A Prescription for Trouble?
It is a sad fact that the UK could be described as the drug overdose capital of Europe. This is according to research conducted by the European monitoring centre for drugs and drug addiction. It has been reported that around one in three drug overdoses across the continent are occurring in the UK1. This alarming statistic comes at the same time as a 16% reduction in government spending in relation to drug and alcohol support services since 20132. This is a growing problem. Over time insurance application questions and medical evidence requests have been altered, in an effort to accurately capture data regarding drug abuse. Application forms now devote entire sections to specific questions designed to filter out those that are uninsurable, whilst requesting drugs screenings or drug questionnaires for those that may pose an above average risk. Despite these changes the insurance industry acknowledges the under disclosure of drug use by customers at application stage. However, the general perception is that drug abuse and addiction is predominantly a problem associated with younger age groups, and therefore is more relevant to those outside of the insured population.
Surprisingly around 36% of young adults in the UK admitted to taking illegal drugs at least once, more than anywhere else in Europe3. This concerning statistic was supported in the Home Office national statistics, who indicate that 19.2% of young adults aged 16-24 in England and Wales had taken illegal drugs between 2016/174. The rise of new types of drugs may also be a factor when considering the reasons for this. The use of New Psychoactive Substances (NPS) such as synthetic marijuana or Spice was on the increase in the UK until May 2016 when the production, distribution and supply of NPS was criminalised. Side effects can range from seizures to acute psychosis, as well as potential development of dependence. Again younger adults between ages 16-24 were three times more likely to have used NPS when compared to older age groups4. These statistics seemingly support the notion that younger age groups are more likely to engage in substance abuse, until we consider the impact of legal and prescription drug addiction across all age groups.
NHS data indicates that one in 11 patients in the UK are being prescribed potentially addictive medication. These include sedatives, painkillers such as opioids, pregabalin or gabapentin and antidepressants. Opioids are prescribed to reduce the intensity of pain-signal perception but they also activate reward regions in the brain triggering a positive feeling, that underlines the potential for misuse and addiction5. These medications are similar to heroin and therefore carry an increased risk of addiction and overdose even when taken as prescribed. Underwriters should take particular care when assessing instances of long-term use in connection with chronic conditions such as musculoskeletal complaints.
The American opioid crisis has seen drug overdoses become the leading cause of death in the USA in people aged under 50. More than eight hundred people a week die from the misuse and addiction of opioids in the form of prescription painkillers, heroin and synthetic opioids such as fentanyl. The upsurge in prescription drug abuse has been blamed on over-prescription and ease of access. Fentanyl is now responsible for more overdose deaths than heroin or prescription painkillers but is relatively easy to obtain via the “dark web”. Socioeconomic status based on education, occupation and income appears to suggest that opioid prescription drug abuse is more prevalent among the lower-middle classes. Lack of education about the dangers of prescription medication abuse, inadequate follow-up care and self-medication for the stress and depression associated with poverty are some possible reasons for this correlation. Individuals who have been exposed to substance abuse or have a past history of abusing other substances are more likely to develop problems with prescription medications.
Since 2012 people aged between 30-49 have recorded the highest death rates as a result of drug misuse in England and Wales. During the same timeframe mortality rates have also been increasing for those aged 50-69 with many blaming this trend on the over-prescription of opioid based medications6. Worryingly UK Addiction and Treatment Centres (UKAT) have seen a 17% increase in admissions of people reliant on over-the-counter painkillers in the last two years5. These statistics are hugely significant from an insurance perspective given the majority of new applicants are aged between 35-50. This would appear to dispel the theory that drug misuse is a problem that largely falls outside of the insured population.
The common underwriting perception of drug abuse relates to the use of recreational drugs such as marijuana, ecstasy and cocaine typically in younger age groups. Given the apparent prevalence of prescription drug abuse underwriting philosophies may need to be revised to reflect the risk posed. This is particularly the case given that non-disclosure rates in older age groups are not yet fully understood. Risk indicators include long-term chronic illnesses, past prescription of opioid medication, any history of substance abuse, mental illness and unemployment. There may be a link between the increased admissions of people dependent on over-the-counter painkillers and reduced government spending on addiction services. This is a trend that is set to continue unless it is directly addressed by government policy, so it is likely to be an important underwriting consideration for the future.