5th December 2019

The Opioid Epidemic: Calculating the Costs

The opioid epidemic continues to impose a tremendous human and societal cost on the world. Big pharmaceutical companies have gotten us into a horrendous mess by dishonestly, unethically, and even illegally pushing opioid painkillers on a public that was unaware of the significant risks of dependency and addiction. Purdue Pharma, the maker of Oxycontin and an industry leader who reaped immense profits from peddling dangerous drugs, recently settled a lawsuit in Oklahoma for a whopping 270 million dollars. There are still approximately 2000 other lawsuits waiting to go to trial across the United States, alleging that Purdue and other large pharmaceutical companies “engaged in deceptive marketing that downplayed the addiction risk from opioids while overstating their benefits.” Before the financial settlements and jury awards start to roll in, let’s take a long look at the human and financial costs of the opioid crisis.

The Pain Paradox

The opioid epidemic has roots not just in irresponsible marketing campaigns, but in the structures of our health-care systems and societal approaches to dealing with pain. In America, HMOs have largely replaced family physicians, and doctor-patient interactions have shifted from intimate, familial relationships focused on long-term health to a customer service model. Meanwhile, funding for holistic, multi-disciplinary approaches to pain management has dried up in many countries. These trends created the conditions which allowed opioid use to spread like wildfire.

Rather than addressing the root causes of pain and working on long-term solutions, physicians (and dentists, the most common issuers of fast-acting opioids) settled on temporary pain relief via pills. Everyone involved with the health-care system was incentivized to settle for oxycontin instead of pursuing the more expensive, complicated, and slower psychosocial and physical solutions that would enable the afflicted to successfully manage their pain.

The Opioid Epidemic's Terrible Human Toll

According to the American Centers for Disease Control, over 700,000 people died of drug overdoses between 1999 and 2017, with 68% of the deaths (almost 400,000 fatalities) involving an opioids. By 2017 the number of deaths involving opioids was 6 times higher than it had been in 1999, and 130 Americans were being killed by opioid overdoses every day! Americans are now more likely to die from an opioid overdose than from a car crash.

Opioid prescriptions were frequently given not just for severe long-term pain, but also for routine procedures which caused a few days of manageable pain, like wisdom teeth removal, bone fractures, and minor surgery. Relying on pills to avoid a few days of discomfort led millions to years of addiction and even death. As evidence mounted that exposure to opioid painkillers heightened the risk of abuse and addiction, the prescriptions continued to pile up.

Nowhere was harder hit by the opioid epidemic than rural communities in America. The state of West Virginia alone was showered with 780 million oxycodone and hydrocodone pills, amounting to “433 pills for every man, woman and child” in the state. One town with a population of 392 and a single pharmacy received 9 million pills in a two year period. Kanawha County, with a population of 190,000 received 66 million oxycodone and hydrocodone pills.

Pharmaceutical companies and legislators were finally forced to address the issue and limit the supply of pills, but that has led to even worse problems. As the legal supply of opioids has dried up, more and more addicts have turned to the black market, which is largely comprised of Fentanyl-based pills. Fentanyl, a powerful synthetic opioid, is manufactured in China, shipped to Mexico where it is processed into counterfeit pills, and distributed around the world. Fentanyl is 30-50 times stronger than heroin and can be lethal in doses of just 2 milligrams. As a US Attorney in Ohio has noted: “One of the truly terrifying things is the pills are pressed and dyed to look like oxycodone. If you are using oxycodone and take fentanyl not knowing it is fentanyl, that is an overdose waiting to happen. Each of those pills is a potential overdose death.”  

The Financial Cost of the Opioid Epidemic

A report from Altarum, an American healthcare research and consulting firm, calculated that eliminating opioid addiction and overdoses would create an annual benefit to the US economy of $115 billion. They calculate that the total cost of the opioid epidemic since 2001 has been over $1 trillion and that an additional $500 billion will be added to the sum by 2020. Others calculate the cost to the government alone at approximately $80 billion annually, without even factoring in the cost of healthcare fees, legal expenses, and lost productivity on individuals and families.

These immense sums boggle the mind, but they fail to reckon with the profound impact of the opioid crisis on communities. Trauma, fractured families, decreased property values, loss of community well-being, educational impacts, and a myriad of other social problems whose impact has yet to be gauged are on their way. The opioid crisis has left behind it a wake of devastation, poverty, and heartbreak. But is there anything that can be done to reverse the tide of human misery?

What's Next?

One necessary step for dealing with the current opioid crisis is embracing the principles of harm reduction. The medical establishment has led millions of people toward addiction by profitably over-prescribing pills. Their victims shouldn’t face criminalization and stigma for following a doctor’s advice. The Portuguese model has shown great promise for dealing with addiction by treating addiction as a health issue. It’s time for other countries to follow suit.

Another important tool for dealing with rampant opioid addiction is iboga therapy. The treatment is a proven success in dealing with substances such as Oxycontin and Oxycodone, acting as an addiction disruptor and opioid antagonist. If governments are serious about battling the plague of opioid addiction, the time to begin clinical trials is now!

But perhaps the most necessary step in dealing with this massive crisis is changing our understanding of pain. Pain management is a necessary part of life, and all of us will have to deal with intense physical and mental pain at some point. It’s time for the medical establishment to embrace comprehensive, holistic pain management plans. Pressure, stretching, motion, and touch are all proven to relieve pain. Cold and vibration-based therapies have been clinically proven to limit opioid use and dull perceptions of pain while the body heals. Sleep hygiene, ibuprofen, magnesium supplements and a host of other options have shown to be as or more effective than opioids in dealing with certain varieties of pain. As Dr. Amy Baxter of Pain Care Labs argues, changing the paradigm from a focus on pharmaceuticals to creating comprehensive, individual “pain plans” will destroy the false dichotomy of pills and “complementary” treatments. There isn’t a “Big Yoga Lobby” taking doctors on expensive promotional junkets yet but using some of the windfalls from lawsuits against pharmaceutical companies to create one wouldn’t be a bad idea.