Best Intentions / Bad Results - The Opioid Epidemic

| December 07, 2016

Opioids, commonly referred to as narcotics, are a class of prescription pain relieving drugs that include Percocet, Morphine, Hydrocodone, Codeine and OxyContin. Heroin is the most common of the illicit opioids.

Last year in the United States there were enough prescriptions written for opioid painkillers to place a bottle in the medicine cabinet of every adult.

Think about this for a second - Over 200,000,000 total prescriptions were written for everything from minor dental procedures to pain relief for terminal cancer patients. This frequency represents a fourfold increase in the rate of prescriptions since 1999. Certainly medical professionals have the best intentions in helping control their patient's pain. However, opioids are very addictive and what started as temporary pain relief can result in the creation of an addict. We have all seen numerous stories of professional athletes who were prescribed opioids for legitimate reasons who subsequently developed a physiological and psychological dependence.

Drug overdose is the leading cause of accidental death in the US and account for the loss of over 47,000 lives in 2014. Approximately 20,000 of these deaths were attributed to prescription drug overdose which is more than that of heroin and cocaine combined. From 1999 to 2014, overdose deaths and prescription volume were running nearly parallel, causing significant concern that medical professionals are unintentionally helping fuel the opioid overdose epidemic. The opioid epidemic is serious enough for the Surgeon General, Vivek Murthy to do what no other Surgeon General has done in the 145-year history of the office -- On August 24, 2016, he mailed a letter directly to over 2,300,000 doctors, dentists and other clinicians addressing the opioid epidemic and calling them to action. His letter touched on many of the issues discussed above and invites clinicians to pledge their effort to reduce the prevalence of opioids. He recommended to clinicians that they initiate opioids only when more conservative treatments have failed, educate their patents in safe usage and carefully monitor them for any signs of abuse. I applaud Dr. Murthy for the initiative he has demonstrated by shining a light on the crisis and taking action toward resolution. In my October blog I discussed that there is inconsistency between the US government and life insurance opinions toward recreational marijuana. In regard to opioids, the government, medical professionals and the insurance industry are all in alignment in their view of the dangers of opioids. Recognizing the prevalence and consequences of opioid usage, a carrier underwriter will scrutinize the file to look for hidden signs of abuse. Specifically:

1) A prescription check will frequently be ordered to confirm that all history is admitted. They will also look to see if the proposed insured is getting    similar prescriptions from multiple sources.

2) A full drug screen will be run on the urine specimen

3) An attending physician report will almost always be ordered. The underwriter will look for any signs of abuse. For example, they will look for escalating dosage to control pain, multiple medications, patient requesting refills prior to due date or claiming to lose medication. Another hidden sign of abuse is recovery from one ailment and then getting medication for a subsequent condition without a gap. Underwriters can view this as an attempt to extend the prescription and is indicative of hidden dependence.

If your client calls you and says that he is taking opioids for pain management, call me to discuss their history in detail. I can help formulate a strategy to paint a favorable picture for the carrier underwriter. Obtaining preferred offers is possible for temporary or tapering usage and standard non-smoker for favorable situations with chronic usage.