Head of Group Benefits, Manulife Canada
Opioid addiction is a chronic disease. There is no cure. The alarming rise in opioid-related poisonings and deaths is being felt in virtually every region across the country. I know, from personal experience involving families in my own circle of friends, that the crisis is destroying individual lives while the loved ones of its victims suffer and grieve.
Today, the availability of highly toxic forms of opioids on the illicit drug market seems to be driving the epidemic. However, we can’t ignore that the roots of the crisis can be traced to the rise in our use of prescription opioids, a trend dating back to the 1980s1. Employers and insurers have a chance, and an obligation, to help reverse that trend.
More prescriptions, more painkillers, reaching more Canadians
Per capita, only the United States uses more prescription opioids than Canada.2 In 2016, there were over 20 million prescriptions written for opioid painkillers in Canada. That equals one prescription for every Canadian over the age of 18.3 At the same time, we’ve seen a corresponding increase in opioid misuse and the personal, social, and economic problems that result. The number of opioid-related deaths in Canada in 2016 and 2017 was higher than the number of people killed those years in motor vehicle collisions.4,5
Why are opioids so dangerous?
Opioids are very powerful pain killers that might be prescribed following surgery or injury. They act in our bodies by relieving the sensation of pain while also producing a feeling of euphoria. For some people suffering chronic pain, opioids are essential medications. At the same time, the Mayo Clinic warns that after five days of prescription opioid use, the likelihood of developing a dependence on the drug increases significantly.6 With long-term use the body can grow accustomed to the opioid and needs more and more of the drug to achieve the same relief or feeling.7
It often starts with a prescription
Many people addicted to opioids were first exposed to them through a prescription. In the United States, a 2013 study found 80% of people who use heroin turned to the street drug after first using prescription painkillers.8
While far too many of these people are not receiving the care and treatment they need, we also need to ensure no more Canadians inadvertently fall victim to the addiction. The medical community is responding with improved guidelines, practices, and monitoring when prescribing opioids for chronic pain that’s not related to cancer.9 This is also a spot where group benefits plans can add an automated layer of prevention, through programs designed to help ensure the medication is closely controlled when obtained through a drug plan.
Opioid management program added to pay-direct drug plans
In April 2019, Manulife widely implemented an opioid management program on all its pay-direct drug plans. The program intervenes on patients who are using opioids for the first time, or patients who haven’t had an opioid prescription in the past six months.
The program encourages the use of short-acting opioids first. In the majority of cases, the higher-risk long-acting opioids are only used after the patient has tried a short-acting medication, or when more pain relief is required. Prescriptions are also limited to an initial seven-day supply. If the patient requires more, they must return to the pharmacy to fill the rest of their prescription.
Fewer leftover drugs means less chance for abuse, misuse and addiction
Between April and July, the program intervened on 2,280 prescriptions for opioids that were written for an average of 17-days’ supply. In each case, the program reduced the amount of medication being dispensed by 10 days. The result? In 95% of cases the patient did not return to the pharmacy for the rest of their prescription.
During the same period, the program found 380 instances when the doctor prescribed the long-acting opioid before the short-acting version of the drug. By flagging these prescriptions, the program has a chance to promote the safe use of the lower-risk drug first. This amounts to only 0.8% of all claims for first-time opioid patients, a sign that doctors are prescribing the short-term opioids in almost all instances.
I’m very encouraged by these early results. It tells me patients are getting the medication they need, with less chance for addiction or health issues caused by dangerous side effects. Plus, there are now 22,800 fewer days’ supply of opioids sitting in pill bottles on people’s bathroom counters, at the bottom of drawers, or in other places where they might fall into the wrong hands and cause harm. That’s significant: Health Canada has found family members are the most common source of opioids that are used by people without a prescription.10
An epidemic that’s eroding quality of life in Canada
While encouraging, make no mistake, there’s so much more to be done about a health crisis that is literally chipping away at the potential of our country.
In its most recent report on the life expectancy of Canadians, released last May, for the first time in decades Statistics Canada reported no increase in Canadians’ life expectancy at birth (2016 to 2017). This, even though older Canadians, both men and women, are living longer.
The report says that younger adults in Canada – especially men age 20 to 44 – were dying at a higher rate in 2017 than they were in 2016. Opioid-related deaths were the major contributing factor leading to a 0.11-year loss in life expectancy for men, and 0.02-year loss for women.11
We care about the health of our neighbours and our communities. There are no easy solutions, but when a health issue is undermining quality of life on a national scale, we all must find ways to step up and address the crisis. On the prescription drug side of the equation, there’s a lot employers and benefits providers can do to educate Canadians and build controls and monitoring to help ensure the safety of the medicines they use, and the way in which they use them.
1Evidence synthesis – The opioid crisis in Canada: a national perspective; Health Promotion and Chronic Disease Prevention in Canada, 2018 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6034966/)
4Canadian Motor Vehicle Traffic Collision Statistics: 2017; Government of Canada (https://www.tc.gc.ca/eng/motorvehiclesafety/canadian-motor-vehicle-traffic-collision-statistics-2017.html)
5National Report: Apparent Opioid-related Deaths in Canada; Government of Canada, June 2019 (https://health-infobase.canada.ca/datalab/national-surveillance-opioid-mortality.html#AORD)
6How to use opioids safely; Mayo Clinic, April 24, 2019 (https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/in-depth/how-to-use-opioids-safely/art-20360373)
7The Neurobiology of Opioid Dependence: Implications for Treatment; US National Library of Medicine, National Institutes of Health; Thomas R. Kosten, M.D. and Tony P. George, M.D., July 2002 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851054/)
8Opioid Overdose Crisis; National Institute on Drug Abuse, Revised January 2019 (https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis)
9The 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain; National Pain Centre, McMaster University, 2017 (http://nationalpaincentre.mcmaster.ca/guidelines.html). The 2017 Canadian guideline does not look at opioid use for acute pain, nor for patients with pain due to cancer or in palliative care, or those under treatment for opioid use disorder or opioid addiction.
10Evidence synthesis – The opioid crisis in Canada: a national perspective; Health Promotion and Chronic Disease Prevention in Canada, 2018 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6034966/)
11Changes in life expectancy by selected causes of death, 2017; Statistics Canada, The Daily, Thursday, May 30, 2019 (https://www150.statcan.gc.ca/n1/daily-quotidien/190530/dq190530d-eng.htm)