Painkiller nation?

The steep rise in opioid use here is a real danger to public health

By KARIN SPINGOLD
August 21, 2019 17:37
Painkiller nation?

The steep rise in opioid use here is a real danger to public health. (photo credit: INGIMAGE)

An OECD report released last week revealed that Israel ranks 11th out of the 37 member countries in the Organization of Developed Countries in the use of addictive analgesics. The figure might have been less worrisome had it not been such a sharp jump in merely three years – in 2013, Israel ranked 24th.

The report, whose data was collected between 2014 and 2016, shows that in Israel, more than 87,000 people regularly consume painkillers from the opioid group. The number of prescriptions in Israel for taking this type of drug increased by 125%, a figure that put us above the average consumption of the organization, which rose by  “only” about 13% in the period in question.
It turns out that “just like in America” is not necessarily a positive concept. In recent years, the United States has been suffering from the so-called “biggest epidemic since AIDS.” Between 1999 and 2017, 400,000 people died in America as a result of this use. The situation led to the fact that in October 2017, President Donald Trump declared a national emergency. He directed all government agencies to fight the deadly phenomenon.

“We are a long way from America and I hope we do not reach that situation,” says Prof. Leonid Idelman, chair of the Institute of Quality of Medicine of the Medical Association. “Physicians in the US dispensed these prescriptions freely and then, when they saw that there was an addiction, they stopped giving them. But people were already addicted to drugs like heroin and other drugs and it caused a real epidemic. There is no other nation with a similar condition. Although the data may be alarming, we are far away from it. I believe we can prevent deterioration.”

How should we act?
“As part of the Institute of Quality Medicine, we are working on creating rules that will guide doctors in determining treatment for the use of these drugs, preventing addiction and referring to prompt treatment for addictions. We are very concerned about this issue,” Idelman explains

What exactly are opioids?
“They belong to a large group of same-family drugs such as morphine [an addictive psychoactive drug] whose effects on pain have been known for thousands of years. Even today, these are the most powerful drugs commonly used in pain medicine, especially acute ones, but also in chronic situations, in instances where other drugs do not help. The problem was created mainly in the United States because the issue of pain rose to consciousness very significantly. Unlike previous periods, the rule has become one that must reach zero pain in every situation. The condition led to increased use of opioids, but then it became clear that there were groups of patients in certain conditions who develop addiction quite quickly. One of the reasons for the spread of addiction is that they have switched to opioid subgroups whose effects are short. It was thought that morphine had a long-term effect, and there was a desire to treat pain more quickly, but it was found that short-acting drugs, such as oxycontin, cause more addiction, especially among young people.”

Not everyone is as optimistic as Idelman. According to Dr. Ron Tomer, director of the Israeli Pharmacy Committee, the report reveals only the tip of the problem.

“No one in Israel knows what the condition is, for better or worse, in the use of painkillers,” he claims. “In my opinion, this is a far more serious problem than the report revealed. There is no computerized system that consolidates the data. The medical centers know what their patients are taking, but there are very many people who are taking advantage of the drugs, among other things by falsifying prescriptions for opiate drugs.”

How do you explain the increase in usage?
“We have an excellent but very busy health system,” said Tomer. “People who suffer from pain need a solution here and now. And because the system is stressed, the continuation of treatment is delayed many times. We all know how long one should wait for an orthopedist or neurologist. Many times you get the opiate medicine in emergencies, in a situation where you’re in pain, but the queue for the real treatments lasts for months. In the meantime, you can’t live with the pain, you keep taking the medicine and then it’s bigger than you and you become addicted to it.”

“With proper management, even if it takes time to resolve the problem, after you have dealt with the pain you should slowly find other ways to relieve it and not continue with these medications for a long time. In the end, you also need to know how to rehabilitate the person who has developed dependence, because you cannot stop it immediately.”

“We need to investigate and understand the data, but in general, we have witnessed an increase in use with the addition of highly addictive products in the market,” says Dr. Hagai Levin, head of the Health and Environmental department at the School of Public Health at the Hebrew University and Hadassah. “After all, what happened in the United States? These products are being pushed by pharmaceutical companies with false promises they won’t cause addiction. The use of any drug should be informed, proportionate, limited and supervised. Unfortunately, when economic interests control, as in the United States, public health is compromised. We may suffer from similar phenomena, although there is a regulatory system in the country. You still need to identify loopholes and block them. In some of the issues, we are not working optimally to sever the connection between pharmaceutical companies and the health care system.”

Tomer also talks about what he calls “underwater use.”

“Increasing the availability of such drugs, falsifying prescriptions and obtaining multiple prescriptions at the same time from multiple doctors, escalated the use,” he says. “It is also a cheaper and less criminal option. After all, if a man is found in the street with cocaine in his pocket, the police will probably detain him and if this is a large amount, they will also arrest him. Conversely, if they find someone with a large amount of medication, even if it’s morphine, they’ll just let it go.

“The treatment of traffickers is also different. I have not heard of many drug dealers who illegally obtained them and went to prison. All these things cause an increase in usage. It is important to note that many of those who abuse it are not just junkies and druggists, but normative people who started taking such drugs to treat real pain that interrupted their daily routine, did not receive the proper treatment or frequency of medical supervision and alternatives, and simply became addicted. The last thing to remember is that the infrastructure of the rehab clinics in Israel also requires upgrading and financial support.”
Tomer notes favorably the two newly formed committees to deal with the issue.

“After 13 years in which we raised an alert and appeared at Knesset committees, two health committees in the Health Ministry and in the Internal Security Ministry have recently been set up. It shows that someone in those ministries understands there is a problem here that needs treating. On the other hand, the State of Israel is fed up with committees. The question is how many tools these committees will give to implement their recommendations. There are many easy solutions: a computerized system, more correct advice, access to information and more rehabilitation clinics. So I hope these committees are a good sign, but without the ministers of health and home security deciding to give it a very high priority, they won’t be worth much.”

So the situation is problematic, but we are not on the road to being America.
Levin says, “We have a good health system. I don’t believe we will be America, but we are definitely narrowing the gap.”
The phenomenon “resembles a subject of an epidemic outbreak investigation. The sooner you identify the outbreak, the better your ability to intervene. Right now, we have a rare opportunity to identify very early and prevent a possible epidemic of using these dangerous substances that cause severe addiction, medical complications and death. What’s better than that? So it is true that the use of opiates in Israel is still relatively low, but the report shows that the growth rate is exceptional and very high. Indeed, as the report states, this is a real danger to public health.”

How do you prevent this phenomenon?
“First of all, we need to collect the data in Israel and know where we stand. In addition, the impact of pharmaceutical companies on policy must be avoided, balancing the real need for painkillers with the risk of addiction.”

Are you worried?
“I am always worried. We need to learn from the bad experience in the world and improve the system to be more resistant to drug companies’ intervention and the danger of addiction. By the way, we also need to monitor the penetration of medical cannabis so that it does not harm public health.”

Translated by Alon Einhorn.


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