The Full Story
There has been an alarming increase in deaths from prescription medicines. Much of this recent increase was caused by overdoses of opioid analgesics. These are pain relievers such as codeine, morphine, fentanyl, oxycodone, hydrocodone, and hydromorphone. Some of the brand names are Percodan®, Vicodin®, and Dilaudid® though these drugs are often sold in generic form.
This is a public health epidemic, but not everyone is at risk. A closer reading of the research helps explain why this problem is growing, who is at risk, and what can be done.
Opioid pain relievers are effective for short-term intense pain, for example, after surgery. They are also effective for relief of long-term pain not relieved by other methods; a common example is cancer pain. Unfortunately, opioids are sometimes prescribed for long-term relief of chronic pain even when other types of pain relief are better and/or safer. For example, chronic lower back pain is not typically relieved by safe doses of opioids but would be better treated with other drugs and therapies.
For a long time, health professionals were often reluctant to prescribe high enough doses of pain killers to treat patients who indeed needed relief. Recognition that pain relief is an important component of healing has driven an increase in opioid prescriptions. On the other hand, inappropriate prescribing allows drug abusers to take advantage of an increased supply of opioids; "doctor-shoppers" obtain more drugs than needed for medical purposes and may sell what they don't take to opioid abusers. From a public health standpoint, a balancing act is needed: to relieve pain while prescribing opioids only to people who need them and only in needed quantities.
Two groups of people are most at risk of prescription drug overdose in this country:
- People who take high doses of opioids for medical uses over a long period of time;
- People who abuse opioids by taking them without a medical reason for doing so.
Several strategies have been proposed to reduce deaths due to opioid use and misuse.
- Prevent the "doctor-shopping" that allows people to obtain multiple prescriptions for opioids they don't need. A combination of programs to evaluate prescription data on a state-wide level plus restriction of refills by insurance companies could be effective.
- Enforce existing laws about prescriptions for opioids, plus enacting legislation in states where it doesn't exist.
- Educate health care providers in how to prescribe opioids safely and effectively, especially in the use of evidence-based guidelines for patients with chronic pain.
- Allow non-medical personnel to have access to naloxone, an antidote to opioid and narcotic overdoses.
- Educate emergency medical personnel about the optimum treatment for patients who have taken overdoses.
- Shift some substance abuse treatment programs from clinics to private medical offices; this would make such treatment easier to obtain and carry less stigma.
If you have a question or make a mistake with medicine, use the webPOISONCONTROL® online tool for guidance or call Poison Control at 1-800-222-1222 right away.
Rose Ann Gould Soloway, RN, BSN, MSEd, DABAT emerita
For More Information
Taking medicines safely (National Association of Boards of Pharmacy "AWARxE" consumer protection program)
Taming the epidemic of prescription overdose deaths requires careful prescribing by physicians, patients who follow prescription drug labels correctly, and strategies to reduce "doctor shopping", enhance access to treatment for acute overdoses, and provide therapy for opioid addictions.
This Really Happened
A 51-year-old woman was found deceased in bed. She was prescribed methadone 240 mg 3 times a day. Numerous bottles of methadone were found at the scene. Her blood methadone level was extremely high, but it was consistent with her prescribed dosage. She had no prior history of suicide attempts, was not known to have voiced suicidal intent, and there was no suicide note. At autopsy, no pills were found in the stomach. She was found to have pneumonia. The cause of death was either a methadone-related abnormal heart rhythm or the contribution of methadone to the development of pneumonia.
Reference: Letsky MC, Zumwalt RE, Seifert SA, Benson BE. Cause of death conundrum with methadone use: a case report. American Journal of Forensic Medical Pathology. 2011;32(2):193-196.