The Opioid Crisis

From the National Institute on Drug Abuse -- January 2019

Every day more than 130 people in the United States die after overdosing on opioids.  The misuse of and addiction to opioids – including prescription pain relievers, heroin, and synthetic opioids such as fentanyl – is a serious national crisis that affects public health as well as social and economic welfare.  The Centers for Disease Control and Prevention estimates that the total “economic burden” prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement.

That’s the economic impact.  Would you like to know the emotional impact of the opioid crisis?  Read David’s story below, written by his father, John Risberg, former Maritz Corporate Secretary & Counsel.

My son, David, died a little more than two years ago, on January 15, 2017, in a single car accident on I-70 between Columbia and St. Louis, MO.  His death is therefore not counted amongst the thousands annually which are attributed to opioid addiction.  Nevertheless, there is no doubt that his death was the result of his addiction.  Here is his story, which provides a cautionary tale for all of us who are concerned about the prevalence and availability of such drugs in the marketplace. 

David started using opioids six or seven years ago in the form of prescription oxycontin tablets which had fallen into the hands of illicit drug dealers.  The unit price of this form of the drug was high, and became higher as efforts to limit misuse increased, but drug dealers are resourceful and soon recommended a cheaper, more readily available alternative--heroin.  At first, David smoked the drug, but, as his dependence increased, he followed the path of most heroin addicts and began injecting it.  Two years before his death, his addiction had become so intense that his need for the drug came to overwhelm all other considerations.  Having worked long and hard for an entire week on a project site located an hour or so from his home in northern California, he was out of heroin and so decided to head for home to get the fix he believed he so desperately needed, even though he was completely exhausted and knew he had no business being on the road.  Half way home, he fell asleep at the wheel, went off the road and hit a redwood tree at full speed.  Seriously injured, he was flown by helicopter to the closest hospital and went into cardiac arrest as he was being wheeled into the ER.  He was revived by a quick-thinking physician, put into a medically-induced coma and transferred to intensive care, where he remained on life support for more than a week.  He spent the next several months in the hospital with a broken back, other broken bones in his arms and legs, a punctured lung and other internal injuries.

Realizing his addiction had led to his accident, and that he needed help to overcome it, David agreed to return home to Missouri to enter a recovery program.  He worked very hard and managed to remain off the drug for more than a year.  Eventually, though, he succumbed to relapse and again began the swift descent into dependence.  He was living in Columbia, MO at the time and, again desperate for help, he agreed to enter another recovery program in St Louis.  Despite his near-death experience in California less than two years prior, on the night before he was scheduled to return to St. Louis to enter the treatment program, he again found himself out of heroin and felt compelled to drive “home” (this time to St Louis) to make a connection “one last time”.  This time, however, he didn’t make it.  His car went into the median and flipped over.  He was ejected from the vehicle and died of multiple traumatic injuries.  Can there be any doubt under these circumstances that his death came about as a direct result of his addiction, and can there be any more compelling illustration of the devastating power of this overwhelmingly lethal class of drugs?  Overdoses are only one consequence of a much larger problem.

At David’s memorial service, I expressed a few thoughts about opioid addiction I would like to repeat here.  The use of opioids is extremely dangerous.  They should only be used as a last resort, and their use must always be limited and carefully monitored.  Here is the problem:  Although opioids are initially effective in easing pain (including mental pain caused by anxiety or depression), their effectiveness diminishes relatively quickly over time. This results in a need for increased dosages to produce the same pain-relieving effects, thus increasing the person’s physical dependence to the drugs.  No one aspires to become an addict.  Addiction does not result from a weakness of will, but from a chemical reaction in the brain.  For addicts, getting “high” is only a way to temporarily diminish their anguish and avoid excruciating withdrawal sickness.  Addicts are miserable.  They are not getting high to have fun but rather to numb themselves.  Once addicted, it takes extraordinary willpower and substantial support to overcome the physical compulsion.  Few are able to succeed in this struggle.  Addicts deserve our compassion, and any addict struggling to overcome the disease deserves our respect, just like anyone else struggling to fight an insidious, chronic, progressive, and almost always fatal disease.

 I hope David’s tragic story will provide you with a better understanding of the dangers of opioids, and a greater appreciation for the challenges these drugs present for all of us, unless tightly controlled and carefully administered for very limited purposes.            

What do we know about the opioid crisis?

The National Institute on Drug Abuse reports . . .

  • Roughly 21 to 29 percent of patients prescribed opioids for chronic pain misuse them.

  • Between 8 and 12 percent develop an opioid use disorder.

  • An estimated 4 to 6 percent who misuse prescription opioids transition to heroin.

  • About 80 percent of people who use heroin first misused prescription opioids.

And, as John Risberg can personally attest to, this disease can touch anyone.

What can you do about the opioid crisis?

  • If you or a family member are going in for surgery, have a candid discussion with your doctor about what you will be given to control pain and how long you should expect to be on it.  Be sure to share a thorough and truthful medical history (including previous or current smoking, drinking or drug habits and if you have a history of depression or other mental health issues). Know the plan BEFORE you start using pain medication.  Follow your doctor’s instructions about tapering-off of the prescription pain medicine post-surgery.

  • Know the warning signs of opioid addiction – for yourself and what you might see in others.  This includes taking pain medication longer than is recommended, taking time to seek out more medication, dropping important obligations (skipping school or not going into work), memory problems and trouble focusing.  Realize that many of these same behaviors can point to other causes.  But, being aware and not afraid to ask questions is the first line of defense against addiction.

  • Don’t delay in asking for help if you need it.  Reach out to your physician, pastor, family members, anyone who will listen.

  • Store medicine safely where children cannot reach it.  Properly dispose of left over medication to keep it out of the reach of others.  Call your local pharmacy or law enforcement office to find out the best way to dispose of medications in your community.

  • Know how to react if you come across someone who is overdosing.  If you are a friend or family member of a person who has an opioid use disorder – carrying Naloxone/NARCAN (used for the emergency treatment of known or suspected opioid overdose) may be an option for you.  This is a conversation that should occur between you and your physician.  If you do carry NARCAN, you must be educated about when and how to use it.

What is Maritz and our pharmaceutical partner Express Scripts doing to combat the opioid crisis?

Express Scripts has instituted an Opioid Management Program to try to prevent addiction and save lives. 

For new opioid pain medications prescribed, you or your covered family member will be limited to a 7-day supply of medication.  This supply should be sufficient for most dental procedures and minor injuries or surgeries. Prior authorization will be required for enhanced long-acting opioids.  For chronic or severe conditions where additional supplies of pain medication are needed beyond the initial 7-days, additional fills will be allowed. 

Letters will be mailed to the home to educate members on the risks of addiction. 

Biodegradable disposal bags will be sent to members to dispose of unused medication to prevent opioids from being easily accessible to others. 

Enhanced monitoring by Express Scripts will result in point of care alerts being sent and proactive pharmacist outreach calls being made if it appears someone may be obtaining prescriptions for pain medication from multiple providers. 

Maritz is taking this seriously . . . you should too.