The Opioid Crisis: Of Pain and Killers

The story of how opioids, the strongest of painkillers, crept into everyday use and abuse is now the stuff of investigative news reports, books and documentaries. So, what is the big deal about these little pills?

Well, consider the following:

  • In Canada, more than 11,500 opioid-related deaths occurred between January 2016 and December 2018; numbers increased steadily from 3,017 deaths in 2016 to 4,460 deaths in 2018
  • In 2018, 94% of opioid-related deaths were accidental
  • Fentanyl and other Fentanyl-related painkillers continue to be at the forefront of the crisis; in 2018, 73% of opioid-related deaths involved Fentanyl or its derivative

What are Opioids?

The term opioid refers to both natural and synthetic compounds that produce an opium-like effect. Opiate is the term used for naturally occurring compounds such as morphine found in the opium of poppy resin. Legal opioids include codeine, morphine, fentanyl, oxycodone or hydrocodone and are doctor prescribed – even something as frequently prescribed and common as Tylenol 3 contains codeine which is an opioid. Illegal opioids include heroin or illicitly produced fentanyl, but the line between legal and illegal painkillers remains blurry. The 2016 death of musician Prince proved just that. Initially prescribed other painkillers by his doctor, Prince eventually moved to stronger illicit painkillers, before finally taking a lethal dose of fentanyl. Natural or synthetic, these drugs reduce pain sensation and induce a kind of euphoria or “high”.

Why are Insurance Underwriters Concerned?

Initially, opioids were used to reduce pain and discomfort during palliative care. Since then, the market for the drug has vastly expanded, targeting the far broader realm of acute and chronic pain. This target marketing has created a group of millions of potential users/clients for whom everyday use is now a reality. Ironically, attempts to reduce pain have led to overuse and adverse outcomes (addiction, death) without appreciably lowering the incidence of chronic pain on a widespread or safe level. Someone who initially takes an opioid for pain relief will oftentimes find themselves at the mercy of the drug, continuously requiring higher doses for only short-term pain relief, eventually leading to addiction and possibly overdose.

Employees taking opioids are less likely to return to work after a long period of pain-related disability and drug misuse increases the risk of a broad spectrum of conditions such as heart attack, falls and motor vehicle accidents. However, respiratory depression remains the most lethal outcome of opioid use.

Increasingly, complaints of chronic pain are documented in medical reports and applicant histories, compelling underwriters to pay closer attention to the possibility of opioid use. Tracking down medical and pharmaceutical records has become a critical undertaking for the underwriter. Now, like never before, underwriters pay closer attention to the danger of daily dosing and look for other conditions that could increase risk, such as co-existing psychiatric conditions, the use of other sedatives and even heavy cigarette smoking – all red flags for overall increased morbidity and mortality.

References

Coscarelli, J., & Eldred, S. M. (2018, April 19). Prince’s Overdose Death Results in No Crimincal Charges. Retrieved from The New York Times: https://www.nytimes.com/2018/04/19/arts/music/prince-death-investigation.html

Government of Canada. (2019, June ). National Report: Apparent Opioid-related Deaths in Canada. Retrieved from Government of Canada: https://health-infobase.canada.ca/datalab/national-surveillance-opioid-mortality.html

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The Opioid Crisis: Of Pain and Killers