The opioid crisis on our doorstep

In the early 2000s, fans of the popular TV series House were shocked not only by Dr Gregory House’s unorthodox bedside manner and startling powers of medical diagnosis, but also by the way he managed his own chronic leg injury pain with a steady and sometimes illegal supply of the powerful opioid drug Vicodin.

According to the United States’ National Institute of Drug Abuse, 8 to 12 per cent of people who are prescribed opioids over several months become dependent on them. That’s sobering news, especially as the Australian Institute of Health and Welfare found that more than three million Australians got at least one opioid prescription in 2016/17.

‘Opioids are highly effective in treating acute, severe pain,’ says Dr Hester Wilson, an addiction medicine expert from the Royal Australian College of General Practitioners. ‘We are lucky to have them, and it’s a tragedy that in some countries people have no access to them. However, the evidence is not there that opioids are effective for the management of chronic pain.’

WHAT ARE OPIOIDS?

Opioids are a family of psychoactive drugs that relieve acute pain. Some, such as morphine, are naturally derived from the opium poppy, while others, such as fentanyl, are synthetic.

Prescription opioids include morphine, codeine, hydrocodone, oxycodone and fentanyl, among others, and may be marketed under different names in different countries. Heroin, which is typically illegal or tightly controlled internationally, also belongs to the opioid family.

TRAGIC OUTCOMES OF OPIOID ADDICTION

Over time, users of opioids can develop a greater tolerance to the medication. They may take higher doses to get the pain relief they once experienced, or they may combine their prescriptions with other medications accidentally or deliberately, sometimes leading to tragic outcomes.

‘Inappropriately high doses of opioids can produce respiratory depression and circulatory failure,’ says Louisa Degenhardt, Scientia Professor at the National Drug and Alcohol Research Centre at the University of New South Wales.

According to the Australian Bureau of Statistics, three Australians a day died from opioid overdoses in 2018. Seventy per cent of these deaths were from prescription opioids, often in combination with other substances.

Research by the Australian Institute of Health and Welfare in 2018 found that deaths from opioids more than doubled from 2007 to 2016, jumping by 62 per cent to 4.7 deaths per 100,000 people.

Across the ditch, the New Zealand Drug Foundation estimates that one person in every 100,000 dies from an opioid overdose each year in New Zealand. Between 2001 and 2012, the opioid-related death rate there increased by 33 per cent.

Data on opioid use across the broader Asia Pacific is hard to come by. Reports by organisations including the Rand Corporation suggest that while heroin remains a bigger cause of opioid-related deaths at present, prescription opioid overuse is a growing problem across the region.

OPIOID CRISIS BY REGION

The US holds the dubious distinction of being the world leader in prescription opioid addiction and deaths. According to the US Centers for Disease Control and Prevention, on average, 130 Americans die from an opioid overdose each day. Research into the US opioid crisis provides insight into the factors that may influence how the situation could play out in other regions.

For example, while New Zealand has seen an increase in prescription opioid deaths, access to illegal opiates such as heroin is much more limited. In the US and other countries where illegal forms are more easily accessible, people who are addicted to prescription opioids may graduate to using heroin if their prescriptions are cut off or no longer meet their usage needs, increasing the number of deaths.

Similarly, in countries like Germany where addiction is viewed as a medical issue rather than a moral issue, there is generally better access to drugs and programs to help people addicted to opioids to get better – improving health outcomes and reducing related deaths.

CHALLENGES FOR LIFE INSURERS

In the US, insurers have been criticised for providing cover that pays for the use of opioids for chronic pain management in preference to non-medicinal methods, such as therapy. In other instances, cover may be limited for medications and treatments for opioid addiction.

The extent and type of cover insurers offer can have a big impact on how and when opioids are used and on recovery from an opioid addiction. ‘The medical defence unions [in Australia] do really well,’ says Wilson. ‘If someone is injured and their recovery drags on, they may wonder if the insurer will cover non-medical and psychological support. Chronic pain is a complex experience, and we need cover funding a nuanced, multi-pronged and compassionate treatment approach.’

In terms of life insurance, most policies won’t cover a drug-related death, unless the drug in question is prescribed by a doctor, typically the case with prescription opioids.

While many policies stipulate that the drug must be taken as prescribed, prescription opioid deaths may fall into a grey area if the overdose is considered accidental. Such a situation might be a person combining opioids with other substances with unintended consequences, or finding themselves more sensitive to the medication than anticipated.

Insurance that covers naloxone, an opioid receptor blocker in the form of a nasal spray that can prevent accidental overdose, could help reduce deaths, as could teaching patients and their families how to administer it.

Wilson says: ‘Take-home naloxone treats opioid overuse and overdoses, and we need to teach people how to respond and that overuse is a risk.’

PREVENTION AND SUPPORT

In workplaces that offer group life insurance, employers can help by creating a safe environment to avoid workplace accidents and by selecting an insurance plan that also covers non-opioid treatments for injuries.

Companies can also train their supervisors and managers to spot the signs of opioid-related impairment and provide stigma-free support to help employees who may be struggling with opioid misuse get the medication and/or therapy-based treatments they need.

Paid time off during treatment and flexibility to work from home can also support employees recovering from injury or getting treatment for an addiction to prescription opioids.

GREATER AWARENESS

Consumers have perhaps the most important role to play in managing their own wellness and treatment and preventing misuse and potential opioid addiction. They are best placed to ask their doctor what medicine is being prescribed, if there are non-opioid alternatives and how long they should be taking a prescription.

Most opioids are prescribed for moderate to severe short-term pain. People who find themselves taking medication for mild pain, or for months after an injury has healed, should be aware that opioids are not considered effective as long-term pain treatments.

AIA Australia’s national wellbeing manager Simonie Fox says 53 per cent of AIA’s claims involve chronic pain. The insurer works closely with Pain Revolution, the brainchild of Professor Lorimer Moseley, from the University of South Australia.

‘The aim of the program is to raise awareness about current pain science through education of the community, as well as medical and allied health professionals,’ says Fox. ‘By providing pain coaching to our customers, we can help them to reduce their pain experience, which then allows them to work with their medical team to address their opioid use.

‘Our customers who undergo pain coaching have a 76 per cent improvement in function and a 33 per cent reduction in pain.

‘Many of our claimants, who are between the ages of 35 and 55, are parents and are very keen to ensure they recover, so they can be a contributing and productive part of their family.

‘This is often a motivator to allow them to explore the possibility of an alternative approach to dealing with their pain.’

Pain Revolution also raises funds to train local pain educator networks in the community. These pain educators are trained in evidence-based pain science and work with Australians who are suffering from chronic pain to retrain their brains and reduce their pain experience.

‘The Pain Revolution program has reached more than 6,000 Australians to date and will help prevent people from getting chronic pain and becoming opioid dependent,’ says Fox.

WHERE TO FROM HERE?

From commercial shipping to firefighting, insurers have improved society by funding research into better practices and policies, and supporting activity that reduces loss, injury and death. The prescription opioid crisis is shaping up to be another such challenge, including for governments and the healthcare industry.

‘A comprehensive and evidence-based public health response is required to substantially reduce opioid dependence and related harms over the coming decades,’ says Degenhardt.

‘Drug policy needs to be driven by public health and prevention of harms to health, which will require decriminalisation of drug use and dependence. Research should be funded to develop and evaluate novel interventions to prevent opioid overdose, improve the quality of treatment for opioid dependence and identify new treatments for opioid dependence and chronic non-cancer pain.’

Kath Johnson, Fidelity Life’s chief operating officer, says: ‘We’re aware of the significant risk opioid addiction poses to customers, insurers and the wider community. We’d support an industry-wide response and are keeping a close eye on developments.’