More people than ever are dying from opioid overdoses in the United States, as the country is grappling with a new wave of the opioid epidemic. We meet the founder on a mission to change that.
Kjartan Thorsson was working as a medical doctor on the orthopaedic department of the University Hospital in Reykjavik when he became aware of the true scale of the opioid crisis.
“At the time, I was prescribing around 30 to 50 opioid prescriptions a week,” he says, reflecting on his career.
“The rule of thumb is that one in 10 patients go on to develop some level of addiction. When you’re prescribing these medications on a weekly basis and you know you’re producing three to five addicts every week, you feel quite vulnerable.”
Opioids are commonly used for the treatment of pain and include medicines such as morphine, fentanyl, tramadol, codeine and oxycontin. However, they can be highly addictive, in large part because they activate powerful reward centres in the brain.
Nearly 645,000 people in the US died from an overdose involving opioids between 1999 and 2021. Last year, more than 73,000 people died from a fentanyl overdose alone, more than double the amount of deaths from three years prior in 2019.
Estimates show that over three million US citizens and 16 million individuals worldwide are opioid-dependent and would meet the criteria for opioid use disorder (OUD).
Thorsson though says the problem may be bigger than we think.
“When we’re talking about the opioid crisis in the US, Canada and the rest of the world, we’re talking about the end of this long journey like people injecting themselves. In reality, that’s just the top of the pyramid.
“There’s a long journey that leads to that point; that journey is exactly where we can do something.”
‘I was becoming part of the problem’
When faced with the prospect of prescribing opioids, doctors are required to follow the relevant clinical guidance to fully understand the clinical use of the drugs and apply best professional practice. Yet, this can be challenging when the guidelines do not match the medical solutions available.
“Healthcare authorities recommend that patients who are prescribed opioids receive education, close monitoring and treatment plans to prevent the development of addiction,” says Thorsson.
“As a healthcare professional, I realised at the time I didn’t have any of that. I became a doctor to help people, but suddenly I felt I got to this point where I was becoming part of the problem.”
More than 16 million individuals worldwide are opioid-dependent and would meet the criteria for opioid use disorder (OUD)
His drive to “fix things” was what led Thorsson to take the matter in his own hands. In 2019, he and his friend entered a hackathon, which they won, and soon after that they set up a web page where they started to design treatment plans to help health professionals provide safer treatments of prescription opioids and other addictive medication.
The project became viral in Iceland so much so that doctors, nurses and pharmacists reached out to Thorsson, asking for a more comprehensive system.
“We said we could either do this within the hospital – which was not very realistic – or we could branch away from the system. And that’s what we did.”
He stopped practising and, after securing some funding, he and his now co-founders, Jóhannes Ingi Torfason and Kevin Oram, built Prescriby, the first data-driven treatment management platform for addictive medication.
The programme, currently available in Iceland and in Newfoundland, Canada, aims to prevent patients from developing chronic use and addiction to medications such as opioids while helping health professionals save valuable time.
“Providing hundreds of thousands of people with methadone for the rest of their lives is not a solution,” says Thorsson.
“Being addicted to opioids is more dangerous than being addicted to cocaine and there’s a really high potential that you will never get off opioids and that you might even lose your life.
“With Prescriby, what we’re trying to do is having an upstream way of tackling the crisis, so we can have a realistic way of preventing people from getting addicted to opioids in the first place.
“The platform ensures safe use of addictive medication throughout the continuum of care, i.e. patients recovering post operatively, in order for them not to develop chronic use, patients with chronic condition that are in need of tapering and those who are in need of tapering due to addiction”.
But the focus of Prescriby, Thorsson tells me, is not just on doctors, but rather on the entire healthcare system.
“I think all professionals are aware of this, but the thing they struggle with – the thing I struggled with – is not being able to offer patients any solution.”
He sees Prescriby as the gold standard for anyone prescribing addictive medications and he says he is not afraid of implementing the programme where the problem is most pressing.
“We’re handing out some of the most addictive substances in the world without informing people about them; it’s pretty absurd if you think about it.
“With our programme, we try to take care of patients without stigma and blame and intervene only when necessary. We know when something is not going according to plan, we just want them to be safe.”
He’s got a long way to go before he sees his mission accomplished. So what keeps him going?
“A few weeks ago, after a presentation, a guy walked up to me and told me that he had to go into rehab after he’d been prescribed benzodiazepines for his anxiety.
“He used it for three years, but he got more and more problems on his hands. He started using more and more benzodiazepines until one day he passed out, fell down the stairs and broke his back. He said if he’d been part of a treatment plan, he wouldn’t have probably ended up there.
“Hearing stories like his is what keeps me going. I now have the chance to help millions of patients, which I would have never been able to do on my own.”
