The Burden of the Opioid Crisis in the United States

The Burden of the Opioid Crisis in the United States

How do you even come close to evaluating the real damage to us as a nation, a culture, an economy, as a result of the Opioid Crisis?

This article is not limited to statistical opioid caused deaths but will try to estimate other important areas of loss to America.

The “opioid crisis” has made a lot of news — and for good reason. In 2016 alone, more than 42,000 people in the United States died from overdosing on these drugs. Another 2.1 million people became addicted to these painkillers. The drugs’ deadliness comes from the way they affect the brain and other parts of the body. Science News for Students, March 2018

Opioids have quickly become a major cause of death among young Americans aged 25 to 34, with one in five deaths in 2016 tied to the drugs, researchers report online June 1 in JAMA Open Network.

What Are These Drugs?

Opioids include drugs such as morphine, heroin, fentanyl and oxycodone. The term “opioid” comes from the word “opium.” It’s a chemical that comes from poppies. For thousands of years, opium has been used to treat pain. And through the years, people also have used and abused it for pleasure. Science News for Students, March 2018

How strong are they?  Fentanyl is 50X stronger than heroin, 100X stronger than morphine. It is the grand murderer of all. It is purportedly justified as a painkiller for intractable pain of cancer, etc. But most justification for painkillers is backpain (Backpain is a leading cause for hospitalization, second only to childbirth).

OxyContin

While all of these drugs are highly addictive, the main felon in starting the crisis was OxyContin, manufactured by Purdue Pharma, owned by the doctors Sackler brothers, who, through the marketing genius of the brother, Dr. Arthur Sackler marketed it with the false assurance (lie) that it was not addictive. The reason for the “contin” at the end of the name, is that it has a “continuous” release of its intrinsic potential rather than one gigantic impact in all its glory. That is the reason Sackler promoted that it was not addictive, and the reason the FDA labeled it as the least habit-forming of all painkillers when it was the most dangerous of all at the time. (That FDA employee later went to work for Purdue at a large salary). They admitted in their inner circle that it was a “nuclear” drug, with more power than any other. Ground into a powder and then “shot up” it is indeed nuclear and delivers an experience to the addict that has created a huge drug culture in the West Virginia area of the U.S.

“As OxyContin spread outside the U.S., the pattern of dysfunction repeated itself: to map the geographic distribution of the drug was also to map a rash of addiction, abuse, and death. But the Sackler family has only increased its efforts abroad, and is now pushing the drug, through a Purdue-related company called Mundipharma, into Asia, Latin America, and the Middle East. Part of Purdue’s strategy from the beginning has been to create a market for OxyContin—to instill a perceived need by making bold claims about the existence of large numbers of people suffering from untreated chronic pain. As Purdue moves into countries like China and Brazil, where opioids may still retain the kind of stigma that the company so assiduously broke down in the United States, its marketing approach has not changed.” The Family That Built an Empire of Pain, New Yorker Oct 30, 2017.

The Sackley family made 13 billion dollars on this drug and have now begun marketing it in South America and Europe, with the same false assurances. Dr. Arthur Sackler has been credited with the “lion’s share” of blame for the existing opioid crisis.  The Family That Built an Empire of Pain, New Yorker Oct 30, 2017.


Deaths

In a recent publication in the Journal of the American Medical Association (JAMA) did a study on “What has been the burden of opioid-related deaths in the United States over a recent 15-year period?” What the results portend for our country is frightening.

Findings: In this serial cross-sectional study, we found that the percentage of all deaths attributable to opioids increased 292% (from 0.4% to 1.5%) between 2001 and 2016, resulting in approximately 1.68 million person-years of life lost in 2016 alone (5.2 per 1000 population). The burden was particularly high among adults aged 24 to 35 years; in 2016, 20% of deaths in this age group involved opioids.

Meaning: Premature death from opioids imposes an enormous and growing public health burden across the United States.

Conclusion: Premature death from opioid-related causes imposes an enormous and growing public health burden across the United States. The recent increase in the proportion of deaths attributable to opioids among adolescents and young adults and the accompanying estimates of YLL (Years of Lives Lost) are alarming, particularly among men. Furthermore, the aging population of people with opioid use disorder requires attention, as the burden of opioid overdose among adults aged 55 to 64 years is growing at a concerning rate. JAMA.

Unchecked, Where Does This Lead?

Reading raw statistics gives an idea of the extent of American deaths as a result of the drug crisis. Standing alone it has major meaning, but until one looks at how that affects life in this country, it is almost meaningless. So how does it impact the economy, the culture, the productivity, and the energy of our nation. Well, in a nutshell, it saps the energy and productivity of our country.  And we all know that a healthy people, alive with vitality as Americans have always been, have what made America the powerful nation it is. Can this destroy us?

How Did this Happen?

When it comes to taking opioids, the United States has the dubious honor of leading the world. For every one million Americans, almost 50,000 doses of opioids are taken every day. That's four times the rate in the UK.

There are often good reasons for taking opioids. Cancer patients use them for pain relief, as do patients recovering from surgery (codeine and morphine are opioids, for example).  But take too many and you have a problem. And America certainly has a problem.

Denial of Addictiveness

Dr. Sackler, being a doctor, knew that doctors wear the cloak of credibility, and doctors believe one another. Using this, as his marketing ploy, he convinced other doctors that Oxycontin was a “Miracle of Nature,” the non- addictive answer to pain through testimony of experts, conferences, and a huge PR campaign.

Good looking girls often are “detail salespersons,” who hawk drugs to doctors in their offices, and give gifts, junkets, dinners, and other gratuities to the doctors to prescribe the drugs they sell.

Payments by drug and device companies to physicians and teaching hospitals

Includes travel, research, gifts, speaking fees, and meals

Amount ($bn) BBC

In 2016, a study looked at the link between doctors, the free meals they received from drug companies, and the medication they prescribed.

The study found receiving free meals was "associated with an increased rate of prescribing the promoted brand-name medication".

What has been done about it? Nothing much.

The following is from an article in BBC News, October 2017:

Dr Richard Frank is professor of health economics at Harvard Business School and served in the Health Department from 2009 to 2016, during President Obama's administration. He thinks medical training in the US has not been good enough.

"Physicians have received almost no training in pain management," he says. "Until recently they have been under some pretty important misconceptions about how addictive various products are." He adds: "A couple of years ago I testified before congress when I was in government. One of the representatives, before going into congress, was a thoracic surgeon.

"He noted that he had gotten almost no training in pain management - and what he had learned came entirely from the nursing staff he worked with."

His criticism is echoed by Professor Judith Feinberg. "Doctors didn't learn anything about addiction at medical school," she says.

American Doctors prescribe...A LOT

Unlike most European countries, the US does not have universal healthcare paid for by taxes. Instead, Americans must get their own insurance - usually via an employer or the government.

"Most insurance, especially for poor people, won't pay for anything but a pill," says Professor Judith Feinberg from the West Virginia University School of Medicine.

"Say you have a patient that's 45 years old. They have lower back pain, you examine them, they have a muscle spasm. "Really the best thing is physical therapy, but no one will pay for that. So, doctors get very ready to pull out the prescription pad. "Even if the insurance covers physical therapy, you probably need prior authorization (from the insurer) - which is a lot of time and paperwork." BBC

What about the Impact on Life in the United States?

Can you imagine life in a family where one or both parents are addicted to drugs? What is it like for them, for their children, for their parents. One addict in a family can be a tragedy. If it is the father, his ability to earn is impaired if not totally impossible. The mother not being able to take care of the infant or toddler is difficult to think with. And it is rampant.  Try to get your mind around a culture with this happening, growing with leaps and bounds.

The Huffington Post itemized the effect of Opioids on Families

Among women who struggle with opioid abuse, 86 percent of pregnancies are unintended, compared with 56 percent of all pregnancies. This means children are more likely to receive insufficient or delayed prenatal care and are at risk of low birthweight and poor mental and physical health.

Between 14 and 22 percent of women nationwide fill an opioid medication prescription during pregnancy. This puts thousands of infants at risk of neonatal abstinence syndrome (NAS), problems stemming from drug withdrawal symptoms which occur in about half of infants with prenatal opioid exposure. In 2012 the maternal opioid use rate in hospitalized births in rural counties was nearly 70 percent higher than that in urban counties.

By 2012, an infant was born with NAS on average every 25 minutes in the United States. Across 28 states, the NAS rate increased by almost 300 percent between 1999 and 2013. NAS-affected infants are at greater risk of premature birth, low birthweight, sleep and growth problems, tremors, and seizures.

NAS costs $93,400 per infant in hospital charges on average and the average hospital stay for an infant with NAS is 23 days. Medicaid covered about 80 percent of the estimated $1.5 billion tab for NAS-related hospital charges in 2012.

Opioid poisonings in toddlers and preschoolers 1 to 4 years old increased 205 percent between 1997 and 2012. Opioid poisonings increased 165 percent among all youths under 19 with younger children and older adolescents most at risk. Huffington Post.

These statistics draw a grim picture of what is becoming of our beautiful culture.

Economic burden of opioid epidemic hit $95 billion in 2016

Maria Castellucci, writer for MODERN HEALTHCARE, in a November 16, 2017 article, wrote:

The report sheds light on the economic impact of the crisis that contributed to 53,054 overdose deaths in 2016.

The vast majority of the economic burden — $43.2 billion — came from losses in the workforce due to deaths from opioids, the analysis found. Another $12.4 billion of the calculation stemmed from productivity losses from surviving opioid addicts.

In the healthcare industry, costs from the epidemic were concentrated in emergency room visits, hospital admissions, ambulance use and Naloxone use.

In total, the opioid crisis cost insurers $21.4 billion, with Medicaid paying for the largest share at $8.7 billion. Rhyan said after Medicaid expansion in 2014, more people who suffered from opioid abuse became insured.

The epidemic cost Medicare an estimated $6.4 billion and private payers and the uninsured a combined $6.3 billion.

The remaining costs of the opioid epidemic on the economy were criminal justice and education expenditures and child and family assistance spending.

Many 2016 cases of child neglect were associated with parents with opioid addiction, the report notes. Child and family assistance spending related to the epidemic was about $6.1 billion in 2016.

The vast majority of the economic burden — $43.2 billion — came from losses in the workforce due to deaths from opioids, the analysis found. Another $12.4 billion of the calculation stemmed from productivity losses from surviving opioid addicts.

Does this sum up the losses?

Not by a long shot. There is a shadow over America.  There is a psychological pall hanging over us that seems to question our sustainability as a leader of nations and our ability to survive.  If we need drugs to survive, then those who make the drugs rule our lives, and that is what it is coming to. With 650,000 prescriptions of opioids filled a day, 3,300 a day visiting Emergency Rooms, 58 babies a day born addicted, 120 a day dying of opioid Overdose, now at 50,000 a year dying---more death than 8 years in Vietnam, 8 years in Iraq, and 16 years in Afghanistan, being the leading cause of death under 50 years of age – yes indeed, we have a problem of unprecedented magnitude.

It is a foregone conclusion that addicts who are trying to work have perception difficulties, they are accidents waiting to happen and make mistakes, their ability to work and health are impaired, and this brings on personal problems which reduces their quality of life and productivity. 

Here it is graphically illustrated in cost:

The cost of the country’s opioid crisis is estimated to have exceeded $1 trillion from 2001 to 2017 and is projected to cost an additional $500 billion by 2020, according to analysis released by Altarum, a nonprofit health research and consulting institute.

Who is Bearing the Cost?

The costs of the opioid crisis are borne by individuals in the form of lost wages; the private sector in lost productivity and health care costs; and federal, state and local governments in lost tax revenue and additional spending on health care, social services, education and criminal justice.

The greatest cost comes from lost earnings and productivity from overdose deaths—estimated at $800,000 per person based on an average age of 41 among overdose victims. This figure is largely made up of lost wages of workers and productivity losses of employers, but it also weighs on government in the form of lost tax revenue. It has increased in recent years as the epidemic has transitioned away from older people to younger ones and from prescription opioids to illicit drugs.

Is There Any Hope?

The present “disease maintenance, symptom treating, pill dispensing as the only “fix” healthcare system may be replaced by healthcare providers who rely on natural healing modalities and who do not write prescriptions or utilize invasive surgery except when totally necessary.  This system is implemented through Medical Integration of Medical doctors and Chiropractors, who collaborate in all phases of diagnosis through treatment of individual patients. Nutrition, exercise physical therapy and natural means are used to heal. This is the answer.