The Israel National Institute for Health Policy Research recently published a study showing that Israeli patients who received high doses of painkillers tend to have higher mortality rates - similar to the United States. The findings are published against the backdrop of a series of data indicating a sharp increase in the use of painkillers in the country.
Earlier in May, a U.S. Congress committee published a special report saying that China directly subsidizes the production of fentanyl components (high-potency painkillers) for sale outside its borders, thereby fueling the opioid crisis in the country, which claimed the lives of nearly a million Americans between 1999 and 2020. Large pharmaceutical companies, including Purdue Pharma, owned by the Sackler family, have been forced to pay billions of dollars in compensation.
The Health Ministry had only recently published a draft for a bill aimed at restricting the use of painkillers, but it is a step taken too late because, as mentioned, over the years, the use of painkillers has increased significantly in Israel.
According to data from the Israeli Center on Addiction (ICA), updated to March 2023, about half of the individuals who reported using opioids reported "high levels of post-traumatic stress following the war in Gaza about six months after it started," compared to only about a fifth of individuals who don’t take painkillers. Furthermore, the data show that nearly half of those who take painkillers report increased intake that goes against their prescription, and about 40% have raised the dosage prescribed to them initially.
One of the patients who became addicted to painkillers is Oron Yitzhaki, 37, from Tel Aviv. "It started with knee pain, and I was already given painkillers then," he says. "Later on, I was in a traffic accident in the military, and that's when my nightmare began. Each time, I took a stronger painkiller until I arrived at morphine. That's how I was for nine years, and in the last two years, I received fentanyl patches, which are essentially a hundred times stronger.
“During those nine years, I was a walking dead. At some point, I realized I was already an addict. I was married and had a job. One day, I called my wife and told her that I wanted her and the children to leave the house. I locked myself in the house for three weeks. I couldn't work, I didn't leave the house, and there was no one to take care of me. Then, my detox process began, and there I got my life back, about five years ago."
He added, "I met successful people who are no longer with us because of these painkillers. There's no supervision over this issue. Not only is there no supervision, but sometimes they give you pills three months in advance, and that means you increase the dosage yourself because you have more pills.”
“Some people are brought down by this substance, and some treat it like cocaine, feeling on top of the world. It turns you into someone you're not. Since October 7, there has been a significant increase in opioid use. You can see it everywhere on social media. I have friends who serve in the military, and they too are look for ways to escape,” he said.
The study conducted by Dr. Reuven Dressler and Dr. Matan Yoel Cohen from the Clalit HMO, and Dr. Ehud Kleiner from the Ministry of Health, focused on the milligram amount of morphine to examine the amount of painkillers patients were prescribed. The findings showed that patients who received more than 90 units per day were at a 2.37 times higher risk of death compared to patients who received less than 50 units.
Patients who received between 50 and 90 units per day were at a risk of 2.23 compared to those who received less than 50 units. Additionally, there was excess mortality among women aged 18-50 who received between 50 and 90 units per day, while men in the group showed lower mortality rates.
In another study published in the institute's journal, a close relationship was found between socioeconomic status and painkiller use, with significantly higher use rates in peripheral areas of the country.
"We are disturbed by the study’s findings published in the Israel National Institute for Health Policy Research’s journal," says National Institute for Health Policy Research Chairman Prof. Nahman Ash.
"We agree with the researchers' position that there’s a need to develop specific programs to address the alarming trend of rising prescriptions and doses of powerful and addictive pain-relief drugs. This is a widespread and dangerous global epidemic that has also spread to Israel,” he added.
Prof. Ash suggests expanding the availability of clinics that provide opioid addiction treatment, while balancing pain management with alternative methods. "One of the troubling findings that emerge from the current study is the partial response given in peripheral communities. Action should be taken to expand services and open additional pain clinics in general and in the periphery in particular, thereby reducing the extent of opioid use and its negative long-term effects on patients."