Posted November 14, 2018
Something is stealing your human capital.
Human capital is intangible collective resources possessed by individuals and groups within a given population. These resources include all the knowledge, talents, skills, abilities, experience, intelligence, training, judgment, and wisdom possessed individually and collectively, the cumulative total of which represents a form of wealth available to nations and organizations to accomplish their goals.[1]
As a financial planner explaining this idea of human capital to someone, I define it as everything that you as an individual bring to bear for the benefit of yourself, your family and your community. Everything includes knowledge, wisdom, life experiences, sense of community, love for your culture, support of family, spirituality… and yes, it of course includes earning power. The list goes on. The important takeaway is that human capital is not only the amount of financial capital your very existence generates, but also everything about you that adds to the greater good of everything your existence touches. There is a recognition that we do not live our lives in a vacuum; we also recognize that just because human captital is intangible, that does not mean it is of no value. In many cases, human capital, when quantified, may be more valuable than capital assets.
In the mid-1990s OxyContin became a “go-to” narcotic to alleviate the suffering of chronic pain. In his book Pain Killer: An Empire of Deceit and the Origin of America’s Opioid Epidemic, Pulitzer Prize nominated investigative reporter Barry Meier describes OxyContin as “a gateway drug to the most devastating public health disaster of the 21st century.” Oxycodone was historically used to provide immediate relief for moderate to severe pain after surgery and to alleviate pain during the final stages of chronic illnesses that result in death. OxyContin was first marketed by Purdue Pharmaceutical Company in 1996. The appeal was that it was pure Oxycodone prescribed at a higher dosage, but with a time release coating. The appeal of such a formulation and the marketing “hooks” were that pain relief could be provided over an extended period of time and there was a reduced chance of abuse because the full effects of the narcotic were not immediately felt…something addicts desired. Doctors prescribed pain relievers derived from Oxycodone (as well as synthetic versions of this narcotic) in doses that “titrated to effect” to make life bearable for those suffering from chronic pain. As patients’ bodies adapted to the relief provided by the narcotics, higher dosages were required and willingly prescribed by some doctors in known increments to provide the relief desired. The term opiophobia, the irrational fear about the addictive powers of opioids, was a label ascribed to doctors that were reluctant to use the powerful narcotics to treat pain. In the 1990s opioid advocates within the medical and pharmaceutical fields supported a decrease in prescription monitoring. During the same time period, pain level was designated the fifth vital sign; the first four vital signs measured and monitored by health care professionals are pulse, blood pressure, temperature and respiration. The fifth sign is a subjective “qualitative” measurement that is quantified by the level of misery indicated on a scale of stick diagram- like smiley faces. By the early 2000s, the abuse and diversion of prescribed OxyContin and similar narcotics derived from the poppy plant were rampant, and OxyContin became known as “hillbilly heroin.” Approximately 20 years after designating pain level as the fifth vital sign, several delegates at a 2016 American Medical Association meeting strongly supported no longer monitoring pain as a fifth vital sign.[2]
The Opioid Crisis is a systemic risk to human capital and by extension, a systemic risk to financial life planning. Why systemic?
- In 1998, Dr. Frank Fisher wrote 46% of all prescriptions for OxyContin in the state of California. The prescriptions were written for patients in a state program specifically designed for low income healthcare recipients. He was arrested and charged with murder. A nearby pharmacy filled four times as many oxycodone type painkillers as any other pharmacy in the United States.[3]
- By 2002, only six years after it was introduced to the market, $1.5 billion of OxyContin was sold to the public[4]
- Between 2007 and 2012, 780,000,000 pain pills with oxycodone or hydrocodone were prescribed in West Virginia. That amounts to 433 pills per person. 1700 people died from fatal overdoses of prescription opioids.[5]
- Neonatal Abstinence Syndrome (NAS) is a postnatal drug withdrawal syndrome in newborns caused primarily by in utero exposure to opioids. In the United States, the incidence of NAS increased 383% during 2000–2012.[6] In April 2018, the West Virginia Department of Health and Human Resources issued a press release that stated the incidence rate of NAS was over 5% of for live births. Bill J. Crouch, West Virginia DHHR Cabinet Secretary believes the state is in the “midst of a child welfare crisis.”[7]
- In 2015 Americans were 5% of the global population, however they were consuming 80% of oxycodone and hydrocodone opioids produced globally; they accounted for 30% of all prescriptions.[8]
- In 2016, 64,000 people died from overdoses; 42,000 attributed to opioids.[9]
- On April 19, 2016 the Ensuring Patient Access and Effective Drug Enforcement Act became law. The law defined the phrase imminent danger to the public health or safety as “due to the failure of the registrant (distributers of prescription medications/middlemen) to maintain effective controls against diversion or otherwise comply with the obligations of a registrant under this title or title III, there is a substantial likelihood of an immediate threat that death, serious bodily harm, or abuse of a controlled substance will occur in the absence of an immediate suspension of the registration” (emphasis added). This change, along with other changes to verbiage in the original Controlled Substances Act, made it more difficult for the Drug Enforcement Agency to thwart the flood of opiates to prescribers and pharmacies when the Agency suspected a pipeline of prescription painkillers resulted in higher rates of diversion or abuse.[10],[11],[12]
- In July of 2016 Adapt Pharma made a donation of 50,000 doses of naloxone (brand name, Narcan), a nasal spray that reverses the affects of heroin and prescription pain killers, to high schools through the state departments of education, community organizations and first responders.[13], [14]
- By 2017 OxyContin sales were over $31 billion.[15]
- Emergency rooms report treating an average of 1000 people per day for opiate abuse.[16]
- While prescriptions for OxyContin have decreased over the years, illicit use of Fentanyl is driving up death count.[17]
- Beginning in 2017, several states, towns, cities and Native American tribes filed class action lawsuits against pharmaceutical companies and distributors for downplaying, deceiving or outright concealing the risk of addiction.
- By 2018 over 250,000 people died from prescription painkillers.[18] This statistic addresses deaths, but not lives destroyed.
- By 2018, although domestic sales of OxyContin decreased, the narcotic is still marketed overseas.[19]
- Today 40 states and the District of Columbia have “Good Samaritan” laws that protect individuals that report or experience overdoses. In order to save lives and provide follow-up care for Naloxone use, immunity is offered to varying degrees for individuals that call 911 in “good faith” to report over-doses.[20]
What used to be thought of as a potential problem for patients experiencing chronic pain is now a mainstream epidemic that grips loved ones; the reach of the Opioid Epidemic is likely governed by less than six degrees of separation. Who do you know that has been trapped by the downward spiral of opiates? Have you ever diverted funds in your budget from a retirement account or vacation to help someone receive treatment? Has jewelry gone missing? Do you have a neighbor that buys clean hypodermic needles at the local pharmacy so that their adult child can get high safely? Is there an increase in crime in your local area because drug rehabilitation centers are filled to capacity, pharmacies are being robbed, abandoned properties are now drug houses, the unemployment rate is higher than average (even at recession levels) and homelessness is rampant? On October 24, 2018 the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, also known as the SUPPORT for Patients and Communities Act was signed into law. The breadth of the bill informs us of the extent and reach of the crisis into our lives: it covers issues of support across the demographic spectrum. The Act can be reviewed at https://www.congress.gov/bill/115th-congress/house-bill/6/text.
Individuals that are personally affected by or provide financial assistance to family members that are affected by this contagion are highly encouraged to address the issue with their financial planning professional. My premise is not that your financial trusted advisor is a behavioral health professional; do not expect behavioral health advice. However, if helping yourself, a family member or a friend results in unexpected financial and emotional burdens that effect your ability to navigate your financial planning waypoints, seek your planner’s support in your efforts. Seek your planner’s objective support as you work together as a team to determine whether your planning objectives and goals must be modified or re-ordered on your priority list. Client comfort level dictates how much information is shared. One recovering OxyContin and heroin addict described the epidemic as “our national treasure being ‘squalored’ away on this affliction… (It is about) human capital, financial capital, overall production… as well as time and destruction of the family structure that can span generations!” When developing personalized financial planning waypoints and developing financial planning legacies, we build them on a foundation strengthened by what we love, what we value and priorities. One look at the list above, which is a tip of the iceberg that tells the story of the damage our families, friends and country contend with, compels us to recognize that diversion, dependence and addiction to opioids is a strain on: newborns and adults; private and public organizations; individual high school students and several generations within the same household; the poor and the wealthy; and law enforcement and community outreach programs. It is not a stretch of the imagination to conclude that the intangible elements of human capital (knowledge, talents, skills, abilities, experience, intelligence, training, judgment, and wisdom) are diminished, if not eliminated, by misuse of narcotics.
Human capital is a part of your life planning portfolio. Be sure to consider it as you cherish the present and plan for your future. Everything about you and the important people in your life that add to the greater good of everything your existence touches is worth redeeming if stolen by, what I believe has become, the systemic thief that keeps on thieving: opioid abuse. Subsequent posts will cover costs of and barriers to recovery, to what extent opioid addiction has been considered a disability, corporate social responsibility, and much more.
-Terry
Peace of Mind Waypoints 