'The Doctor Told Me, Sir, You're a Junkie': The Opioid Epidemic Hits Israel

One in 10 Israelis is at risk of becoming addicted to painkillers. The Health Ministry set up a task force to consider regulation of opioids three years ago – but it has yet to take action. The Shomrim media nonprofit reveals the panel's protocols

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An illustration of a doctor typing while people sit in pill bottles in front of him
'I found myself completely enslaved, and the dosages kept get bigger and bigger.'Credit: Moran Barak
Daniel Dolev, Shomrim
Daniel Dolev, Shomrim

To an outside observer, Udi Margalit would have appeared to be living a wonderful life. Although he was wounded during his service in the Israel Defense Forces in the 1970s and developed a dependence on painkillers during his recovery, he managed to pull himself together and kick the habit. He studied accounting, opened a successful business and raised four children. Five years ago, when he was in his mid-60s, everything changed.

“I was involved in a minor road accident, which caused me serious issues with my back. Some of the [vertebral] discs were knocked out of place, and I had nerve damage. I was diagnosed as suffering from chronic pain. Since then, I have had a lot of encounters with the health system, and that’s what I want to talk about.” This is what, two years ago, Margalit told the special committee established by the Health Ministry to formulate its policy on tackling the overuse of painkillers and opioids. In the United States, which has been rocked by the plague of opioid use, the Centers for Disease Control and Prevention reports that a half-million people lost their lives to the problem between 1999 and 2019.

“I went to my doctor with one complaint: I’m in pain,” Margalit told members of the committee. “So much pain that I wasn’t able to live a normal life – day or night. In response, the health system inundated me with painkillers, without explanation, without knowing, without investigating, without listening to me or hearing my history of addiction from 1973 to 1979. The doctors listened but didn’t hear what I was saying. Their ears were sealed. I was prescribed OxyContin or some other painkiller without a second thought. From OxyContin, I went on to fentanyl patches and no one explained the dangers.”

The physicians treating Margalit swapped out the drugs occasionally and increased the dosage, but he had not yet recognized that he was again addicted. “I found myself completely enslaved,” he said, “and the dosages kept get bigger and bigger – because I was still in pain. And when the pain still didn’t subside, they decided on even higher dosages – which is something they do a lot. I was walking around doped up; I didn’t know day from night. I was losing my cognitive abilities and a lot of other things. I lost my sense of taste and my mouth was always dry – but I craved sweet food. I needed nine teaspoons of sweetener to make my tea sweet enough. And I still didn’t realize I had a problem.”

The realization dawned on Margalit during a family vacation in the summer of 2018. “My wife and I took the grandchildren to Italy and I forgot my pills at home. That was the first time in my life it happened to me,” he said. “I was supposed to switch my fentanyl patch that day. Two days later, I found myself in a hospital near Lake Garda. I was going through severe withdrawal symptoms. It was only then that I understood I was addicted.”

When he returned to Israel, Margalit told the panel, “I was given a prescription for methadone, but discovered that I could only get it filled in Tiberias. I drove there and I stood at what they call Methadone Junction. I was in line with street junkies, who had fresh needle marks from injecting heroin, who had come to get their methadone fix. Them and me in the same line. Why? What did I do wrong? My only crime was to be innocently driving one day when a stupid driver put his car into reverse and hit mine.”

Margalit is furious. Not with the surgeons who operated on his back, but with the physicians who, he claims, did not inform him about the highly addictive nature of the painkillers they prescribed him. “You read the leaflet and they sound very innocent. ‘Can cause dependency in some cases,’ it says. And the doctors? Not a word about addiction. They just said that they would have to consider changing the drug after one year. So perhaps the starting point should be to recognize that there’s a problem. That doctors are giving out prescriptions for drugs willy-nilly … I’m not talking about mistakes made by doctors or what if the surgeon had been more cautious. That’s not the issue. The problem is the deception, the lack of information. They took away my control over my life and gave it to someone else. Now I’m fighting to get my life back.”

Margalit delivered his harrowing testimony to the special Health Ministry task force established to tackle the over-prescription and overuse of opioids. The committee was established three years ago by the ministry’s then-director general, Moshe Bar Siman-Tov, to make recommendations about regulating the use of these painkillers. The committee convened just eight times in over two years – the first time in March 2019 and the last in May 2021. It has yet to submit any recommendations. What it discussed behind closed doors remained far from the gaze of the public.

Until now. For the first time, the Shomrim Center for Media and Democracy, a nonprofit investigative news organization, is revealing, via documents and first-hand testimony to which it was given access by anonymous sources, the workings of the committee – which paint a picture that should be of grave concern for every Israeli. After all, Margalit was just injured in a traffic accident, a frequent occurrence here, and no one is immune from the possibility that he or she will need treatment involving highly addictive painkillers. This is especially true when one looks at the recent history of opioids in the United States, where physicians prescribed the drug in large quantities to anyone who wanted it – turning millions of Americans into addicts and killing hundreds of thousands since the late-1990s.

New rules of the game

To understand their situation, it’s enough to hear the testimony of L., who was diagnosed with cancer in 2014, and was one of the two addicts (the other being Margalit) to address the Israeli committee: “I began chemotherapy, suffered from great pain, and was hospitalized repeatedly because I couldn’t deal with the pain at home. I would get chemotherapy and be out of commission for two weeks in bed. At some point a doctor told me: ‘We’re sending you home, to home-hospice care,’ and I was sent away with painkillers.”

L. found a company that conducts genetic testing for cancer sufferers, and a treatment was found that improved her condition. “But I’m still stuck with the same painkillers,” she told the committee in tears. “I want to quit this thing, I use it uncontrollably. It burns my stomach, causes side effects… I’m really asking you, don’t leave me like this. Help me. I don’t want to live like this… I want to return to normal life. For that I need to go through withdrawal and start taking new pills, which are also addictive. Help me break this cycle. I don’t want to take pills anymore. These pills are burning my stomach, burning my soul, burning every aspect of my life. I don’t want this anymore.”

Recovered addict Udi Margalit. “I found myself completely enslaved.”Credit: Shlomi Yosef

The opioid epidemic hit the United States long before anyone had ever heard of COVID-19. The origin of the crisis can be traced back to the mid-1990s. Up until that point, opioids – which include morphine and the street drug heroin – were used in the medical context almost exclusively to treat extreme pain, in emergency situations and with terminal cancer patients.

The rules of the game were changed by the now-notorious drug developed by Purdue Pharma – Oxycontin, which is the same drug Margalit was prescribed. OxyContin is a slow-release opioid painkiller that can be taken twice a day. As has now been portrayed extensively in both fiction and non-fiction, in print and on-screen, the Stamford, Connecticut-based company, owned by the Sackler family, was engaged in aggressive marketing of its new product. According to an academic study that examined the U.S opioid epidemic, and that was shown to the committee, it financed research that downplayed the addictiveness of the drug, funded medical conferences and organization that declared that their goal was to help ease the suffering of chronic-pain patients, disseminated medical propaganda, and withheld from U.S. regulators information suggesting that the drug was in fact addictive.

The U.S. Food and Drug Administration approved the drug, included a note in the accompanying leaflet stating that the risk of addiction was low, and permitted Purdue to distribute out marketing material containing misleading information. The payback wasn’t long coming and it was catastrophic: Other companies started developing similar drugs and physicians prescribed them in huge quantities too. One statistic that shocked the American people found that, between 2015 and 2017, for the first time since World War I, the average lifespan of Americans fell – a decline blamed on opioids.

At the height of the epidemic, thousands of suits were filed against companies manufacturing opioid-based painkillers. Last year, Purdue Pharma was convicted as part of a federal plea bargain on several counts relating to the marketing of its drugs, and was fined some $8 billion. Meanwhile, many states are still engaged in separate compensation talks with the company, which has since filed for bankruptcy. In September, it was reported that a $26-billion deal had been agreed with four other companies that produced opioids, while in the last week of December, a jury in Suffolk County, New York, found Israel’s Teva Pharmaceuticals guilty of contributing to the crisis in the U.S.

Clearly, the United States has recognized that it is in the grips of an opioid epidemic and is doing something about it. The former head of the FDA described the crisis as one of the “great mistakes of modern medicine,” and, in 2017, President Donald Trump declared a national emergency. But the spread of the drugs did not stop at the borders of the United States. In Israel, too, use of opioids has become increasingly prevalent in recent years.

‘Chemical prisoners’

Israel’s special opioid task force was headed by Dr. Hadar Elad, of the Health Ministry’s medical division. It also included representatives from the country’s four health maintenance organizations, from the Pharmaceutical Association of Israel and several well-known public health experts (among them Dr. Paola Rosca, director of the ministry’s substance abuse-treatment department; Dr. Ronny Berkovitz, head of the ministry’s enforcement unit; Hagai Brosh, who heads the treatment and rehabilitation division of the Israel Anti-Drug Authority; and Prof. Pesach Schwartzman, a family doctor who specializes in pain treatment and heads the Israeli Association of Palliative Care). The committee member who came out most strongly against the use of opioids was Evyatar Samulsky, chairman of Lealtar: the Narcotic Patient Support and Assistance Foundation.

In the first meeting of the panel, Rosca confirmed that Samulsky was the first person to alert the Health Ministry to the phenomenon and that he had done so around a decade earlier. At the same meeting, Prof. Shaul Lev-Ran, head of the Israel Center on Addiction at the Lev Hasharon Mental Health Center, presented a study which found that at least one in six patients undergoing long-term treatment with opioids would become addicted. Samulsky interrupted Lev-Ran’s presentation and asked to focus on the development of physical dependency, which the report found had even higher incidence than the addiction levels, which is more of a psychological issue. According to Samulsky, every single person given opioids over a long period of time would develop physical dependency on them, leading to painful withdrawal symptoms, just as Margalit experienced in Italy.

“The important thing is what happens after,” Samulsky explained to the committee. He has been studying people who have developed opiod dependency for many years – and even managed to tackle his own addiction to opioids after 13 years of use. “When patients become chemical prisoners of this drug, and they plead with us to help them, we tell them that they’ve just got an addictive personality. It simply isn’t true.”

In a conversation with Shomrim, Samulsky said: “There’s no disagreement on the panel that I was the person who brought the growing scale of the problem to the attention of the authorities, so I’m amazed that I have encountered very clear and transparent efforts to insist that there is no problem and to deny that the whole issue will blow up in our faces."

Activist Evyatar Samulsky. Told the ministry about the opioid problem a decade ago.

The main problem the committee encountered was the absence of comprehensive data. As far back at 2017, the Knesset Research and Information Center published a report on addiction to prescription drugs, in which it pointed out that Israel does not have a national database documenting the extent of the phenomenon. The report also stated that the Health Ministry asked the HMOs for data, but was given only partial information, and that, since each HMO had different definitions of addiction, it was impossible to consolidate the data.

At one meeting, Tal Morgenstern, a senior official from the ministry, revealed that in 2018, more than 9 percent of all Israelis had been prescribed long- or short-term opioid painkillers. That added up to about 800,000 people – up from 700,000 in 2014, a 16-percent increase over just five years. In addition, the average number of days of opioid treatment per patient rose by around 20 percent during the same period – reaching an average of 99.5 days per patient.

The figures Morgenstern provided gave only a partial picture, however, since, for example, they did not differentiate between cancer patients, for whom opioid treatment is more commonplace, and other patients. The committee decided to ask representatives of the four HMOs to provide more detailed statistics, especially on non-oncological patients who had been taking opioid painkillers for more than six months.

As noted, members of this panel convened just eight times over the course of two years. They tried to get more detailed information from the HMOs, but at every meeting, encountered a new problem relating to the data that prevented them from getting a comprehensive picture.

“I understood that this was a whitewash,” one committee member told Shomrim. “I knew that nothing concrete would come of it and that not a single patient would be saved. The HMOs, for example, could have admitted that there was a problem that they should have been aware of, that they didn’t do enough and that’s why the situation has reached such a critical stage here in Israel. Instead, they claim that it’s not such a big deal and that it’s not as bad as it seems.”

“I’m worried that we’ve had seven or eight meetings and we’re chasing the data the whole time,” said Yosi Lomnitski, chief pharmacist of the Maccabi HMO, at one of the meetings. “We need to stop chasing after data and start doing things. We can see with our own eyes what’s going on.”

“The alarm bells have been ringing in the Health Ministry and with the public,” David Papo, chairman of the Israel Pharmacists Association, told the panel at one of its meetings. “The figures we’re being given sound okay, but there’s no doubt that, given what’s going on in the world, we are on the brink of an epidemic here. We’re in a war, so we need to take drastic measures.”

Indeed, testimony from senior physicians who were invited to speak to the taskforce highlight the problem better than the often-confusing and occasionally contradictory statistics.

“I underwent training to study pain management,” Dr. Omri Lubovsky, deputy director of the orthopedic surgery department at Barzilai Medical Center in Ashkelon, told the committee. “I heard a lecture by a surgeon from Sha’are Zedek Hospital who urged us not to be miserly with morphine and said that a good physician knows how to manage his patients’ pain. And that’s how I behaved for many years.

“The turning point came two years ago with the huge lawsuits filed against Purdue Pharma in the United States, when it was revealed that doctors were behaving like the worst drug dealers.... I felt frustrated and cheated, because I see that my responsibility as a doctor in terms of my patients is to ensure that they are not in any pain. I was also taken in by the pharmaceutical salespeople with their long-acting opioids. I thought I understood pain, but, until 18 months ago, every patient I would release after surgery would automatically be given a prescription for OxyContin or Targin, as part of the pain-management approach. Because there’s no need for a patient to be in pain.”

At the last meeting, about six months ago, Elad, the committee chairman, announced that at long last, the HMOs had agreed on a shared format by which they would be able to present their data on opiod use in a uniform manner.

The Health Ministry told Shomrim that it has in its possession the most recent figures, and that they were shown to Prof. Hezi Levi, who was its director general until four months ago. What is certain is that that data never reached committee members, who did not then hold a vote or draw up agreed-upon conclusions. The ministry rejected a request from Shomrim to see the figures it claims it presented the ex-director general.

Shomrim did received updated and detailed statistics from the Meuhedet HMO, which provides health services to about 13 percent of all Israelis. The figures – which were obtained in response to a request from the Movement for the Freedom of Information – show that during 2021 alone, some 9,100 Meuhedet members were prescribed a course of opioid painkillers for six months or longer.

Rising consumption

Oren Miron, a public-health doctoral student at Ben-Gurion University, began studying opioids when he was a research associate at Harvard Medical School. Last year, he published a study based on figures from the Clalit HMO, which serves about half of the Israeli population. According to Miron, in 2018, one in every 10 Clalit members – that’s around 450,000 people – was given at least one prescription for opioids.

Miron also found that, over the decade ending in 2018, the amount of opioids consumed by the HMO’s members rose by a factor of 2.2. A deeper examination of the figures reveals even more worrying findings: It turns out that, while the use of so-called weaker opioid-based painkiller dropped during that period by 45 percent, the use of stronger, more addictive drugs – especially fentanyl, but also including Oxycontin – increased threefold. The researcher also found that the largest increase in opioid consumption was among non-oncological patients aged under 65.

Public-health expert Oren Miron. Saw the biggest increase in use of fentanyl – 50 times stronger than heroin. Credit: Ronen Akerman

Miron told Shomrim: “Our study appears to show that the large number of patients being prescribed opioids are not being given a weak drug for a day or two. We see that fentanyl – which is 50 times stronger than heroin – makes up most of the increase in consumption. That’s not a drug that physicians prescribe for a day or two to help someone recover from an operation. It’s a drug that is usually prescribed for long-term courses. Once, it was given almost exclusively to terminal cancer patients, but now we’re seeing it prescribed to the general population. I spoke to one soldier who broke his arm during his military service and was prescribed very strong opioids. He got addicted and nearly paid with his life. That is the most worrying thing.

“There are so many people – people just like you and me – who trusted the physician who prescribed them 30 oxycodone [a generic form of Oxycontin] pills,” Miron adds. “So, they take the pills and they get addicted. It’s a tragedy. People who believed that painkillers were safe fell into a very deep hole. That’s why it’s so important, on one the one hand, to stop the initial prescription of opioids and, on the other, to offer recovery programs to people who have become addicted. You can’t just stop giving them their prescriptions, because an addict will just move on to heroin. We have to also offer an alternative.”

Yossi (not his real name) is someone who trusted his doctor. Today he is 62. A decade ago, he was diagnosed with Hodgkin lymphoma. “After around six months,” he says, “the pain became unbearable. It’s well known that chemotherapy involves a substance that attacks the nervous system. I found myself suffering from neuropathy, as well as a very bad infection of the colon – which is still with me. The pain centered on the left lobe of my brain. Terrible, terrible pain – accompanied by fevers. It felt like a hundred spiders were crawling over my back and legs, and were biting me. At first, I was prescribed Targin and OxyContin, but they didn’t help. Then they decided to start me on a fentanyl patch.”

Over time, Yossi’s fentanyl dosage was repeatedly increased. From 12.5-microgram patches, Yossi was eventually prescribed 75-microgram patches. “When you’re taking fentanyl, all you want to do is sleep and be left alone,” he explains. “When it was at its worst, my family couldn’t stand me. People on fentanyl are cranky, tense, they need quiet. You’re like a junkie. It’s hard to function. I would lose my balance and fall a lot. One time, I hurt my eye and my shoulder.”

At some point Yossi underwent a series of tests at Sheba Medical Center, Tel Hashomer, where one doctor told him: “Sir, you’re a junkie. You have two options: Either you get a liver transplant in a year, or there’s a good chance you’ll die in a year because upping the dosage is very dangerous.”

After reviewing a few rehab options, Yossi learned of a treatment for addiction conducted in the United States under full anesthesia, called “accelerated neuro-regulation.” “I’m a religious man,” he says. “If there had been a window open after I underwent the treatment, I would have jumped out of it. You go through four hours of withdrawal under anesthesia. After you wake up, you go through rehab. It was very difficult. But as of today I’m happy about that step, which gave me back my life.”

For his part, Dr. Daniel Flusser, head of internal medicine at Soroka Medical Center in Be’er Sheva, described to the ministry task force a phenomenon in which addicts, who formerly injected drugs intravenously, ostensibly “get clean” – when in practice have merely switched drugs, and now get their supply the legal and easy way: with a doctor’s prescription. “Most of the time they don’t inject,” he told the panel. “Sometimes they do and sometimes they don’t. But their family doctor provides them with an alternative. In the absence of regulation, the solution lies with the family doctor. The doctors prescribe fentanyl patches for lower back pain, as well as Percocet [an opioid pain reliever], but nobody stops to ask them what their patients are suffering from. Because by law they can prescribe them. We’re living in a country without regulations. Total anarchy.”

For their part, pharmaceutical companies argue that, given the lack of solid data relating to use of opioid-based drugs in Israel, there is no justification for restrictions on the prescription of these painkillers. In a medical opinion written for these companies, Dr. Schwartzman, of the palliative care association, pointed out that while there is no central body in Israel that supervises the prescription of opioids in real time, he takes his figures from the Clalit HMO.

In fact, according to the figures Schwartzman presented, between 2011 and 2016, there was an average annual increase of 4.5 percent in the prescription of opioids to non-cancer patients. However, he claimed, “this increase almost certainly represents improved pain-management policy in Israel and possibly rectifies the underuse of opioids in the preceding period.”

Data relating to mortality in Israel does not help gauge the exact extent of the fatal-overdose phenomenon, since, according to members of the task force, it is not detailed enough. For example, even if a patient died of hypoventilation as a result of overdosing on opioids, the cause of death will be listed as hypoventilation. The committee was presented data collated by the National Center of Forensic Medicine, but its researchers do not claim to offer a broad picture of the situation, since the center only performs autopsies if there is a suspicion of foul play.

Black market, white market

Data regarding the legal use of opioids is indeed unclear, but the ministerial panel did not even hear any rough estimates of the extent of the problem on the black market. Rather, members discussed the methods used by dealers and addicts to obtain the drugs – and especially the fact that the Health Ministry is light-years behind those individuals.

A 2019 protest outside a Boston, Massachusetts, courthouse where inside, the state was suing Purdue Pharma for its role in the opioid epidemic.Credit: Mark Lennihan/AP

This past October, Dr. Israel Levin, a 73-year-physician from Omer, in the south, admitted to illegally exporting opioid painkillers. Levin treated foreigners who came to Israel for treatment – so-called medical tourism. He kept photocopies of their passports and, after they left the country, continued issuing prescriptions for drugs in the names of their owners. He would then collect the pills himself and sell them to buyers overseas on the internet at a significant profit. Over four years, he sold 102 packs of fentanyl, 302 packs of Percocet and 154 packs of Ritalin (a non-opioid).

As part of a plea bargain, Levin was convicted by the Be’er Sheva District Court of exporting drugs, fraud and tax violations. The prosecution will ask the court to impose a one-year prison sentence, in addition to of a fine of 1.2 million shekels ($388,000) and payment of back taxes.

Although the public learned of Levin’s case only recently, it also came up back at the Health Ministry’s committee meeting in November 2019. Most of the discussion focused on the subject of what can be called the opioid “white market” – encompassing tens and perhaps hundreds of thousands of Israelis who are regularly given prescriptions for these drugs, often without any real medical necessity and without taking into account their highly addictive nature.

How does the seepage from the legal market to the black market work? Here’s one example: Until recently, Israeli physicians could only issue handwritten prescriptions for opioids, not digital ones. This allowed them to prescribe them during home visits of critically ill patients, without needing to return to the office for that purpose. In August 2020, the Health Ministry changed the regulations, allowing for electronic prescriptions for these drugs, while leaving the option for hand-issued ones as well. However, this made it even easier to forge prescriptions; an unscrupulous patient could take one of them, photocopy it and then go to any number of private pharmacies to have it filled several times, without the transaction being registered in the system.

“If someone has copies of a prescription and buys opioids at a private pharmacy, what’s to stop them going to another pharmacy, then to the HMO’s pharmacy and then to one of the big chains? No one would know,” says Ronny Berkovitz, of the ministry’s enforcement unit. “Beyond the fact that there are countless forged prescriptions, there’s also the phenomenon of repeat buying with a single prescription.”

According to Tal Morgenstern, from the ministry, “we started looking into this after encountering the strange case of a pharmacist who appointed himself as a kind of service provider for terminally ill patients at the clinic where he was employed. At first, he decided arbitrarily to help some of the patients, and then he saw that it offered quite a nice little side income, so he simply went to the doctors and told them he needed a prescription for some patient or other. They gave him prescriptions for Fenta 100 [the strongest fentanyl patch available in Israel] and he sold them. He managed to get about 110 packs in five months before we caught him. He was a senior pharmacist, who was held in high esteem and was up for promotion.”

Dana Sonnenfeld, head of the Israel Police’s drug analysis lab, added that, “of late, there’s a huge quantity of fentanyl patches on the streets. We have had reports of deaths resulting from people using these patches without any real medical need. We’ve also heard that, instead of affixing them to their skin, some users are chewing, sucking or snorting them.”

‘It’s like buying a gun’

The task force discussed a system by which all opioid prescriptions would be registered in a digital database, which could be accessed via every pharmacy and hospital database. That would prevent people from photocopying prescriptions, since the system would recognize used ones. It would also recognize forged prescriptions and, at the press of a button, could provide reliable data about the use and users of these drugs.

Simple enough. But it turns out that a similar proposal was brought to the Health Ministry back in August 2003 – but nothing was done about it. Committee members learned that then, as well as several other times when such a system was under consideration, the Justice Ministry, citing patient privacy, opposed the idea.

Members of the task force expressed their frustration over the situation on several occasions. “Obviously, there’s the [privacy] issue related to tracking an individual’s use of opioids,” a representative of one HMO said. “But we’re not talking about a pint of milk or some snacks. It’s like buying a gun. Or illegal drugs. Why doesn’t the Justice Ministry understand that any harm to privacy would be done to protect people?”

Another suggestion was to require pharmacies to inform the HMOs each time they fill an opioid prescription, to minimize the issuing of double prescriptions.

Oxycodone pills. “People who believed that painkillers were safe fell into a very deep hole."Credit: Mark Lennihan/AP

When might the ministerial panel make its proposals, something that would allow for concrete steps to be taken? The Health Ministry is taking its time, to put it mildly. This infuriates Hadas Ziv and Prof. Nadav Davidovitch, from Physicians for Human Rights, who were not task-force members but were invited to address the group several times and have been keeping tabs on its work. Last year, for example, the Health Ministry wanted to freeze the committee’s work because of the COVID-19 pandemic. Only after PHR intervened did the ministry move the meetings to Zoom.

“The whole operation of the committee was bizarre,” Ziv explained to Shomrim. “There was, for example, another Health Ministry panel that examined racism in the health system. That committee held meetings, published reports and updated us all the time. But here? Since we appeared before them, we haven’t heard a word from the opioids committee. We keep getting the feeling that we’ve been forced into being the committee’s watchdog. We want to say, ‘You’re supposed to be preventing the opioid crisis. That’s not our job. Where are you?’”

In light of the fact that the task force has yet to show actual results, there are those who have been taking action outside its framework.

Says Evyatar Samulsky: “Since I was on the committee to represent the public, patients and victims – and as chairman of Lealtar – I prepared a whole series of recommendations [to his colleagues on the committee], without waiting for it to act officially. After all, I did not have high hopes or expectations of the task force.”

Among the recommendations Samulsky submitted was one calling for a total ban on the use of opioids, other than in emergency situations, as well as another for new regulations that would rescind the driver’s license of people taking opioids, and have a legal guardian appointed for them.

During the committtee meetings, Samulsky got into arguments with Schwartzman, who seemed to be dubious about the problem, and even disputed the use of the phrase “opioid epidemic.” As Schwartzman tells Shomrim, Israel is in a far better place than the United States and he warns against “throwing out the baby with the bathwater.” In other words, he opposes any restrictions on the use of opioid painkillers.

“We’re a long way from what the Americans are experiencing,” he says. “We are in exactly the same situation as the Europeans. There’s no crisis here, in my opinion. At the same time, one of the things that we often do is copy-paste from the Americans, for better or for worse. So, we just have to remember not to get into the mess the Americans got themselves into. And that entails reasonable behavior. That’s the bottom line.” (Schwartzman also wrote a medical opinion two months ago in support of two companies that market opioids in Israel, which are seeking to dismiss a class-action suit filed against them.)

For his part, Samulsky, along with PHR, recently petitioned the Supreme Court to force drug companies to place much clearer warnings on their painkillers, like the health warnings on cigarettes.

In response to this article, the Health Ministry told Shomrim that “the ministry advocated in recent years for legislative changes that would allow for the establishment of a computerized system, but the issue was stymied because of concerns over privacy. Tighter supervision of physicians issuing prescriptions is one of the ways of ensuring more regulated use of such drugs and of stamping out abuse. The Health Ministry committee is looking at various recommendations to raise awareness regarding opioid prescriptions and to encourage doctors to keep closer tabs on their patients.”

The ministry also said that, “the committee’s work dragged on because of the complexity of the issue, but mainly because of the outbreak of the coronavirus pandemic, which forced us to put most of our resources into dealing with the outbreak. Updated consumption figures, interim conclusions and possible recommendations were presented to the previous director general of the Health Ministry and, once missing details are provided, will be sent to the current director general.”

Daniel Dolev is a reporter for Shomrim: The Center for Media and Democracy, a nonprofit investigative news organization.

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