The Health Ministry is worried about the widespread use of prescription painkillers in Israel, the use of which rose two and a half times, or 150 percent, in the past five years. That, according to data on opioid prescriptions submitted to the ministry by the country’s health maintenance organizations. Drug rehabilitation clinics and centers have reported a rise in the number of people needing treatment for narcotics addiction. Health Ministry officials say that unless the trend is reversed, Israel could find itself in a situation like that in the United States, where opioid abuse is an epidemic.
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“It began six years ago, after I received a fentanyl patch after a bypass operation and became addicted easily,” relates Charlie Alfasi, a recovering opioid addict who is a social activist and an addiction counselor with the welfare department of the southern Israeli city of Ofakim. “After four months, the pain was gone but I realized I was in deep. It’s a narcotic in every way. You wake up in the morning and if you don’t have it you go into a kriz,” withdrawal symptoms,” Alfasi says.
Two years after getting his first prescription, Alfasi stopped using, on his own. “We now see increasing numbers of addicts — it’s easy to obtain these drugs. People pretend to have serious back pain and the doctor prescribes a narcotic.” Street addicts use prescription opioids as substitutes for methadone, the heroin substitute. “This addiction leads to a psychiatric ward, to prison or to death.” says Alfasi.
Every year, an estimated 200,000 to 300,000 Israelis are prescribed opioids at least once, and according to professional estimates as many as 10,000 may have an opioid addiction.
Both men and women are affected. Between 2010 and 2015 prescription opioid use tripled among Israelis aged 45 to 74 and doubled among those aged 75 and up, according to the figures submitted by multiple health insurers. Only 1.1 percent of the prescriptions were written by pain specialists; most are prescribed by physicians in other specialties or by general practitioners. The number of prescriptions for fentanyl and morphine has declined, but there is a rise in use of Oxycodone and other opiates.
The sharp spike in opioid use is surprising, but not the overall increase. Doctors and addiction professionals have been issuing warnings for years. The health care system and the public seem not to have absorbed the extent and the implications of the problem of abuse. After all, the drugs themselves are approved and effective painkillers that have met scientific and medical standards, thus making people oblivious to their risks.
Opiates affect receptors in the central nervous system. They are made from poppies, which are also the source of opium, heroin and morphine. Fentanyl and Oxycodone are also part of this group. In the United States, sales of such medications surged by 300 percent over a decade and a half despite no changes in reported pain levels. Opioids were involved in over 28,000 deaths from overdose in 2014, a fourfold increase from 2000.
Israel is not there yet but powerful painkillers have become an available and easy solution to pain. Oxycodone, 1.5 times stronger than morphine, and Oxycontin have become popular in Israel’s black market for drugs. Fentanyl, a synthetic, is 100 times stronger than morphine due to its greater ability to penetrate the central nervous system and attach to pain receptors there.
People who become addicted to prescription drugs tend to fall into one of three groups. The first consists of people with severe pain due to injuries as a result of traffic accidents or due to serious or chronic illness. Some of them become addicted, and may visit multiple doctors in order to obtain prescriptions. The absence of a centralized dispensing system prevents monitoring of such abuse.
The second group consists of people who receive methadone for narcotics addiction who obtain painkillers illegally in order to enhance the effect of the methadone. A third group consists of recovering addicts who relapse after being prescribed opioid painkillers for new health issues or after a traffic accident.
The Israeli Medical Association recently issued a position paper calling for a review of the use of opioids. While acknowledging the need for such drugs as part of the physicians’ “arsenal” for treating severe pain, doctors are called upon to use them more responsibly, only after making a thorough diagnosis and considering possible alternatives.
Some leading pain experts in Israel believe the situation here is not so dire, despite the rise in opiate prescriptions. Six percent of people using opioids for severe pain take them for extended periods of time, of six months, but not all of them develop an addiction. However, a recent study showed that at least 17 percent of patients who received opioid painkillers became addicted. There are claims that the HMOs are not sufficiently aware of the problem and are not doing enough to limit usage of these medications. One pilot project has just been launched in order to deal with such addictions and HMOS are being approached in an effort to address the problem.