Black Market Fentanyl Driving Overdose Deaths

Nancy Grover

Sarasota, FL ( – “I’m reading a lot of headlines right now about the fact that opioid overdose deaths continue to increase. That is a true statement,” said Phil Walls, chief clinical officer for myMatrixx. “Then in some instances I will hear that to be translated a little bit differently, in that opioid prescribing must be on the increase. That is not necessarily the case.”

While that may seem counterintuitive, the recent increase in opioid deaths is not due to prescription medications — or heroin. During a recent webinar produced by the National Workers Compensation and Disability Conference, speakers discussed the latest opioid-of-choice and how the workers’ compensation system can help stem this latest crisis.

The Stats

“In 2017 there were over 70, 000 overdose deaths in the U.S. That’s a huge number from, really, prescription medications,” said Adam L. Seidner, MD, chief Medical Officer for The Hartford. “Now what we’re seeing is over 81,000; this is through May of 2020. That’s 11,000 more than just four years ago and we had made quite a bit of strides in combatting the opioid epidemic. But COVID-19 has really had a negative impact here.”

The good news is there has been a steady decline in deaths attributed to prescription opioids — 13.5 percent in the 2017-2018 time period. There’s also been a decline in heroin related overdose deaths of 4 percent.

It is synthetic opioids, especially fentanyl, that are driving the increased opioid-related death rate.

Workers’ compensations stakeholders may know of fentanyl from Duragesic, the fentanyl patch. But the drug has become increasingly available on the black market. Since it is man-made it is cheaper and easier to produce.

“We have seen in 10 western states a 98 percent increase in opioid deaths because of these synthetic opioids,” Seidner said. Opioids “is still an issue we need to address and understand.”

Pain Management

The use of opioids, whether by prescription or illicit use is driven by the need to manage pain. More than 100 million Americans suffer from chronic pain, according to statistics, and the vast majority of the time they are prescribed opioids or other pain medications. The number of injured workers who suffer from chronic pain has increased from less than 10 percent a decade ago to more than half today.

The overuse of pain medications is taking a financial toll — more than $1 trillion to the U.S. economy, including $560 – $635 in direct medical costs and loss of productivity. Drug overdoses have claimed nearly 450,000 lives since 1999, largely related to opioids.

“The focus on opioids has to continue,” Walls said. The issue can be best addressed through public policy and by healthcare providers. But physicians may be increasingly frustrated about their role in pain management.

“We will intervene with a prescriber on a drug of concern. At one point in time it may have been compounds…then it became more about opioids. Then is became about private label topicals that are being dispensed by doctors at egregious prices,” Walls said. “Doctors are literally asking us, ‘what do you want me to do? Every time I prescribe a drug, you tell us that we shouldn’t be prescribing that drug.’”

What to Do

An integrative pain management approach is viewed as the best way to prevent the unnecessary use of opioids and other pain medications, which could, in turn, drive the injured worker to use synthetic opioids. In addition to prescriptions for non-addictive medications, providers can also focus on non-pharmacological strategies.

“What do doctors need to do? One, they need to prevent — and understand they can prevent — chronic pain. And this is done through proper management of acute pain and other conditions,” Seidner said. “The second thing is they need to manage patient expectations. What is the patient expecting— to be 100 percent pain free? Being 100 percent functional? That may or may not be reasonable depending on the condition that they have.”

Looking at the injured worker from a whole-person perspective is also vital, Seidner said. Comorbidities, sleeping habits, behavioral or psychological issues and social determinants of health, can all impact how well the injured worker adheres to a treatment regimen.

“And then, finally, there should be some understanding of the patient’s health literacy and also self- efficacy,” Seidner said. “Does that patient feel like they’re going to be able to have a positive impact on their care through successful outcome?”

The mental health aspects of pain management must also be included. There are a number of solutions for injured workers who experience catastrophic thinking or fear avoidance behavior, for example. The key is to look holistically at the injured worker and proactively address any issues that may impede his recovery.

“Remember, chronic pain is preventable,” Seidner said. “There’s plenty of research out there that shows that the proper management of pain early on can prevent a chronic pain condition.”

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