Opinion Journal:The Opioid Crisis: Lessons Learned So Far3:54
American Enterprise Institute Resident Scholar Sally Satel on why primary care doctors are struggling to stop overdoses. Photo:
Painkillers now killing more Australians than heroin
AMERICA’S opioid crisis is getting so bad, even the central bank is weighing in.
Earlier this month, Federal Reserve Chair Janet Yellen told a Senate committee that opioid abuse, which began with a major increase in painkiller prescriptions in the late 1990s, was tied to the country’s declining workforce participation rate.
“I do think it is related to declining labour force participation among prime-age workers,” Ms Yellen said. “I don’t know if it’s causal or if it’s a symptom of long-running economic maladies that have affected these communities and particularly affected workers who have seen their job opportunities decline.”
Bill Polacek, who runs a manufacturing company in Pennsylvania, interviewed 350 people to fill 50 openings for welders and machinists a few years ago, but after narrowing the list down to 100, found more than half either had criminal records or failed their drug tests.
“We weren’t attracting the right people,” he told Bloomberg.
In the US Federal Reserve’s latest “Beige Book”, which highlights economic activity by district, the Federal Reserve Bank of St. Louis noted that “many contacts reported a desire to hire, but they have been unable to find suitable employees”.
“Manufacturing contacts in Louisville and Memphis reported difficulties finding experienced or qualified employees, with some citing candidates’ inability to pass drug tests or to consistently report to work,” the bank wrote.
According to US government data, an estimated 2.7 million, or 1.3 per cent, of adults aged 26 or older were misusing painkillers as of 2015, while a further 236,000 used heroin. Meanwhile, Labor force participation has plummeted since the start of the century.
Heroin use has doubled across the US since 2010, according to the Drug Enforcement Administration, partly as users transition from high doses of powerful prescription painkillers, leading to a surge in overdose deaths.
Princeton University economists say the opioid crisis is one reason the mortality rate for middle-age white Americans with less education is climbing. “We are seeing, as I mentioned, an increase in death rates — which is extremely unusual,” Ms Yellen said in her Senate testimony. “[The trend is] partly reflecting opioid use, and it is obviously a very serious and heartbreaking problem.”
It comes as a new study by the National Drug and Alcohol Research Centre at the University of NSW finds prescription opioids are now killing more Australians than heroin. Between 1990 and 2014, there has been a fourfold increase in the prescribing of opioids such as OxyContin, Tramadol and Fentanyl.
The UNSW report, which analysed cause of death data from the Australian Bureau of Statistics, found the rate of accidental deaths due to opioids had more than doubled among Australians aged 35 to 44 since 2007, with 70 per cent of deaths caused by pharmaceutical opioids rather than heroin.
In 2013, the last year for which finalised data is available, 597 Australians between the ages of 15 and 54 died from accidental overdose of opioids, with the majority 70 per cent being due to opioids other than heroin, including strong prescription painkillers.
Unlike the heroin epidemic of the late 1990s and early 2000s, prescription opioid overdose is more likely to affect older Australians.
Lead researcher Amanda Roxburgh said while Australia was seeing a rising number of opioid-related deaths, the problem was not as widespread as in the US. “They’ve got problems on a much larger scale,” she said.
“These medications were very much marketed in a different context over there. None of these medications are advertised on TV here, whereas in the US they’ve got a really different advertising framework. That said, we really want to keep on top of this.”
In her book Crooked: Outwitting the Back Pain Industry and Getting on the Road to Recovery, journalist Cathryn Jakobson Ramin explains how OxyContin, launched in 1996, was aggressively marketed to GPs and the public.
“For decades, physicians had recognised that opioids were highly addictive drugs, and that to prescribe them to any patients other than those who suffered from terminal cancer was illegal,” she writes.
“But with Oxy, the tide had turned: suddenly, physicians who allowed patients to ‘suffer needlessly’ from back pain were labelled as lacking in compassion. For general practitioners, who found themselves with ‘failed’ back surgery patients entrusted to their care, OxyContin offered an answer to their prayers.”
According to research from Amcal Pharmacy, one in three Australians suffer from chronic pain and many are “self managing” using prescription medication, either with or without the advice of a doctor.
Pharmaceutical Benefits Scheme data from 2014 shows the rate of prescribing painkillers is rising, with more than 150,000 people accounting for almost two thirds of total drug prescriptions.
The number of Australians receiving treatment for dependence on the painkillers codeine and oxycodone trebled in the nine years from 2002, according to a 2015 study from NDARC.
Ms Roxburgh said Australian prescription guidelines for opioids should be brought back to pre-2007, when they were broadened to include pain presentations other than cancer.
“We want continued, careful prescribing and shorter times to review so GPs can keep monitoring pretty closely whether people are developing problems with use of these medications,” she said. “We also need to look at other options for treating chronic pain that don’t involve medication.”
Sydney mum Lucinda Castaing, 33, was severely injured in 2012 after slipping on her bathroom floor, and was at one point on a cocktail of 12 medications taking 20 pills a day.
She told news.com.au she had weaned herself off all painkillers and instead manages her pain through meditation, stretching and a technique where she spends 10-15 minutes a day “dwelling” in the pain.
“It’s like the world was in colour again,” she said.
Originally published as Killer crisis coming to Australia