A way to predict who'll become a drug addict
Allen, 25, works in a Trenton, New Jersey, auto body shop alongside a middle-aged man who’s straining to lift bumpers and fenders. Allen’s co-worker came back after a hip replacement because he feared that he would be fired. Allen knows this guy will turn to “street meds” to ease his pain.
Dr. Adam Seidner knows the same thing -- from his sky-high view as global medical director at Travelers Insurance (TRV). Armed with “big data” on 1.5 million injuries and disabilities, Seidner believes he can predict who’s at risk of becoming an addict -- and how best to treat them. That has led Travelers to develop a system to profile not actual painkiller addicts, but potential ones.
If Seidner is right, it could help address a problem that’s now a plague. Some 2 million Americans are hooked on highly potent prescription drugs like fentanyl, while another 500,000 are “in the clutches of heroin.” In recent years, more Americans have died annually from overdoses, 33,000 of them, than from car accidents -- a list that includes celebrities such as Prince and Michael Jackson.
So what’s Seidner’s solution? First, get rid of the addiction fiction claiming that people choose to become junkies. “Perhaps 5 percent of addicts do it for the euphoria,” said Seidner, who spent years detoxing prisoners. “Most take opioids to relieve suffering from chronic pain.”
And that’s scary because it puts an estimated 50 million Americans who suffer from chronic pain in the cross-hairs of potential addiction. They come to doctors’ offices complaining of bad backs, repetitive stress, falls, strains and “soft tissue” injuries.
Ever since the 1980s, about nine times out of 10, doctors have traditionally prescribed the most effective remedy for pain: drugstore opioids. They range from the mild, like codeine, to the strong, such as OxyContin (oxycodone) and Percocet (a combination of acetaminophen and oxycodone).
Although opioids curb the pain, they don’t cure the patient. And they have a will of their own. Within a month, these drugs invade the patient’s mind, which then tells the body to “feel” pain, whether it’s real or not, and thus creates a dependency.
Patients then demand the opioid -- in stronger and stronger doses -- and if they can’t get it legally or through their medical plan, they may steal prescription pads, use drugs like Imodium that mimic some of opioids’ effects and ultimately move on to street sources, where a $10 bag of heroin is both cheaper and stronger than a $200 prescription.
After years of trying to “just say ‘no’” to an epidemic that kills 46 people a day in the U.S., the medical profession, along with federal and state governments, recognized the danger. “I will not willingly watch another 1,600 of our citizens die,” former presidential candidate and New Jersey Governor Chris Christie told his state legislature this year.
On Jan. 19, the mayor of Everett, Washington, also asked the city council to authorize a lawsuit against Purdue Pharma, the maker of OxyContin, alleging that it knew the painkiller was being diverted to the illicit market and didn’t do enough to stop it.
But stopping the deadly flow of painkillers is a difficult process. As one doctor in Princeton, New Jersey, who asked not to be identified, said: ”What do you do when a patient comes to you in pain?” Physicians still write more than 200 million opioid prescriptions a year.
The latest data from Maryland, Ohio and New England, where the opioid crisis is most intense, shows an increase in fatalities. Drug companies have promoted medications like fentanyl, a synthetic opioid that can be as much as 50 times more potent that heroin.
“It’s like pushing on one side of a balloon,” said Travelers’ Seidner. “It just bulges out the other.”
Travelers has a big dog in this fight. It’s the largest workers’ compensation insurer in a $45 billion business that helps companies manage medical benefits for employees injured on the job. It handles a quarter-million of these claims each year.
The longer an employee stays off the job and runs up medical bills, the more the insurer loses. The average claim now runs $40,000 over three years. But with caps on temporary disability now declared unconstitutional in some states, claims could last for decades.
That’s where Travelers’ addict-prediction model comes in, because the first step is to identify a potential addict. To do that, Seidner has assembled “statisticians and brainiacs” to predict which injuries will turn into chronic pain cases and push the patient down the “slippery slope” to opioid dependency.
Travelers developed a program called Early Severity Predictor, which looks at four areas:
- Pharmaceutical frequency. What drugs are the patients using and how much. Are they also popping pills on the side?
- Co-morbidity. Are they suffering from other conditions, like diabetes or osteoporosis? Do they smoke?
- Muscular health. Are they in good condition?
- Mental health. Are they angry with their employers? Do they fear going back to work and facing the same injury?
Other factors the model considers are sex, socioeconomic status, education and the nature of the injury: shoulder, knee or slipped disk.
A typical person with a chronic injury who might become dependent could be a middle-aged white male factory worker with a bad back.
Identifying the potential addict is only part of the problem. Getting rid of the chronic pain and the potential addiction is the other.
Once such a patient is identified, Travelers can begin to harness resources. It starts by talking to the patient’s doctor. In many states, doctors are under no obligation to talk to the insurer, but nearly seven in 10 will. This is probably because the insurer covers treatments like physical therapy, sports medicine, stimulation devices, yoga, stretching and psychology.
“We embrace all modalities, but we don’t do traditional psychoanalysis,” said Seidner. “Instead, we use therapy that will change behavior.”
Seidner and his team have analyzed 20,000 cases of opioid addiction since 2015, identified 9,000 at-risk patients and worked with 2,500 of them. Since then, about 1,400 no longer demonstrate any significant use of opioids, and medical expenses have fallen by 50 percent.
Much of that reduction has come from reduced use of opioids, which used to constitute 50 percent of all the prescription drugs that workers comp paid for, according to Travelers Vice President Rich Ives. Now it’s only 23 percent.
Vice President Loretta Worters of the Insurance Information Institute, which represents the industry, concurred that “Travelers Early Severity Predictor is certainly helping.”
Let’s be clear. Travelers will only help the companies that pay its premiums and the people employed by those companies. But its strategy, including how to predict drug addiction, provides a roadmap for governments, doctors or anyone with a chronic injury who wants to escape the curse of opioid dependency.
In some instances, it’s as easy as looking in a mirror. If you’re taking drugs for a bad back, consider stretching. If you hate your job, try to find another one before you’re reinjured. If you’re depressed, seek help.
Opioids will only make things worse. And when you take an opioid of any kind, the addiction clock is ticking. If taken longer than a month, you may already be addicted and not even know it.
Finally, when you see a doctor for pain, ask whether another treatment beside opioids might work -- before he or she pulls out the prescription pad.
“Probably 80 percent of the time it’s a bad idea to prescribe opioids,” Seidner said. “We need to address the pain, but how we do it is the important thing.”