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Israel has surpassed the United States in opioid consumption, becoming number one worldwide in the use of the pain narcotics, according to a new study by the Taub Center.

The study, authored by Prof. Nadav Davidovitch, Dr. Yannai Kranzler, and Oren Miron, warned of a possible opioid epidemic in Israel. The researchers consider immediate actions that should be taken to reduce consumption and over-subscription, including safer alternatives for managing pain, improved accessibility for medical treatment, mental health and social services, and reducing the stigma connected to the use and abuse of drugs.

Increased opioid dispensing to young, healthy, and poor Israelis

International studies have shown that outpatient opioid consumption mostly stems from fentanyl consumption by non-elderly and non-malignant patients. The studies also found that since 2014, most of the increase in opioid consumption occurred among patients with a low socioeconomic status.

The US, where the phenomenon has reached epidemic proportions, reported that in 2021 there were 80,000 deaths from opioid overdoses. Israel has not yet reached this level, but due to religious restrictions religious reasons, Israel has one of the lowest autopsy rates among developed countries, it is difficult to detect opioid mortality or to spot the signs of an epidemic in time.

Opioid abuse has a variety of negative effects, some of which are life-threatening

Drowsiness, confusion, nausea, constipation, and respiratory depression that can be life-threatening are just some of the negative effects of opioid abuse. Long-term opioid abuse causes the body to develop high tolerance levels and a need for increased dosage beyond the original prescription level. Without appropriate responses by the healthcare system and a supportive social environment, this need may lead to abuse and the search for illicit drugs, which in turn increases the likelihood of overdose and death. In addition, unsupervised opioid withdrawal can expose the body to difficult withdrawal symptoms.

Steps to prevent an epidemic and to reduce consumption

The Taub Center researchers recommend learning of other countries that have witnessed the worst opioid crises, like the United States and Canada, and to adopt the best practices developed and implemented successfully by them. They recommend establishing safe protocols for prescriptions, the immediate reduction in the share of non-justified prescriptions for fentanyl, expanding treatment and checks for abuse, as well as inter-organization cooperation and increased accessibility to social assistance.

An additional policy step worthy of advancement would be to include fentanyl in regular drug screening. In the US, when testing for fentanyl was added to screening tests, it was found to be responsible for the majority of drug overdoses. For example, in 2019, over 80% of the screening tests for fentanyl in the State of Maryland were found to be positive.

The researchers also point to a number of steps that would help protect the most vulnerable from addiction and the negative effects of opioid misuse:

  • Improved surveillance both of opioid prescriptions and adverse outcomes such as opioid use disorder and overdoses, including publicly available, near-real time data related to prescription drug use.
  • Increasing the number of autopsies in the case of suspected deaths due to substance abuse and the formation of a mortality review committee. The availability of electronic health records places Israel at an advantage over the United States for monitoring patients’ prescription and medical histories, which can be utilized to inform decision making, especially for those most vulnerable to addiction.
  • Safer prescription practices, including appropriate use of fentanyl substitutes and alternatives for opiate-based medications, particularly among high-risk patients, through, for instance, utilization of prescription drug monitoring systems to inform provider decision-making in the hospital, community clinic, and pharmacy, as well as educators.
  • Increased access to a variety of treatment approaches for addiction and services to reduce the damage from opioid abuse.

Prof. Nadav Davidovitch, one of the authors of the research, says: “those activities cited in the research, alongside consciousness-raising in the public regarding the use of medications and addiction, can contribute to reducing the stigma and encouraging the use of non-addictive alternatives. What is needed is an integrated program on the national level. Only in this way can we hope to reduce the destructive results of rising opioid consumption and its concomitant mortality, and give better treatment to those with the greatest need.”