Death Wish: How America Brought the Opioid Crisis On Itself

Published June 8, 2016

Prince’s death from an apparent opioid overdose is shocking and tragic. A musical and business wunderkind, Prince apparently depended on powerful painkillers and waited too late to get help. As an artist, Prince was exceptional. Unfortunately as a middle-aged American addicted to opioids, driven to overdose — he is all too ordinary.

Opioids are an acid eating their way through the heart of our country. In 2013, 46,471 Americans died from drug overdoses, compared to 33,636 from firearms and 35,369 from car crashes. Opioid addiction and associated heroin use are key reasons why life expectancy for middle-aged whites and people in rural areas is stagnant or falling. The collateral damage is staggering, whether or not an addict dies. Failed marriages, personal bankruptcy, theft from parents and loved ones, violence –it’s ugly.

As patients became addicts, they spiral down. After running out of pills and unable to get refills, many seek leftover meds from family members and friends. From there it’s a short journey to buying pills on the black market and then on to the much more affordable and scary route of heroin. That’s how America has found itself in an opioid and heroin epidemic.

How did the opioid crisis develop and what can we do about it?

Two decades ago pain was undertreated. Narcotics were prescribed sparingly for fear that patients would become addicted. Pain wasn’t always taken seriously, and patients suffered.

Then the pendulum swung in the other direction. Sam Quinones’ book, Dream Land lays out the timeline of the epidemic and its impact on the American heartland. A few highlights:

  • 1986 Paper in the journal Pain suggest broadening the use of opiates to treat chronic pain
  • 1996 Launch of OxyContin, time released oxycodone, aimed at chronic-pain patients
  • 1998/99 Veterans Administration and Joint Commission adopt pain as a vital sign
  • 2004 Washington State Department of Labor publishes findings on widespread opiate-related deaths of injured employees receiving workers’ compensation benefits
  • 2008 Drug overdoses surpass auto fatalities as leading cause of accidental death
  • 2014 Actor Philip Seymour Hoffman’s death from heroin overdose is a headline news wakeup call to the crisis of the progression from a doctor’s prescription to street heroin

Pharma companies developed powerful opioids based on real need and then aggressively marketed the new products to physicians, many of whom prescribed the drugs liberally. Health insurers provided generous coverage in keeping with the new standards on the value of pain management.

But the pain-killer has turned into a plain killer. Since 1999, opioid prescriptions have grown over 400%. In 2013 just over eight thousand Americans died of heroin overdoses – four times the death toll in 2006. Almost all of the opioids available today are just as addictive as heroin. The CDC reports that those who depend on or abuse opioid painkillers are forty times more likely to become heroin users. Rising rates of heroin abuse are driving outbreaks of Hepatitis-C and HIV that are overwhelming the public health infrastructure in middle America.

At last, the pendulum is swinging back. Health Plans, medical societies and the CDC are leading the way.  Cigna has just announced a plan to reduce the use of opioid medications to the pre-crisis level of 2006. “I think in hindsight… we’re able to see that, gosh, we missed this,” Cigna behavioral health chief medical officer Doug Nemecek told Fortune.

Cigna’s approach mirrors best practices that are being developed around the country:

  • Educating physicians and patients about the new CDC guidelines for opioids
  • Leveraging data on prescribing to identify patients at risk for addiction
  • Encouraging a more holistic approach to pain management that includes drug-free approaches such as cognitive behavioral therapy, massage and chiropractic
  • Easing access to drug rehabilitation programs for members who need it
  • Taking steps to remove the stigma from addiction

Cigna is going a step further by partnering with the American Society of Addiction Medicine to analyze claims data in order to improve addiction treatment.

The opioid epidemic evolved from good intentions and a seemingly enlightened approach. Looking back we can see the tragedy that’s been wrought by unintended –but not completely unforeseeable—consequences. We should examine our actions today with the lessons of the opioid epidemic in mind and take care not to repeat our mistakes.