HCB News: What do they do then?

DB: They often turn to heroin, opting for a $15 single “hit” of heroin rather than a single OxyContin pill that can cost between $50 and $80 on the street. Overdoses increase in these instances because heroin is so often “cut” with street fentanyl to assure it gives users a buzz. Fentanyl has a significant association with respiratory depression. Today, first responder units are often outfitted with naloxone injectable solutions, which seek to reverse respiratory depression in these overdoses.


HCB News: So is heroin the real danger here?

DB: It’s not the whole story by a long shot. Not all opioid addicted individuals end up feeding their addiction that way; some remain under attentive physician care. But these individuals still grapple with dependency, and they can also develop opioid hyperalgesia, a condition where even normal, daily activity becomes painful.

HCB News: What is the extent of the issue?

DB: Research suggests that 80-85 percent of all of the world’s opioids used are in the U.S. though we are only 5 percent of the world’s population. Another example that is particularly startling, and a good illustration about how opioid addiction exceeds boundaries related to income, social status, or educational level, is the state of Tennessee. A 2014 report on Tennessee suggests that for each of the state’s 1263 deaths attributable to opioid overdose, there are 851 people in various stages of misuse, abuse and treatment. That means 1 in 6 of the state’s residents is wrapped up in opioid addiction in some way.

HCB News: You earlier referred to secondary effects of this type of widespread misuse, can you elaborate?

DB: The effects on families, on relationships, are really horrific. The breakdown of trust – it’s extremely hard on everybody. But there are some more quantitative effects, too. For one, there’s a massive cost of providing treatment and rehabilitation. For another, there are the losses to workplace productivity. One study done years ago in 2007 found that opioid abuse alone cost employers more than $25 billion in 2007. Absenteeism, disability, safety are other associated issues, and people facing opioid addiction are also more likely to use workers' compensation benefits. The problem has grown since then, to the extent that the US Congress just passed the Comprehensive Addiction and Recovery Act, which some are calling landmark legislation to address the opioid epidemic.

HCB News: What’s being done about the crisis? Is there any good news?

DB: For individuals, there are a host of resources that can help. For employers, employee/family awareness, education and intervention can have a positive impact. Employing predictive analytics will give us the ability to help both employers and physicians proactively manage opioids. Addiction medicine specialists will be an important part of the solution, and family physicians and local agencies can help in providing referrals. As a healthcare system and as a nation, we’ve taken some smart steps recently, but we still need to do more. Our care guides, for instance, work with both employers, individuals and physicians to provide informed guidance on this most critical of issues.

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