Opioid Epidemic is Costly

“First do no harm” is often quoted from the translation of the Hippocratic Oath. Scholars say that is not an accurate quote. Rather according to a Harvard ethicist, it says “Doctors should help their patients as much as they can by recommending tests or treatments for which the potential benefits outweigh the risks of harm”.

As research changes, those treatments change. The situation with opioids is a perfect example of this. Historically they were rarely prescribed due to addiction risk. The pendulum swung to a much more free use of the drugs when physicians were told that OxyContin had almost zero risk of addiction. With the current opioid addiction epidemic, the pendulum has swung back to advising much more caution in the use of these powerful drugs. But it is taking time to make those changes.

In 2007, Purdue Pharma and its top executives pleaded guilty to charges that it misled doctors and patients about the addictive properties of OxyContin and misbranded the product as “abuse resistant”. They paid $600 million in fines.

In the past it was a common perception that opioid addicts were the heroin junkies shooting up in a seedy location. Today, that stereotype could not be further from the truth. During the Medicare Part D Rx open enrollment period, our clients provide us with a list of their current medications. I am astounded at the number of opioids that are being taken by these clients.

I see the same situations with many of my younger clients as well. One story is near to my heart.

Whenever I would encounter Dylan, he was quick to share his mischievous smile and dry sense of humor. You simply couldn’t help but like this guy. Following surgery for a sports injury, he was prescribed opioids by the surgeon. His ultimate addiction resulted in his death at age 29 from a heroin overdose. His is a common tale.

This epidemic is expensive in both hard and soft dollars. A 2016 study from Castlight Health covering nearly 1 million Americans showed that nearly 1 of 3 opioid prescriptions is being abused. The abuse includes over-usage and sharing medications. This study revealed that these abusers cost the plan nearly twice as much ($19,450) as non-users.

Locally, we have our own issues with this epidemic. It has to be confronted on several levels. The primary level is the source of the initial prescriptions. Physicians must unlearn this fraudulent message provided by big pharma.

Clearly there is still work to be done. According to a recent report for the period 109/1/2015 to 98/130/2016 the top 20 local prescribers (3.16%) accounted for over 50almost 28% of the prescriptions for opioids. Equally disturbing is the report that Opioid prescriptions were filled by 55,692 unique Shasta County residents during that time-> 1/3 31% of our adult population!

Insurance companies recognize this epidemic and have been placing stricter rules around filling opioid prescriptions. Initial prescriptions may be limited to low doses and just a few pills. Since starting their Narcotic Safety Initiative in 2015, Blue Shield has “reduced the proportion of new opioid utilizers progressing to chronic use by 25 percent, and has seen an overall reduction in all opioid consumption”.

Anthem has implemented a similar program directed at those considered to be a safety risk. According to their website: “Even after overdosing on opioids – more than nine out of 10 people continued to get prescriptions for them”, according to a 2015 study published in the Annals of Internal Medicine. Seventy percent of patients who overdosed later received prescriptions from the same health care professional who prescribed opioids before their first overdose.

I serve on a local task force called No Rx Abuse. The group is trying to educate physicians on the danger of these prescribing habits. It is not an easy task. Reports that identify the problem with prescribers, do not allow access to the identity of the prescriber. So there is no way to specifically direct training to those that need help understanding the danger of their prescribing patterns.

Clearly we are in the process of reversing the trend at the initial supply source: prescribers. But what about all those who are addicted? How will that be addressed before they progress to heroin when they can no longer access their prescriptions? A methadone satellite clinic will be opening this month. It’s a start.

Margaret R. Beck
Margaret Beck  CLU, ChFC, CEBS started her insurance practice in Redding in 1978. As an insurance broker/consultant,  she represents businesses and individuals as their advocate.  She assists in choosing proper products, compliance with complex benefit laws and claims issues once coverage is placed. All information in her column is provided to the best of her knowledge, subject to final regulation by the respective agencies. Questions to be answered in this column can be submitted to info@insuranceredding.com. Beck's column is also published in the Redding Record Searchlight.
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22 Responses

  1. cheyenne says:

    High Country News had an in depth and informative article, two months ago, about how a pain doctor moved to Craig, Colorado and basically in a decade addicted a lot of the town to opioids.

    • Steve Towers Steve Towers says:

      I’m a long-time subscriber to High Country News—for my money, the best periodical addressing life in the West (particularly the small-town West) in existence.  I more or less grew up in Steamboat Springs, and my dad grew up in Craig.  The shift described in that article of a population with a small fraction of meth addicts replaced suddenly by a large population of oxycontin addicts, followed by a heroin epidemic when the pill mills were brought down, is familiar territory to Shasta County residents.

  2. Joanne Lobeski Snyder says:

    This is an excellent article.  Pain and pain management are a huge issue.  I’m convinced that a family member who had repeated surgeries on the same shoulder, did it because of the drugs.  I don’t know why the 5th or 8th or 12th surgeon didn’t stop and say….”Hum.  This surgery didn’t work before.  Why are we doing it again?”  I’m convinced that his pain was worse than mine for the same injury because his brain was totally on board with the “more drugs” idea. He died of an overdose.

    I wonder if a project for No Rx Abuse might be patient awareness of the dangers of  addiction.  I’m sure you task force is doing this, but I’ve been alarmed at how readily co-workers accepted opioid prescriptions without understanding the power of these drugs.  I have two friends that are now addicted.   Can detox be prescribed and covered by insurance?

     

  3. Common Sense says:

    Excellent article! Medical Cannabis can help the majority of the people that are battling Opioid Addiction! But most people don’t want to talk about that around Shasta County…..Plenty of articles point out that studies show promise using this “Natural” Pain killer!

    I would provide links but two of my articles with links to further information got my post banned from this website….that or someone is Censoring on the topic?

    So what DO all these people who are addicted have in common?……Lack of Connection…….they don’t feel connected to other people…..they have been abused….many of them….and they don’t feel accepted! Solve that Problem….and you will make some Real Progress on this topic!…..Followed by Housing…….and treatment for those that WANT to change…….

    Doni’s Note: I’m adding this link to a video that was contained in one of Common Sense’s unapproved comments.)

  4. cheyenne says:

    Good video.  I do have concern about legalize all drugs.  It may work in small Portugal but in spread out America there are basically several different cultures and what works in one may not work in another.  Some areas have connecting communities while others not so connecting, and Republican or Democrat doesn’t make a difference, it happens in both.  And opioids are legal, it is the prescribing doctors that are the problem.  Making all drugs legal there has to be an accountability for the prescribers.

  5. Common Sense says:

    Cheyenne, I think you may be missing the point……Alcohol is legal also….and it is 100x worse than Cannabis!…the root of the problem is lack of connection……if people felt connected….to themselves….to family….to friends….to loved ones…..there would be virtually no drug addicts….there would be less pain….and pain is one of the number one reasons people go to the Dr.To get relief from the pain…..Cannabis takes care of that….it’s natural…..it was only outlawed because of Money…..When William Randolph Hearst and a couple of other Billionaires got together to have it outlawed during the early Nixon years it was solely based on money…..Hearst Stood to lose Millions if Hemp continued to gain market share! His Timber products and newspapers would have suffered…..Hemp is a superior product to produce paper with….the Second draft of the Constitution was written on Hemp Paper! So they Outlawed Hemp and Cannabis….to make it easy…..they look very similar….They then started the Campaign to slander it and make people think it was the worst thing in the world….. kind of funny fast forwarding approx 70 years now….it’s still considered terrible in many states and many are still stuck in their Cognitive Dissonance on the topic but Research shows up it can help get MANY Off THE Opiates.So the one thing that can help the Epidemic is the ONE thing that many are Still Fighting…..mmm ponder that one…..

    If we look back in History….Cannabis was in approx 90% of the Pharmacopeia in this Country….up until the early 1900’s….Why?….Because it worked……The unfortunate part is…..the outlawing of this natural plant was not done properly…..it has to be in the Constitution…..and it wasn’t ……
    If the federal government has a law on the books, and the law was made under the authorities granted by the States in the United States Constitution, and a state, or city, passes a law that contradicts that constitutional federal law, the federal government’s law is supreme based on The Supremacy Clause. However, if the federal law is unconstitutional because it was made outside constitutional authority, it is an illegal law, and therefore is not supreme over similar State laws.

    An example of the federal government acting upon the assumption that all federal law is supreme over State law is the medical marijuana laws in California. The actual constitutional legality of the issue illustrates my point quite well.

    California passed a law legalizing marijuana for medicinal purposes, but federal law has marijuana as being illegal in all applications. Therefore, using the authority of the federal government based on the Supremacy Clause, federal agents (or at least until recently) have been raiding and shutting down medical marijuana labs in California. However, there is no place in the U.S. Constitution that gives the federal government the authority to regulate drugs, nor has there been an amendment passed to grant that authority to the federal government, therefore the raids on medical Marijuana labs in California are unconstitutional actions by the federal government.

    The Supremacy Clause applies only to federal laws that are constitutionally authorized. Therefore, federal drug laws are unconstitutional. As a result, California’s medical marijuana laws are constitutional because they are not contrary to any constitutionally authorized federal laws.

    “Contrary” is a key word in the Article VI, Section 2.
    It’s all about the MONEY at the end of the day!….the RX Industry is a Multi Billion Dollar Industry…..The Doctors get “Perks” for each and every RX they write…..call it a vacation fund or travel expenses paid if you will…..
    The Main Stream Dr.’s don’t make money with Cannabis….the RX Industry doesn’t make money off Cannabis….well there are some exceptions GW Pharmaceuticals is one that is doing very well….but the majority don’t…..its not patentable for the most part….so the Corporations are not going to support it one bit….unless…they can make money off it!

    • cheyenne says:

      I respectfully disagree with you.  The Federal Government is not raiding state legal marijuana grows or stores in Colorado despite MJ being illegal in the feds eyes.  The problems in California, which voted in MMJ in 1996, are state, county or city problems.  Opioids, which I was posting about, are abused by pain doctors.  MJ and opioids are two different discussions.

      Common Sense, perhaps you should do like I, and several other Anews posters have done, write an article for Anews describing your opinion instead of trying to relay your message in a long post.

      • Carter Slade says:

        And I have to respectfully disagree with you C, on several fronts.   In regard to marijuana, “the problems of California being only state, county or city problems” is silly. The Feds have cannabis listed as a Schedule I drug. That being the case, in reality, there are no “state legal marijuana grows”. And the Feds, even under Obama, have indeed closed dispensaries out here on the left coast by threatening not only property seizures to building landlords leasing to dispensaries but threatening city and county workers who issue any cannabis related licensing. BTW, as it stands, not a dime of  legitimate cannabis profit is going into any bank, anywhere because of the Feds and Sched 1. Not even in Colorado. So to say the Feds dont call the shots…please…

        “MJ and opioids are NOT two different discussions.  They are as connected as keys to a keyboard.  You do realize that left to it’s own, the cannabis industry might well rival Big Pharma as a competitor, the likes of which Big Pharma has never seen. Opioids are Big Pharma.  The author, along with the general public is just beginning to wake up to the fact that the opioid epidemic is real and it didn’t just happen accidentally. Big Pharma, while the feds look the other way, have been quietly turning us into a nation of pill junkies. If you dont believe that, watch any of the Big Pharma tv ads where they say – take our pill but if you die, stop use immediately and call your doctor

        When cannabis is finally reclassified from a Schedule 1 drug, a classification it should never have received to begin with as it was purely political, Big Pharma will be there, first in line, put there for and by the Feds.

        • cheyenne says:

          Advertising in the Denver Post Cannabis Report is weedapp.com.  They offer, per their ads, banking for cannabis stores at FICA banks across the nation.  This allows the stores to use credit cards for purchases which was already being done by some MJ stores in Colorado.  The status for the Fourth Corner Bank in Denver is still up in the air.

      • Common Sense says:

        I prefer Facts Cheyenne over “Opinions”  –
        “Opinion is really the lowest form of human knowledge. It requires no accountability, no understanding. The highest form of knowledge… is empathy, for it requires us to suspend our egos and live in another’s world. It requires profound purpose larger than the self kind of understanding.”
        Bill Bullard

        —————————————————————————————————

        The Facts on the Topic are- The Current Policies on MJ are Unconstitutional……

        MJ helps many many conditions….people have cured their own Cancers with the Concentrated MJ….

        Why no one raids the local shops ? They have bigger fish to fry!

        The Current Drug Policies are an Abysmal failure! A Trillion Dollar Failure….we have MORE drugs now and more Drug problems than years ago!

        Follow the Money Trail…….The RX companies know the writing is on the wall……their RX numbers in legal states have declined…they are representing their share holders….That’s why they put money toward the No Legalization efforts.

        Local Law Enforcement relies on the Federal MJ Enforcement money to keep the doors open…..It’s about 10% of their budget I have heard…I have not verified that personally…..so that can be classified as hearsay…..but it helps fund 3 deputies yearly I understand….

        Complete legalization across the board with pretty much wipe out the RX Industry unless they adapted……. Do some research on G.W. Pharmaceuticals…..they are doing well……

        I agree with Carter on many points…..it’s a Political thing….it was Never Based on Facts….and Never based on Science!

        As far as Colorado…..I don’t know much about all that there….you are the expert there if you live there…..

  6. Common Sense says:

    Cheyenne, It’s OK to disagree…..that’s what leads to good debates….and hopefully learning by all! We are not talking about Colorado…..we are talking about California…..This website is based in California…..the Problems in California are Not State problems when the Federal agencies have raided the collectives in the past….that is a Federal Problem( over stepping states rights)…..MJ and Opioids are two different situations but share a common bond…..MJ can and does Relieve Pain…..that is a Scientific Fact…….it can be used to get people OFF Opioids…… So my Analogy for MJ and Opioids is this…what is worse…..a dented fender on your car….or a head on collision at 70mph?

    The Drug war has been a Trillion Dollar Failure……. the Laws outlawing MJ are Unconstitutional….. laws must be based on the Constitution or an Amendment only…..can anyone show me either on MJ?  https://www.thenewamerican.com/usnews/constitution/item/24598-with-marijuana-votes-tenth-amendment-wins-big

    I am happy to change my view if anyone can show me an Amendment to the Constitution/Bill of Rights that outlaws MJ!

  7. cheyenne says:

    Why is the federal, state or county governments not raiding Shasta Lake City’s MJ stores?  Shasta Lake City is in Shasta County and when I lived there the Shasta County Sheriffs Office was Shasta Lake’s LE.

    And MJ and Opioids are two distinct different discussions.  There are more people killed by Grizzly Bears than MJ and there are more people killed by Opioids than in car accidents.

    • Carter Slade says:

      LOL C, everyone knows the Grizzlies dont drive cars after getting high.

      Lake Shasta City has it’s own city council. They voted to allow the 3 dispensaries and are actually getting ready to vote on whether to allow a cannabis extraction company which looks like it will happen. It’s a bold move considering the extraction company, under the Schedule 1 classification, is actually “manufacturing a controlled substance” which is considered a felony. Ironically, the “manufacturing of a controlled substance” is a big part of Shasta County’s case against the Benno family, going on as we type (speak).

      Yes, the Shasta Co sheriff also has the Lake Shasta City jurisdiction in terms of law enforcement but you have to remember the Shasta County dispensary ban is based on a local nuisance ordinance. Lake Shasta City’s ordinances, being their own local government can differ. I suppose the Sheriff could refuse service to Lake Shasta City but the would open a real can of worms I imagine simply because there isn’t really a big  civil infraction. If you want a real mind boggler, Prop A bans growing outdoors in Shasta county except in the city of Redding where you or your neighbor can grow 6 plants. No dispensaries are allowed but you can stink out your neighbors all summer long and for some bizarre reasoning, that isn’t considered a nuisance.  Alrighty then.

      The Feds could come in today and raid any or all of the Lake Shasta City 3 dispensaries and any other dispensaries in the country for that matter under the Schedule 1 law but Fed priorities lie elsewhere right now. Your Colorado banking claim cannot possibly be Federally Insured (FICA?).  The bank would be considered to be laundering drug money under the Schedule 1, a violation of federal law I would think.

      The cannabis/opioid argument is simple – they are both used for pain management but one has been made out to be a  society killer while the other one actually is. Isn’t it sad the one that does the most destruction to our society in general and it’s members is the one that’s Federally approved(opioids)…

       

  8. cheyenne says:

    CS, I didn’t make the FICA claim the bank did.  And in Colorado marijuana news, from the Cannabist, Republican Represenative Mike Coffman said he voted against both the MMJ and the MJ laws but the voters have voted them in.  He said both MMJ and MJ are legal by law in Colorado now.  He said he would use all his power to fight Sessions if the AG tries to interfere in Colorado marijuana.  That was in today’s news.

    The only reason I bring up Colorado is because I see too many posters posting how it is in Colorado and they are wrong.

    • Rod says:

      CS, Carter and Cheyenne,  thanks for teaching me how to bite my tongue, I stayed out of the discussion.

      It’s true we’re in the wrong business, unless you love the money.  MMJ advocacy is making sound and beneficial progress precisely because we combat the political and financial establishment.  Contrary to political pressures, cannabis usage is good for Americans.  We’ve reached the tipping point concerning positive scientific research, we’re on the side of an absolute.

      Way back, 1934 or so, cannabis needed to be eliminated for financial purposes.  The economic potential of chemical medications required government backing.  Imagine expecting an old-timer to relinquish his/her weed for unheard-of pills and snake-oils produced from who knows what?

      I agree with what Cheyenne requested…try to publish an article so that we can ALL join in there.

  9. Rod says:

    Here’s todays opiate news and why pulling investment cash out of big pharma stocks might be wise.

  10. Common Sense says:

    It’s Ironic that the one thing that can help people get off the Opiates is the one thing that Shasta County is fighting so hard against! Case and Point…the Bennos….

     

    http://www.huffingtonpost.com/johann-hari/the-real-cause-of-addicti_b_6506936.html?

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