The use of addictive painkillers – opioid prescription drugs – in Israel increased more than twofold in the five years since 2011, found an Organization for Economic Cooperation and Development health report, released last week. According to the report, in 2011, there were about 5,000 pills being every day used per 1 million people, while in 2016 the figure jumped to over 10,000 per day.
Israel’s rise in addictive painkiller usage during this period was the highest of all the 36 OECD nations. The trend did not stop then. The figure has risen consistently since then, say Israeli health professionals – even if it has not been reflected in mortality rates. Other data back up their claims.
The OECD health report includes a sizeable section on the so-called opioid crisis. Since 2011, the mortality rate from the drugs has risen on average by over 20 percent in developed countries, and is responsible for some 400,000 deaths a year in the United States alone. The increase in deaths caused by opioid use is particularly notable in Canada, Sweden, Norway, Ireland and England.
These painkillers belong to a family of drugs that includes well-known medication and brand names such as fentanyl, oxycodone, buprenorphine, targin, tramadol and Percocet – all intended for treatment of severe pain for patients after operations, accidents or other severe injuries, as well as for cancer patients and others suffering from severe chronic pain.
“Opioids are a narcotic pain medication that have become the cornerstone therapy for treatment of moderate to severe pain in many high-income countries,” states the report. “In parallel, illicit opioid use for nonmedical purposes has created illegal, increasingly commercialised global markets.” Abuse of the drugs can lead to tolerance to opioids, which can require the user to take larger doses of the medicine to attain the same pain relief effect, causing drug dependency and addiction, says the report.
Larger dosages can also lead to opioid intoxication, drowsiness, slowed breathing and low blood pressure and overdose, which can cause death. The availability of the drugs – the number of prescriptions written – has been on the rise, going up by 110 percent during the first decade of the 2000s. This increase in usage has dropped 5.4 percent per year from 2011 through 2016.
The big news on opioids has been coming from the United States, where the scope of the abuse, along with the drug industry’s conduct in enabling the problem, are now being exposed in class action lawsuits. Opioids have become a huge and extremely profitable business there as drug companies have made pain management a marketing goal for doctors and patients. No less than 240 million prescriptions for opioid painkillers were written in 2015 in America – almost one for every person.
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The opioid crisis is not just a health crisis. It also has economic, legal and social aspects, such as unemployment, housing, exclusion and stigma, states the report. The number of deaths from opioid overdoses has been continually on the rise in the United States. In most cases those affected are drug users since the painkillers have become a street drug, sometimes used in addition to other narcotics.
It’s easy to claim that Israel is far behind in opioid usage and there is no real danger here – mostly due to the difference in the healthcare system here. Israel has a broad and centralized public health system and the HMOs have much more control – and serve as a filter between the drug industry and the healthcare system. In addition, the number of deaths related to opioids has not risen in recent years. But the data still show a rise in opioid use, and the Health Ministry is worried.
The signs that powerful painkiller use is on the rise comes not only from the OECD’s report. In November 2016, Haaretz reported that from 2011 through 2015, addictive painkiller prescriptions rose by 150 percent. “We have been following the matter with concern for a number of years,” said a senior Health Ministry official. “There has been an increase in Israel in the use of opioids and various addictive prescription medicines.” Half a year ago, the ministry appointed a professional committee to examine the issue, but it has not yet completed its work, nor submitted its recommendations.
Other signs are also appearing. The withdrawal and rehabilitation centers run by Health Ministry are one example. The ministry’s division for treating addiction reported that since 2018, the number of patients treated for opioid addiction has been higher than for any other addiction: 978, compared to 748 treated for marijuana addiction. There are far fewer patients undergoing treatment for cocaine and alcohol addiction. The Health Ministry now has a protocol for those addicted to opioids at every methadone treatment center. “We now see more people who are addicted to fentanyl than to heroin,” said a senior ministry official. The quantities and range of opioids making their way to the streets is also growing.
The problem is that these drugs play a major clinical role, making it hard to limit their use. They are the best drugs available for treating pain, and are needed in cases of acute injury, says Dr. Itay Gur-Aryeh, director of the pain unit at Tel Hashomer’s Sheba Medical Center. For short term usage and in correct dosages, the risks are quite small, he says. But the main problem is long-term usage after patients are released from the hospital. He says Israel must learn from America: “To pay attention whom you give [the drugs] to and how you end the treatment.”
“At the same time, not to let the cancer patent die from pain. Don’t throw out the baby with the bathwater,” he added.