A 2017 study has revealed interesting patterns in the use of opioids near the end of life. The authors of the study wanted to gain insight into the opioid crisis that has affected thousands of individuals across the United States. In 2015, 52,504 deaths were caused by accidental overdoses. Approximately 63 percent of these deaths were caused by opioids. Over a 14-year period, from 2000 to 2014, the annual rate of deaths caused by opioid overdose tripled—from 3 per 100,000 individuals to 9 per 100,000 individuals. Further, more than 360,000 emergency department visits were related to the nonprescription use of opioids in 2011—twice the rate observed in 2005.
To attempt to curb the number of deaths and injuries caused by opioid abuse, many local, state, and federal government entities have launched programs and policies to cut down on the number of unnecessary prescriptions for opioids. In addition, these entities have tried to provide treatment centers and other programs for opioid dependence.
The authors hypothesized that learning about the health care use patterns in the months preceding an opioid-related death may provide insight into risk factors. One study in West Virginia noted that of 298 accidental overdose deaths in the state, close to a third (29.1 percent) had received prescriptions for analgesics in the 30 days preceding death. Close to two-thirds (64.8 percent) filled prescriptions for alprazolam in the same time period.
In North Carolina, a report showed that in 301 unintentional deaths caused by opioid analgesics, rates of musculoskeletal disorder treatment were nearly triple that of drug dependence. Those who died by opioid overdose are more likely to have a chronic pain condition; these individuals would make up a unique subset of opioid-related fatalities. Studying the health services used by this group may allow healthcare providers to identify patients who may be at risk for opioid abuse.
The study examined the services the decedents used during both the 12 months and 30 days prior to their deaths. The study only looked at data for those whose deaths were caused by opioids. Further, the study limited its data to only include those using Medicaid, since Medicaid enrollees are at a higher risk of opioid-related deaths.
The study analyzed data for 13,089 individuals who died from opioid-related causes. In this group, it was discovered that 61.5 percent had been diagnosed with a chronic pain condition in the year leading up to the decedent’s death. Approximately 59.3 percent were diagnosed with back pain, 24.5 percent were diagnosed with headaches, and 6.9 percent were diagnosed with neuropathies. Other pain conditions were common in this group as well.
More than half of the decedents had gone to a healthcare facility for at least one outpatient visit in the 30 days preceding death. Interestingly, in the 12 months preceding death, a diagnosis of a substance abuse disorder was common—more than 40 percent received such diagnoses. However, in the 30 days before death, a substance abuse diagnosis was less common—just 12.3 percent of the individuals studied had been diagnosed with this disorder. Only 4.2 percent were diagnosed with opioid use disorder specifically.
Most of those who died from opioid-related causes were between 35 and 54 years old. Most fatalities were seen in white females. This group was more likely to have gone to an outpatient facility for medical care and to have been diagnosed with drug use, opioid use, alcohol use, and substance abuse disorders during the 12 months and 30 days prior to dying.
As for specific opioid use, roughly two-thirds of the decedents obtained opioid or benzodiazepine prescriptions in the year before death. About half filled both. Other common prescriptions that were filled included antidepressants, mood stabilizers, and antipsychotics. More than one-third of the group filled at least one opioid prescription. Individuals from this group were also more likely to have suffered a non-fatal drug overdose.
Medical professionals and personal friends and relatives of those who are prescribed opioids should be aware of these traits to reduce the risk of overdose. For example, medical professionals who treat patients diagnosed with mental health disorders should carefully monitor them for signs of opioid abuse. Similarly, those who have suffered a non-fatal opioid overdose should be treated accordingly to prevent the risk of a fatal overdose.
What else can be done about the opioid crisis?
Of course, it is essential for healthcare providers to be careful when they prescribe opioids to their patients. When possible, alternative drugs that do not have the same high risk of addiction should be prescribed. Pharmacies should also monitor the amounts of opioids that are ordered and dispensed.
In addition, some cities, states, and local government entities have begun pursuing legal action against the pharmaceutical companies that manufacture opioids. These plaintiffs argue that pharmaceutical companies that create and market these drugs—such as OxyContin—should be held responsible for the harm these substances may cause the public. In some lawsuits, claims have been made that the pharmaceutical companies intentionally misled healthcare providers and the public about the addictive nature of opioid substances.
Other claims state that pharmaceutical companies were deceptive in their advertising and in their information booklets provided with the medications. Additionally, many argued that the pharmaceutical companies failed to provide enough information about the dangerous side effects that may occur for those who take prescription opioids.
The cost of opioid addiction is exorbitant for many communities. It is estimated that annually, opioid addiction costs close to $80 billion. These costs include:
- $2.8 billion in substance abuse treatment
- $7.6 billion in criminal justice proceedings
- $26.1 billion in health insurance costs
- $46 billion in lost productivity
Clearly, opioid addiction affects entire communities and regions, as well as individual families. The cases that have been filed against pharmaceutical companies have claimed millions of dollars in damages. Many of these suits have resulted in multi-million dollar verdicts—for example, a case filed on behalf of Kentucky settled with Purdue Pharma for $24 million, and Cardinal Health settled claims with Maryland, Florida, and New York pharmacies for $44 million.
Many claims against pharmaceutical companies proceed as multi-district litigation, which is similar to a class action lawsuit. In multi-district litigation, one judge generally oversees all of the proceedings in the case, no matter where the claims may originate. There are multiple benefits to multi-district litigation. For example, the rulings in the case will be consistent, which is usually not the case when there are numerous rulings from different states. In addition, it is much more cost efficient to have one case for all of the claims. Civil litigation in especially large cases can easily reach hundreds of thousands of dollars or more in attorneys’ fees, court costs, and other legal expenses.
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