Opioid addiction kills thousands of people every year. In 2014, for example:

• There were 18,893 overdose deaths related to prescription painkillers
• There were 10,574 overdose deaths related to heroin

Despite these shocking numbers, the problem continues to grow. (It quadrupled in the first decade of this century and continues to explode). In the past twelve months, the Drug Enforcement Administration (DEA) has been forced to issue new warnings on drugs such as fentanyl, a potent opioid more than 100 times more powerful than morphine and 30-50 times stronger than heroin. While fentanyl has killed thousands of people over the past few years, many only heard of it recently, when it was attributed to the death of the musician Prince.

Close to Home: Opioid Addiction from Prescription Sources

Given the dangerous nature of some of the most common prescription painkillers—not just from concerns about addiction but from accidental and intentional overdose (the leading cause of accidental death)—it may be surprising to find out just how common it is to find opioid medications in the home.

In 2012, the Centers for Disease Control (CDC) calculated that healthcare providers wrote 259 million prescriptions for opioid painkillers. That is enough for every American adult to receive a bottle of pills.

While there have been efforts to reduce the number of prescriptions written, the number of prescriptions remains very high and the volume of opioid medications already distributed is also alarming.

And this is a key contributor to the opioid addiction crisis. According to the CDC, most people who abuse prescription opioids get them for free from a friend or relative. Essentially, people give their old prescribed medications to friends or relatives. Or, alternatively, abusers take old prescription pills from friends and relatives without their knowledge.

Even among the people at the highest risk of overdose (using prescription opioids non-medically 200 or more days a year) a friend or relative’s medicine cabinet is a common source of finding opioid medications. Among that population:

• 27 percent use their own prescriptions;
• 26 percent get them for free from family or friends;
• 23 percent buy them from friends or relatives; and
• 15 percent buy them from drug dealers.

Cleaning Up: Reducing the Availability of Prescription Opioids

Since the early years of the decade, state and federal authorities have made a concerted effort to reduce the regularity by which opioid medications are being prescribed. In particular, there has been a focus on reducing the ability of abusers to use multiple prescribers to issue painkillers.

Several states have achieved various degrees of success. In New York, the number of patients seeing multiple prescribers for painkillers was reduced 75% percent between 2012 and 2013 after prescribers were required to check the state’s prescription drug monitoring program before issuing a prescription.

In the same time-frame, Tennessee saw a 36 percent reduction in the number of patients seeing multiple prescribers for painkillers when it instituted a program similar to New York’s.

Florida saw a 50 percent reduction in oxycodone overdose deaths between 2010 and 2012 after it regulated painkillers and stopped providers from issuing painkillers from their offices.

In addition to programs aimed at healthcare providers, the Federal government has directed resources towards educating consumers about disposing prescription opioids and other medications. The Food and Drug Administration provides information on the safe disposal of painkillers such as Fentanyl patches. The Drug Enforcement Administration is also providing information for the public regarding disposal as well as created a program to authorize and register drug disposal collectors.

A Pioneer in Substance Use Management

Magellan Health is a pioneer in offering integrated, comprehensive opioid risk and substance use management programs. We have an unyielding commitment to ending the current epidemic. And we are uniquely positioned to bring together behavioral, medical and pharmaceutical programs to positively impact overall population health and reduce cost.

Opioid addiction has grown over the past fifteen years from a personal issue to a national emergency. A new infographic from Magellan Healthcare reveals the devastation that this epidemic is causing.

• In 2014, there were 18,893 overdose deaths related to prescription pain relievers
• There was a 3,203% rise insurance claims for opioid dependence diagnosis from 2007-2014
• Prescription opioid abuse is costing employers $25,000,0000 a year

The opioid addiction crisis is causing such an unprecedented amount of harm precisely because it is such a complex, multi-faceted issue. Those looking for answers as to how such an epidemic could have happened, will need to examine a swath of individual problems, including:

• The enormous quantity of prescription opiates
• The limited patient knowledge of opiate risk
• That diversion of opiates to family and friends is so common that only 20% of those with opioid abuse problems are actually using opioids prescribed to them
• The struggle to adequately assess patient’s substance use history and risk of addiction when prescribing opiates
• The lack of clear guidance as to who should receive opiates and for how long
• The difficulty in maintaining patient adherence to withdrawal management treatment plans.

New solutions are needed to tackle each of these individual issues. At Magellan Health, we intend to do precisely that. The opioid addiction crisis has already taken a huge toll and it grows worse every day. It is manifesting itself in myriad ways among thousands of communities across the nation. At Magellan Health, we have an unyielding commitment to ending this epidemic.

Magellan Health marked October as Substance Abuse Prevention Month, with its chief medical officer, Dr. Karen Amstutz, releasing the following statement:

“Substance abuse does not discriminate. It pays no mind to gender, race, age or income level. According to the National Institute on Drug Abuse, the abuse of alcohol, tobacco and illicit drugs costs the United States more than $700 billion annually related to crime, lost work productivity and healthcare. Substance abuse, and in particular, our nation’s opioid epidemic, is gripping families and communities all across the country. Chances are, you know someone who is coping with substance abuse, though they might be doing so in silence.

“Magellan Health has worked in the field of behavioral health management for over 40 years, and we believe strongly that the treatment of substance abuse, including opioid misuse and addiction, is possible. Magellan Health advocates for medication assisted treatment (MAT), a well-researched and highly effective approach combining medication to treat the physical effects of opiate dependence, with counseling and recovery support services. Magellan Health is poised to support treatment professionals, legislators, third-party payers and patient advocates in the implementation of prevention efforts, best clinical practices, and elimination of potential barriers to treatment and recovery. Working together, it is important to shine a light on this dark epidemic and provide hope to people seeking to live a healthier, more vibrant life.

“If you or someone you know is dealing with substance, please call the Substance Abuse and Mental Health Services Administration’s Help Line at 1-800-662-HELP (4357). For Magellan’s resources related to substance abuse, please visit http://magellanhealthcare.com/opioids“

Painkillers, Heroin and Addiction: The Opiate Crisis Laid Bare

From East to West, North to South, the Opiate addiction continues, almost unchecked, to claim lives, destroy families and ruin communities.

Opiate Addiction: The Overdose Emergency

Fueled by both prescription painkillers and illegal substances, opiate addiction kills thousands every year. In 2014, for example:

• There were 18,893 overdose deaths related to prescription painkillers
• There were 10,574 overdose deaths related to heroin

Despite those shocking numbers, the problem continues to grow. (It quadrupled in the first decade of this century and continues to explode). In the past twelve months, the Drug Enforcement Agency (DEA) has been forced to issue warnings on new drugs such as Fentanyl, a potent opiate more than 100 times more powerful than morphine and 30-50 times stronger than heroin. While Fentanyl has killed thousands of people over the past few years, many only heard of it recently, when it was attributed to the death of the musician Prince.

Still, by far the most prevalent cause of overdose is prescription painkillers. This encompasses a much broader swath of the Opioid family (Opiates and their synthetic and semi-synthetic variants). The most common culprits are:

• Methadone
• Oxycodone (such as OxyContin®)
• Hydrocodone (such as Vicodin®)³

In 2014, the United States saw nearly 4.3 million people ages 12 or older using prescription painkillers non-medically. To put that into perspective, that is almost 2% of the entire population. According to the Centers for Disease Control, more than 1,000 people are treated in emergency departments for misusing prescription opioids every day. Finally, almost 2 million Americans either abused or were dependent on prescription opioids in 2014.

Painkillers, Addiction and the Economy: What the Opiate Crisis is Costing America

The opiate addiction crisis has an obvious and tragic human cost. Addiction to painkillers and illegal opiates cause death and healthcare emergencies every day. But they also have a profound economic cost that affects people, employers and governments all over the country.

One estimate, conducted in 2011, put the economic cost at $55.7 billion

• Workplace costs accounted for $25.6 billion (46%);
• Healthcare costs accounted for $25.0 billion (45%); and
• Criminal justice costs accounted for $5.1 billion (9%)

Of those figures, the study’s authors offered the following breakdown:

• Workplace costs were primarily driven by lost earnings from premature death ($11.2 billion) and reduced compensation/lost employment ($7.9 billion).
• Healthcare costs consisted primarily of excess medical and prescription costs ($23.7 billion).
• Criminal justice costs were largely comprised of correctional facility ($2.3 billion) and police costs ($1.5 billion).

To put that in perspective, the $55.7 billion that opiate addiction erases from the economy is roughly equivalent to the annual Gross Domestic Product of the entire state of Maine. It is greater than that of Alaska, North Dakota, Montana, South Dakota, Wyoming and Vermont.

Medication, Therapy and Shifting Thinking: Opiate Addiction Solutions

Opiate addiction is deadly, it’s costly, but it is anything but simple; especially when it comes to finding solutions or even identifying the root causes of this crisis. Some point to the high availability of opiates compared to the past — the number of prescriptions for opioids (like hydrocodone and oxycodone products) escalated from around 76 million in 1991 to nearly 207 million in 2013 — others point to socioeconomic factors or to the increased focus on pain management in recent decades.

The answer is, most likely, that all of these answers are correct, at least some of the time. Tackling opiate addiction and prescription painkiller abuse will take a multi-faceted approach which recognizes that while opiate addiction and overdoses are the hurdles, there are many different paths to overcoming them.

One such solution is increasing the availability of medication-based treatments for opiate addiction. Both Medication Assisted Treatment (MAT) and Office Based Opioid Treatment (OBOT) offer physician-supervised treatment options that use several medications to treat and even prevent addiction to opioid painkillers. These treatments combine medication with behavioral therapy to help ease a patient away from their opioid addiction over time and have been proven to be highly effective. However, both MAT and OBOT have obstacles to overcome before becoming more widely accepted for use.

There are challenges matching medication providers with supportive counselors as well as a lack of access to prescribing physicians. Furthermore, there is some opposition to MAT and OBOT from providers that support 12-step programs as well as among providers who view such methods as swapping one addiction for another. Both MAT and OBOT have been clinically proven to be an effective tool for overcoming addiction to both prescription painkillers and illegal analogs such as heroin as well as alcohol.

A second option for solving the opiate addiction crisis is to change techniques for pain management entirely. For example, back pain is one of the most common reasons Americans go to the doctor. From 2001 to 2011, the number of spinal fusions in U.S. hospitals increased 70 percent, making them more frequently performed than even hip replacements.

This reliance on surgery is controversial. Although many patients expressed satisfaction with the outcome of surgery, 51% of patients who were using opioids before the surgery still were using the drugs one year later, and among those who were not using the drugs before surgery, 18% were using them a year after their surgery.

An increasingly popular alternative is to channel more people, where appropriate, away from opioids and surgery and into more effective treatments such as physical-therapy. By reducing the number of people being introduced to opiate painkillers, the number of people who develop an addiction is reduced.

Thirdly, there is increased interest in deploying Cognitive Behavioral Therapy (CBT) to improve treatment response as a primary or conjunctive treatment option. CBT is a particularly appealing solution for some as it can be deployed in very innovative ways, both in-person and online and it remains just as effective. CBT can help people with an opiate addiction by teaching the patient to recognize and avoid negative and destructive thought patterns and behaviors.  This teaches the individual to recognize the triggers that cause a craving for drugs, then avoid or manage those triggers. CBT works well in conjunction with other treatments.

Other non-opiate based interventions for pain include mindfulness therapy, the use of non-addicting medications such as non-steroidal anti-inflammatory agents (NSAIDS) and anti-depressants to name a few.

A Pioneer in Substance Use Management

Magellan Health is a pioneer in offering integrated, comprehensive opioid risk and substance use management programs. We have an unyielding commitment to ending the current epidemic. And we are uniquely positioned to bring together behavioral, medical and pharmaceutical programs to positively impact overall population health and reduce cost.

We offer many substance use solutions, including medication assisted treatment (MAT), shown in the monograph as an invaluable tool in the fight against substance abuse. We continue to evolve our MAT program and other offerings to most effectively meet the needs of our customers and those they serve.