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he Health Ministry is to consider more aggressive warning labels on opioid painkillers, the state told the Supreme Court earlier this week. The move comes after Dr. Paula Rosca, the head of the Health Ministry’s Addiction Division, testified that the long-term use of opioid painkillers would lead, without exception, to physical addiction.

Opioids are chemically related to heroin and morphine, but some are stronger and much more addictive. The irresponsible and criminal marketing of these drugs in the United States has left over 600,000 people dead from overdoses in the past two decades. As Shomrim revealed in a series of articles last year, Israel also failed to contain the phenomenon, and there has been a steady rise in the use of these powerful painkillers. 

The court was hearing a petition filed jointly by Physicians for Human Rights and Le’altar, a nongovernment organization that offers help to people addicted to narcotics. The petitioners argued that the current warning labels on the drugs are insufficient and asked the court to instruct the state to increase the size of the labels and change the wording. Last week, the Health Ministry announced a series of new measures aimed at reducing the use of painkillers – but changing the wording of the warning labels was not one of them.

The label's current wording states, “Long-term use can lead to addiction.” During the hearing, Supreme Court Justices Ruth Ronen, David Mintz, and Khaled Kabub asked representatives of the Health Ministry whether there were any circumstances in which the long-term use of opioids does not lead to addiction. Representing the ministry, Dr. Rosca started by explaining the difference between physical addiction – characterized by withdrawal symptoms when the patient stops taking the drug – and addiction, which is a medical term that includes the psychological and behavioral elements of addiction. She went on to say that while not every patient will become an addict, the long-term use of opioids will always lead to the patient becoming physically dependent.

On hearing Dr. Rosca’s testimony, the justices proposed that the petitioners withdraw their case and that the Health Ministry agree to reconsider changing the wording of the warning label. The court also proposed new wording – “The long-term use of this drug causes physical addiction” – to replace the less ominous warning that currently appears. Significantly, the word “can” no longer appears. Both sides agreed to the court’s suggestion, and the petition was withdrawn.

Tighter Restrictions, Better Monitoring

Last week, the Health Ministry informed the High Court that it would be implementing a series of measures designed to reduce the use of opioids and improve supervision of prescriptions. Among these measures is the formulation of means testing, which will allow the state to transfer funds to a health maintenance organization that is treating addicts, introduce tighter controls over the prescription of opioids, and set up a nationwide database to monitor the consumption of these drugs.

The only move that has already been implemented was the publication some two weeks ago of a circular from the Health Ministry’s General Medicine Division. According to the circular, every healthcare facility in Israel would have to establish a special committee, headed by a deputy CEO, to build a program “to optimize the use of opioid painkillers and to monitor prescriptions.” The plan, which must be approved by the board of each organization, will include pain management training for medical staff, the use of alternative treatments to limit the usage of addictive painkillers, identifying caregivers who are not sufficiently aware of the dangers of opioid addiction and offering them professional refresher courses.

In addition, the circular stipulates that HMOs will report annually to the Health Ministry on the extent of the use of opioids among their members. At this week’s hearing, the state’s official said that Health Ministry Director General Nachman Ash had ordered a monthly report to ensure the necessary reforms were being implemented.