In collaboration with the Israeli Center for Addictions
One of the most alarming and common phenomena in recent years in the Western world, is the addiction to prescription painkillers from the opioid family.
These drugs are given by doctors to relieve the patient's pain, but over time he may develop a dangerous dependence on them.
Patients are not always aware of the potential for addiction to these drugs, and uncontrolled use of them may significantly increase the risk of developing harmful patterns of use.
The opioid drugs are usually intended for those who suffer from moderate to severe pain.
Many times as the treatment progresses, the patient develops tolerance to the drug - the painkillers are no longer as effective as before, and he will feel the need to increase the dose to maintain the effect that initially helped him.
However, "loss of control" over the dosage recommended by the doctor, and the need to take these drugs not in accordance with medical treatment, may indicate an addiction that requires professional intervention, for fear of overconsumption that could lead to severe injuries and even death.
Data from the Israeli Addiction Center's annual report last week to President Yitzhak Herzog and Prime Minister Naftali Bennett show that among the most common substances used by addicts, painkillers are in fourth place (seven percent).
Dr. Nadav Shalit, director of the Addiction Treatment Clinic at the Lev Hasharon Mental Health Center and the Israeli Center for Addictions (ICA), explains the source of addiction to these substances: " The prescription drugs for the treatment of pain and the 'addicts' who use opioids other than medical prescription.
"According to this view, the risk of addiction among patients who receive prescription drugs is very low, while members of the second group are labeled as criminals who try to exploit the system for their own needs."
The reality is of course much more complex - on the one hand, we know that patients with chronic pain, such as many cancer patients, are at increased risk of developing painkiller addiction, while the non-medical group of users often face severe trauma, significant mental pain and pain. Physicals that are addressed by the opioids.
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When is the use of these substances defined as an addiction? At what stage does the person realize that he is addicted to using them, beyond the medical treatment given to him in the first place?
"There is no black and white here. Let's take for example a substance that is not a prescription given by a doctor - alcohol. It is said that I go out with friends every week, sometimes drink a little more, sometimes less, all knowing that alcohol is an addictive substance. When do I define it as a problem? It depends. The diagnosis is simpler in extreme situations - after all, if someone drinks a glass of wine once a week on a Friday he is probably not addicted to alcohol, but if someone drinks a bottle of vodka every day - even before I examine how it affects his life, I most likely problem.
The more complex conditions are those that are not at the edges, such as in cases where a person is receiving opioids and it is no longer clear whether the pain he or she is dealing with has hurt him or her more, or whether the effect of the drug is leading to even more severe functional or risk impairment.
We need to find out with the patient what prices he pays for the use, medically assess the degree of risk to his health and how much the person's functioning is impaired in all areas - at home, at work, at school and the like.
Contrary to popular belief in denial among addicts, most people who deal with such a problem are aware of it, simply not always willing or interested in solving it, because on the one hand it is a problem, but on the other hand the same problem - opioids - is a solution to other problems. Mental health. "
How does a person become aware that they are in a problem that requires professional intervention?
"It depends first and foremost on himself. Every person has his ambivalence about the change he is willing to make, and that is also the basis of our treatment. We start working on this ambivalence. We will take cigarettes for example. From a certain age, most smokers will say they want or consider quitting. At least at some point in the future, this very thought suggests that they understand that smoking continues to come at a price, but on the other hand they may not feel willing to give up the benefits of continuing to use them. For people to tilt the spoon in the direction of a break or reduction, and most importantly - to minimize damage.
Of course the ultimate damage minimization is to completely stop using the addictive substance, but if for example we are talking about a cancer patient with chronic pain - we do not necessarily want him to stop using.
We want to reduce the damage that will result in overuse, which can lead to apnea and death.
"The goal is not always complete detoxification, but to improve people's health and reduce the dangers of overuse."
Pain patients - at high risk for addiction
Dr. Shalit explains that the treatment of opioid addictions is not fundamentally different from other addictions and includes medical, psychological, social, group work and individual treatment. According to him, it is that the health system is creating difficulties for patients because of the fear that they will misuse these drugs.
"On the one hand, these are effective drugs with very good evidence that they reduce morbidity and mortality, but on the other hand, their availability for patients is not good enough," says Dr. Shalit.
Drug treatment for opioid addictions ultimately requires the administration of specific drugs, which are safer and allow the patient to return to functioning in society, and when difficulties arise in achieving them, fewer patients receive the treatment and more patients continue to face the risks associated with this addiction.
The two main drugs currently given in addiction treatment frameworks are buprenofin (suboxone) and methadone.
Because historically these drugs are publicly associated with 'addicts', or offenders and users of the margins of society, treatment is limited to Ministry of Health clinics, and the regulation allows for the distribution of a limited number of doses at a time, to prevent abuse or trafficking in the above substances.
But this stigmatized perception labels large groups in the population in advance as criminals, and in practice deprives thousands of respectful treatment and life-saving treatment.
"Existing clinics do sacred work, but their number is limited, and for many patients the need to get the drug frequently, often far from their homes, in a system that is separate from the HMO where he receives the rest of the medical treatment - leads many patients not to seek treatment in the first place."
According to Dr. Shalit, there is a built-in mistrust of patients on the part of the system, which makes treatment very difficult:
There is no logical reason why a woman in her 50s, a teacher in the education system and a family member who has developed an opioid addiction that she received from her doctors, can get a high-dose opioid prescription for a month, but when she comes to receive the same treatment - she is treated as a criminal and given Give her a prescription for only a week for days at a time. "
In the health care system, Dr. Shalit explains, there is a misconception that a patient receiving opioids for pain is at less risk of addiction and should be less concerned about it.
"Research information suggests just the opposite," he says. And are referred to frameworks that do not belong to the HMOs.Suddenly they are forced to go somewhere, sometimes far away, and stand in line once a week to get the drug for addiction treatment.
The fact that within the pain centers there is not enough reference and treatment options, does not make medical sense.
The funds actually give up on an addiction caused as a result of medical treatment, and like many side effects, it is appropriate that its treatment takes place on a single treatment site.
In recent years, several clinics have opened in the HMOs to treat opioid addiction, but this is still in very small numbers and on a limited scale.
Currently, this is a regulation that ultimately makes it difficult for patients without justification.
Recently, a committee in the Ministry of Health made a decision to transfer the insurance responsibility for the treatment of addictions to the HMOs, and even initial budgets were allocated for this - we must ensure that this process continues and expands the HMOs to have the tools and means to implement the above decision. ".
In collaboration with the Israeli Center for Addictions