Drug Addiction

Drug addiction is a chronic, often relapsing brain disease that causes compulsive drug-seeking and use, despite harmful consequences to the addicted individual and to those around him. Although the initial decision to take drugs is usually voluntary, the brain changes that occur over time challenge an addicted person’s self-control and hamper her ability to resist the intense impulse to take drugs. Treatment, and how to fund such treatment, lead to complicated insurance issues.

Background

It has been estimated that substance abuse in the U.S. costs over half a billion dollars annually, including productivity, health and crime-related expenses. The negative consequences of substance abuse stretch far beyond numbers, as family disintegration, loss of employment, failure in school, domestic violence, and child abuse come into play.

The differences between psychological dependence, physical dependence, and addiction are important. Psychological dependence is a form of dependence that involves emotional withdrawal symptoms, such as a state of dissatisfaction, a reduced capacity to experience pleasure, and anxiety upon cessation of drug use. Physical dependence causes an individual to rely on a drug to prevent withdrawal systems; over time, tolerance to the drug increases and more of the drug is needed to produce the same effect. Physical dependence itself does not constitute addiction, but often accompanies addiction. Addiction is defined more broadly as a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and relief by engaging in substance use and other damaging behaviors.

Injuries and Damages

The most common addictions are tobacco, painkillers, and alcohol.

Nicotine and Tobacco
Nicotine, a component of tobacco, is the primary reason that tobacco is addictive, with some experts estimating that approximately 50 million Americans are dependent on it. Tobacco use, particularly smoking, kills hundreds of thousands of Americans each year. Smoking harms almost every organ in the body, causes many diseases, and compromises smokers’ health in general. Also, second-hand smoke has been proven to be harmful to others.

Cigarette smoking has been conclusively linked to cataracts and pneumonia. It accounts for about one-third of all cancer deaths, including cancers of the mouth, esophagus, stomach, pancreas, cervix, kidney, bladder, and lungs. Smoking has been linked to about 90% of lung cancer cases, a condition which is often fatal. Smoking also causes lung diseases such as chronic bronchitis and emphysema. Smoking makes asthma symptoms worse. Smoking substantially increases the risk of heart disease, including stroke, heart attack, vascular disease, and aneurysm. More than half of all smokers express a desire to quit smoking each year, but most relapse, often within a week.

The news is not all negative, however. The Centers for Disease Control and Prevention (CDC) reported a significant decline in the number of smokers since the mid-1960s.

Opioids
More than two million Americans suffer from addiction to opioids such as heroin, morphine, and prescription pain relievers like codeine, Vicodin, and Oxycontin.

These drugs are commonly prescribed to treat pain, however, addiction can develop from seemingly harmless initial levels of use.
Prescription opioids are similar in many ways to heroin and morphine. Opioids present an intrinsic abuse and addiction liability, particularly if used for non-medical purposes. Opioids are most addictive when taken via routes that increase the “high”, such as crushing and snorting pills, injecting the powder, or combining pills with alcohol or other drugs. In the past decade, evidence has suggested a relationship between increased non-medical use of opioid painkillers and heroin use.

Opioid use, even a single large dose, is incredibly dangerous. Researchers are studying the long-term effects of opioid addiction and brain function, and some propose that the depressed respiration caused by opioid abuse can lead to a comatose state. Opioid abuse can cause brain damage, collapsed veins or clogged blood vessels, weaken the immune system, and lead to an increased risk of HIV, infectious disease, and hepatitis. Read more about opioids.

Alcohol
Alcohol abuse and alcohol dependence are currently commonly referred to as Alcohol Use Disorder (AUD), and considered to be a chronic relapsing brain disease characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. A diagnosis of AUD may carry a “mild”, “moderate,” or “severe” sub-classification. It is widely thought that recovery is possible regardless of severity. According to the 2015 National Survey on Drug Use and Health (NSDUH), 15.1 million adults ages 18 and older are dealing with AUD. The researchers found that about 6.7 percent of adults who were diagnosed with AUD received treatment; an estimated 623,000 adolescents ages 12-17 had AUD and approximately 5.2 percent of those youths received treatment.

Heavy drinking, even if not rising to the level of a dependency, is still significantly detrimental to public health. Statistics show that excessive alcohol consumption leads to early death, especially among working-age adults, and carries with it billions of dollars in economic costs.

Legislation and Regulation

In 2016, President Obama signed into law P.L. 114-198, the “Comprehensive Addiction and Recovery Act (CARA)”, often considered to be the most comprehensive effort launched to combat the opioid epidemic, and the first major federal addiction law passed in four decades. The law addresses overdose reversal, criminal justice reform, law enforcement, recovery, treatment and prevention. It provides, among other requirements, that: 1) educational efforts be concentrated on counteracting the abuse of methamphetamines, opioids and heroin; 2) first responders may carry and administer the overdose-reversal drug naloxone; 3) jailed individuals suffering from addiction may be identified and treated; 4) opioid-prevention and intervention programs may be instituted; and 5) state-level prescription drug diversion programs charged with extending and monitoring services for at-risk individuals may receive federal assistance. The program, must be funded annually through the appropriations process. On March 15, 2018, HR 5311, referred to as “CARA 2.0 Act of 2018”, was introduced to reauthorize and expand the CARA, but its chances of passing are uncertain.

Liability and Insurance

While addiction treatment can cost tens of thousands of dollars per year, many insurers recognize that the negative consequences of substance abuse in the absence of treatment are ultimately far more expensive than treatment. Many insurers consider mental and behavioral health services to be essential health benefits. Public and private health insurance often compensate a portion of the cost of outpatient or inpatient treatment for many types of abuse. Many addiction experts contend that treatment approaches tailored to each patient’s drug abuse patterns and to any co-occurring medical, psychiatric, and social problems are most likely to lead to sustained recovery.

Litigation

Litigation has developed a certain role in the fight against prescription drug abuse, particularly opioids. Lawsuits have been brought by individuals and governmental entities, but the ultimate financial worth of these cases is undetermined. Criminal prosecutions by governments have achieved a certain conviction rate, but it is uncertain whether these litigations have had much impact on the drug addiction problem. Plaintiffs have asserted several theories against drug makers, including design defect, inadequate warnings, breach of implied warranty of merchantability, negligent marketing, violation of consumer protection statutes, civil conspiracy, fraudulent misrepresentation and more, however, drug companies have been largely successful in defeating these claims. Also, the courts have mostly denied attempts by plaintiffs to bring class action suits, generally on the basis that the representatives of the putative class were unable to satisfy class action requirements. Criminal prosecution of opioid producers, doctors who overprescribe the drugs, and “pill mill” pharmacies is another litigation tactic, but it is not yet apparent what the impact of these suits might be on the underlying problem of drug addiction.

Future Outlook

Since 1975, The National Institute on Drug Abuse (NIDA) has conducted a “Monitoring the Future” survey that measures drug, alcohol, and cigarette use and related attitudes among adolescent students nationwide. As of December 2015, the researchers reported that drug use trends remained stable or in decline among teens. Prescription painkillers are considered a necessity in the U.S. for pain management. However, some medical experts assert that the number of prescriptions written far outpace the number of people who actually need the levels of drugs prescribed. It has been argued that raising awareness of the health problems related to addiction may help discourage new users from misusing prescription drugs, and that providing accessible and affordable treatment for people with drug addiction problems can help current abusers conquer their problems.

Insurers will benefit from being a part of any proposed solutions to combat the expensive problems of drug, alcohol and tobacco misuse and addiction.

In the News

2016

• Greater Share of U.S. Workers Testing Positive for Illicit Drugs - Lauren Weber, The Wall Street Journal (09/14/2016)
  The share of U.S. workers testing positive for illicit drug use reached its highest level in a decade, according to data from millions of workplace drug tests administered by Quest Diagnostics Inc., one of the nation’s largest medical-screening laboratories. Detection of illicit drugs—from marijuana to heroin to methamphetamine—increased slightly both for the general workforce and the “safety-sensitive” workforce, which includes millions of truck drivers, pilots, ship captains, subway engineers, and other transportation workers. Employers are required to test those individuals at random, as well as in specific situations such as after accidents occur. Overall, 4% of worker drug tests were positive in 2015. Among safety-sensitive workers, positive tests rose to 1.8% from 1.7%. In the general workforce, positive tests rose to 4.8% from 4.7%.
• Senate passes bill expanding addiction treatment coverage to 30 days - Katie Lannan, Salem News (07/15/2016)
  Health insurers would be required to provide 30 days of addiction treatment coverage under a bill the Senate passed on Friday.
• 140,000 in NH now eligible for addiction treatment under Medicaid - Mark Hayward, New Hampshire Union Leader (07/04/2016)
  Some 140,000 Medicaid recipients became eligible for addiction recovery services last week under revisions to state Medicaid practices, state health officials said.

2014

• U.S. judge tosses FDA panel report on menthol cigarettes - Mica Rosenberg, Reuters (07/21/2014)
  A federal judge ruled on Monday in favor of two tobacco companies that challenged a 2011 U.S. Food and Drug Administration committee report on menthol cigarettes, finding three of the panel's members had conflicts of interests.
• A price tag on life? Rehab for drug and alcohol addiction can be financially damaging - Melissa Leong, Financial Post (05/13/2014)
  Drug and alcohol addiction inflicts untold financial damage on families and the price of recovery can be steep as well. In 2002, the Canadian Centre on Substance Abuse measured alcohol abuse’s affect on health care, law enforcement and work/home productivity and estimated that it accounted for an overall social cost of $14.6-billion; illegal drugs accounted for about $8.2-billion [Canadian dollars].
• ACA adds addiction treatment to all policies - Christine Haines , Herald-Standard (05/04/2014)
  Under the Affordable Care Act, all Americans are to be insured, and addiction treatment is one of the key areas each policy must contain.

Additional Items

Positive Drug Tests Among U.S. Workers Reach Highest Level in 16 Years
The percentage of working Americans testing positive for drugs climbed last year, particularly for marijuana, according to a new report, indicating employee drug use was on the rise just as the coronavirus pandemic created new stresses.