Israel Is Facing an Opioid Epidemic, Study Finds

Prescriptions for powerful pain relief drugs have soared over the past decade, with many patients unaware of their addictive properties. However, professionals say steps can be taken to avoid the crisis.

Israel is facing a serious medical crisis, with a rapid increase in the usage of opioid prescription drugs that threatens to become an epidemic similar to the one in the United States, according to a study published by the Taub Center for Social Policy Studies in Israel recently.

The study shows that Israel has become a world leader in opioid consumption, surpassing even the per capita usage in the US.

It calls for immediate action by health officials to avoid a crisis, which could have far-reaching effects on the health system and on the general population.

Prescriptions for opioid drugs, used for pain relief, were given much less freely until about a decade ago. Often only patients after major surgery or suffering from the effects of cancer were allowed access to opioids.

Professor Nadav Davidovitch, a co-author of the study and health policy program chairman for the Taub Center, said that over the last decade in Israel, there had been a major shift in how pain was treated.

“In the past, pain management was not treated seriously enough. The treatment needs to be appropriate according to the case,” he said.

The study shows an alarming increase in recent years in the use of the powerful pain relief drug fentanyl, which is considered 50 to 100 times stronger than morphine. Data from the Organization for Economic Cooperation and Development shows that the availability of opioids in Israel increased by 125% between 2011 and 2016, the largest increase among OECD countries.

Davidovitch laid the blame for the increase on the large pharmaceutical companies, which aggressively market their drugs.

“It is very tempting because the drug is very potent and efficient. The drug immediately works and has few side effects in the beginning,” he said. “But it is highly addictive very quickly.”

Last year, Israeli drug conglomerate Teva reached a settlement in the US in which it was forced to pay out over $4 billion after state governments said Teva played a major role in the American opioid epidemic. The lawsuit against the company claimed that it pushed for medications usually used for cancer pain to be used on non-cancer patients while obscuring the risk of addiction and encouraging doctors to increase dosages. Despite agreeing to pay, Teva denied any wrongdoing.

According to the Center for Disease Control and Prevention, in 2020 almost 100,000 Americans died of opioid overdoses. In Israel, for religious and cultural reasons, the rate of autopsies is not high, and therefore data on deaths from opioid misuse is not available.

Giora Eiland, a former senior military commander who headed Israel’s National Security Council, was diagnosed with cancer in 2016. His life plunged into a spiral of operations, medical procedures, and pain medication, which led to addiction.

“I was going out of my mind, screaming with pain, but nobody tried to understand the cause of the pain, they just pushed more and more medication,” Eiland said. “It is so tempting to use the drugs because they are easily available, and they help instantly.”

Mirroring events in the US, a change occurred in Israel in the last decade. Once belittled, chronic pain began to be treated more seriously, with the understanding that chronic pain has serious ramifications for a person’s quality of life. However, this has led to many patients with common back pain, for example, being prescribed opioids, often with little warning of their addictive properties.

“Even if someone would have warned me of the risks, I didn’t care, I was addicted, always looking for my next fix,” Eiland said.

Dr. Ran Nissan, a pharmacist and head of the clinical division at the Pharmaceutical Society of Israel, said: “The treatment may sometimes be merited, but it needs to be stopped in time and gradually. Once such medications are given for chronic conditions, the patients are exposed to their problematic side effects, including addiction and higher tolerance which requires larger doses.”

According to the Taub Center report, there is still time to stop the crisis by adopting several measures. Among them would be making pain clinics that offer a wide range of alternatives before narcotics more accessible to sufferers.

“The family doctor is often pressed to offer a quick solution for a patient who is desperate for relief. The doctor gives the prescription with the hope that the patient will seek further treatment in a pain clinic,” Nissan said.

However, appointments for pain clinics are not so readily available and patients often do not even try.

“Many times it’s the patient who insists on getting the treatment, and if he doesn’t get it in one place, he goes to another,” Davidovitch told The Media Line, describing a phenomenon of “doctor-shopping.”

Inna Artzi, head of the Addiction Department at the Dr. Tal Center, a therapeutic clinic for mental and emotional support, has been treating addictions for years and sees an underlying cause for the reliance on a quick fix.

“This rapid increase in usage, abuse, and addiction we are seeing is because of the Western way of life, in which one can never slow down and one always has to be on top of the game,” Artzi said. “Sickness and pain are not tolerated and society encourages people to push through and project power, while not coping with pain and suffering.”

In the clinic, she sees dozens of patients addicted to opioids. In her experience, they either arrive under different pretenses or are referred by psychiatrists or other professionals who realize there is a problem. In denial or unaware, their addiction is hard to kick, not only because of the physical and mental aspects but because of the social context.

But also, it is an addiction that is almost encouraged by the health system.

“What we see with these addicts is the embodiment of human pain and suffering,” Artzi said. “It is the doctors who gave the prescription for a legitimate reason and there is nothing that makes a person second-guess this path.”

Whereas addiction to illegal drugs often comes with a social stigma or a legal price, addiction to a legal drug does not. A patient obtains a prescription and fills it, often unaware of potential consequences.

Davidovitch and the team of researchers are optimistic that the Israeli health care system can overcome the opioid epidemic. The first step is to improve the care given by doctors, the first responders in such cases, by making sure they do not prescribe such medication if not needed.

The public health care system, which is highly digitized with electronic digital records, makes monitoring much easier.

Earlier this year, the Supreme Court ruled in favor of a petition submitted by the NGO Physicians for Human Rights that would re-label opioids, obliging labels to state that such drugs lead to physical dependence after continued use. Before this, the labeling said the drugs “could” lead to dependence.

“People need to know they are being prescribed medicine that can be dangerous,” said Nissan. He said pharmacists are now being told to alert patients with specific guidelines and warnings about opioid use when filling their prescriptions.

“I hope this will all seep through and will change things,” he added.

Davidovitch said that it does seem “that there is more openness” to deal with the problem. “We have the potential to overcome this, but it needs a holistic approach with social services, law enforcement, and local councils,” he said.

As in the US, it is believed that there is a black market in Israel for the drugs. This distorts the current data, perhaps downplaying the problem.

“It is clear that the numbers we are seeing are the tip of the iceberg,” Davidovitch said.