Opiod Epidemic – Its Causes

An October 2017  article in the Harvard Business Review written by David Blumenthal and Shanoor Seervai discusses the contributing causes of our national opioid   emergency.

This crisis kills almost 100 Americans a day, more than motor vehicle accidents.  Every  part of the country is battling this epidemic.  The worst sates include Ohio, West Virginia and New Hampshire, locations of notable economic displacement.    Based on a National Survey on Drug Abuse and Health, about 92 million, or 37%, of American adults used prescription opiods in the year prior to the survey, 2014.   11.5 million or 4.7%, misused  them and 1.9 million or 0.8% had a use disorder.  By comparison there are 17 million heavy alcohol users among adults over eighteen.

Doctors have played a role.  Beginning in the mid-1990s, doctors over prescribed  opioids without adequate attention to the consequences.  At the time it was believed that pain had been under-treated.

Pharmaceutical companies bear   responsibility by fueling the epidemic to increase their own sales.  The role of health insurers also needs scrutiny.  Insurers have provided easy access to opioids, while  limiting access to less addictive but more expensive   medication and addiction treatment

Socioeconomic forces also play a role with unemployment, lack of health insurance and poverty associated with the higher prevalence of prescription opioid misuse.  Hopelessness and social drama are also contributors.

A soar in death rates from opiate abuse has led to an increase in the mortality rate among working age white Americans.  There is only one other recent example of a large industrialized country where of mortality rates rose over an extended period of time – working age white adults in  the decades before and after the collapse of the Soviet Union.

Researchers estimate that the economic cost of the U.S. opioid epidemic to be  as high as $ 80 billion  a year even excluding the economic value of a lost live.  Nearly one third of prime  working age men who are not in the labor force take prescription pain medication.  Some studies estimate that opioid account for  20% of the decline in labor force participation from 1999 to 2015.

Several changes obviously need to be made.  Addiction treatment must be more available and insurers must be required to cover such treatments. These  treatments must be made available to everyone in need – with or without insurance.  Medicare covers less than half of the cost of treatment medication.   Harvard researchers found that states that expanded Medicaid and actively promoted naloxone, an opioid blocker, experienced greater reductions in opiate related deaths.  In addition doctors need to rethink how they treat pain.

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