Cracking Down On Opioid-Peddling Doctors – TIME, January 1, 2018
Drug And Alcohol Deaths At U.S. Workplaces Soar – Wall Street Journal, December 19, 2017
Scientists Just Solved A Major Piece Of The Opioid Puzzle – WIRED, January 8, 2018