A new study by the Taub Center presents some serious facts regarding pain relief narcotic consumption and its devastating effects. In 2020, Israel was ranked number one in the world in opioid consumption — pain narcotics, among them fentanyl, which is 50 times stronger than heroin — and has overtaken the United States.
Taub Center researchers, Prof. Nadav Davidovitch, Dr. Yannai Kranzler, and Oren Miron consider the immediate actions that should be taken to reduce consumption and over use, including safer alternatives for managing pain, improved accessibility for medical treatment, mental health and social services, and reducing the stigma connected to the use and abuse of drugs.
International studies have shown that outpatient opioid consumption mostly stems from fentanyl consumption by non-elderly and non-malignant patients and among patients of low socioeconomic status.
In the US, where the phenomenon has reached epidemic proportions, it was reported that in 2021 there were 80,000 deaths from opioid overdose. Israel has not yet reached this level, but due to mainly religious reasons, Israel has one of the lowest autopsy rates among high-income countries and so it is often difficult to detect opioid mortality or to spot the signs of an epidemic in time.
Opioid addiction has a variety of negative effects, like drowsiness, confusion, nausea, constipation, and respiratory depression that can be life-threatening. Long-term opioid abuse causes the body to develop high tolerance levels and a need for increased dosage beyond the original prescription level. Without appropriate responses by the healthcare system and a supportive social environment, this need may lead to abuse and the search for illicit drugs, which in turn increases the likelihood of overdose and death. In addition, unsupervised opioid withdrawal can expose the body to difficult withdrawal symptoms.
Prof. Nadav Davidovitch, Principal Researcher and Chair, Taub Center Health Policy Program; Director, School of Public Health, Ben-Gurion University of the Negev. Dr. Yannai Kranzler, post-doctoral student, School of Public Health, Ben-Gurion University of the Negev. Oren Miron, doctoral student, School of Public Health, Ben-Gurion University of the Negev. The full study appeared in March 2023 and can be found on the Taub Center website.
The researchers recommend learning of other countries that have witnessed the worst opioid crises, like the United States and Canada, and to adopt the best practices developed and implemented successfully by them. They recommend establishing safe protocols for prescriptions, the immediate reduction in the share of non-justified prescriptions for fentanyl, expanding treatment and checks for abuse, as well as inter-organization cooperation and increased accessibility to social assistance. An additional policy step worthy of advancement would be to include fentanyl in regular drug screening. In the US, when testing for fentanyl was added to screening tests, it was found to be responsible for the majority of drug overdoses. For example, in 2019, over 80% of the screening tests for fentanyl in the State of Maryland were found to be positive.
Recommended steps to prevent an opioid crisis:
- Improved surveillance both of opioid prescriptions and adverse outcomes such as opioid use disorder and overdoses, including publicly available, near-real time data related to prescription drug use.
- Increasing the number of autopsies in the case of suspected deaths due to substance abuse and the formation of a mortality review committee. The availability of electronic health records places Israel at an advantage over the United States for monitoring patients’ prescription and medical histories, which can be utilized to inform decision making, especially for those most vulnerable to addiction.
- Safer prescription practices, including appropriate use of fentanyl substitutes and alternatives for opiate-based medications, particularly among high-risk patients, through the utilization of prescription drug monitoring systems to inform provider decision-making in the hospital, community clinic, and pharmacy, as well as educators.
- Updating patients and their families when prescribing opioids regarding the dangers of abuse, and follow-up with patients at health funds and during their prescribed use of the medication.
- Treatment that considers the particular conditions that are necessary for safe use and a good treatment outcome – mental health needs and other health issues like food security, family support, and a stable housing situation. A treatment system should be in place to deal with trauma and social instability related to increased risk of opioid abuse and addiction.
- Increased access to a variety of treatment approaches for addiction and services to reduce the damage from opioid abuse.
The researchers recommend immediate action to formulate a national strategic plan in order to reduce the devastating effects of increasing opioid consumption and overdoses. The plan must include the steps as outlined in this paper, alongside consciousness-raising in the public regarding the use of medications and addiction and the encouragement for the use of non-addictive alternatives.