MORE THAN 41,000 AMERICANS DIED OF DRUG OVERDOSES IN 2011,
according to the Centers for Disease Control and Prevention (CDC). That’s 145 percent more than in
1999. Figure 1 (see Page 42) tells the grim story. From 1999 to 2011, death rates from drugs have risen in
every age group—from teens to octogenarians. Drug abuse is now the leading cause of accidental death
in the United States, ahead of auto accidents or firearm incidents.
Only this isn’t your father’s drug problem. It’s not crack or
weed. It’s not illicit, and there’s a good chance it’s in your medicine cabinet. The problem is painkillers—specifically a class of
drugs known as opioids. Though that name may not resonate
the way that, say, heroin does, opioids are killing thousands of
Americans. Of 38,329 drug overdose deaths in 2010, more than
16,000 involved opioids. Put another way, opioids by themselves
in 2010 killed as many people as did all drugs in 1999, legal or not.
To a certain degree, the insurance industry has been paying
for this epidemic. That’s not to equate insurers with the dope
peddler lurking by the junior high. But insurers are certainly
tangled in the growing hazard posed by the latest pain pills spilling off the pharmaceutical industry’s conveyor belt.
In 2012, doctors wrote 259 million painkiller prescriptions, one
for every adult in the country, according to the CDC. The pills are
expensive, and insurers have a clear handle on how much opioids
are costing them. Because workers’ compensation, for instance,
has no deductibles and no copays—it offers a straight assumption
of all liability for just about anyone hurt on the job—whatever doctors prescribe, insurers usually end up paying for as claims.
It’s possible, in fact, to trace the arc of opioid abuse through
the files of workers’ compensation insurers, whose researchers
have documented many of the problems as they emerged, as
well as the effectiveness of various approaches for dealing with
the problem. (Although I’m sure health insurers are investigating similar issues and pursuing solutions just as diligently, as a
property-casualty actuary, I’m going to focus on the line of business I know best—workers’ comp.)
While there are signs the opioid epidemic may have passed
its peak, that isn’t going to solve the entire drug problem. It’s a
tale with a Hollywood ending, but not a happy one.
Pain and Pleasure
Opioids are the close cousin of heroin. I exaggerate, but only by
degree. The two aren’t 100 percent the same. I can be fairly precise about the degree to which they differ, thanks to an opioid
conversion chart I found at an online information site for junkies
(studious junkies, by the way—the conversion chart’s footnotes cite
among its sources government research in the states of Washington and California, as well as the province of Alberta). Other more
reputable sources follow the same contours as the junkie’s analysis.
Taken intravenously, 6 milligrams of heroin is equivalent to
20 milligrams of oxycodone, the punch behind the best known
opioid, OxyContin. Taken orally, 30 milligrams of heroin is
equivalent to 20 milligrams of oxycodone, though the junkies
hasten to add that street heroin isn’t made precisely as Pur-
due Pharm makes OxyContin. And the opioids one picks up at
Walgreen’s would need quite a bit of tweaking to deliver such
a concentrated pop—processing that drug manufacturers make
harder to perform all the time.
Opioids are dispensed under many names, some trade-
marked: OxyContin, Vicodin, Percocet, Zohydro, morphine, and
oxycodone are a few. Each differs in potency and how quickly
it delivers pain relief. It’s important to emphasize that opioids
can be used legitimately and, often, safely. Having Oxys in your
medicine cabinet doesn’t make you a drug fiend (though it is
important to exercise caution when taking them).
Chances are good that if you’ve made a workers’ comp claim,
you’ve had opioids in that medicine cabinet. Narcotics make up
25 percent of workers’ comp drug costs, according to the Na-
tional Council on Compensation Insurance, and more than 45
percent of narcotics costs pay for drugs containing oxycodone.
Drug abusers manipulate the basic drug—often by crush-
ing—to convert it from a painkiller to a powerful high. Still, 30
milligrams of heroin is equal to 20 milligrams of oxycodone. The
same ratio applies to morphine taken orally—it’s equivalent to
20 milligrams of oxycodone. Orally, oxycodone delivers a big-
ger pop than either.
As one self-professed addict, OmarLittle, anonymously de-
clared online in 2009: “In my years of being a junkie and out
of all the people I met and know, NONE prefer morphine over
OxyContin/oxycodone. Morphine pills are almost worthless to
just about everyone I know and have met. On the other hand,
OxyContin is probably the single most desired drug by the peo-
ple in my area (D.C., Maryland) other than weed and coke. Oxy
is def the most popular and used opiate by people I know.”
Just like heroin or morphine, they seek out opioid receptors,
nerve endings residing mainly in the brain that cause the body
to react to chemical stimulus. The opioid drugs attach to the re-
ceptors, muffling pain signals sent from other parts of the body.
They make pain go away, or at least reduce it.
This is a desirable goal. No one wants to be in pain, which
is extremely unpleasant. The awfulness that is pain is so I S T