Over the last decade, a new danger has emerged in American communities becoming the third leading cause of injury-related death and claiming over 30,000 lives annually. Unintentional poisoning. What exactly is unintentional poisoning? In this case the poison is nearly always a drug and most often a prescribed medicine, ingested at a lethal dose by accident or in a suicide. Unintentional poisoning is often a scenario similar to Heath Ledger’s untimely death by a lethal combination of OxyContin, Valium, Xanax, Restoril, Unisom and Vicodin, all FDA- approved medications prescribed by his physicians.
Prescription drug abuse is the nation’s fasting growing drug problem. The United States makes up less than 5% of the world’s population, yet it’s citizens are currently consuming 80% of the world’s painkillers. In the last decade, death from accidental prescription painkiller overdose increased by 415% in women and 250% in men. Prescription opiate-based painkillers, like OxyContin and Vicodin, have been called a gateway to heroin, with the high cost of painkillers driving younger users to opt for a $5 dose of heroin over one $30 pill of oxycodone to achieve a similar high. In the past year, 12 million Americans reported using prescription painkillers, and more than 4.5 million Americans have used heroin at least once in their lifetime. Of young people who inject heroin, nearly half report abusing prescription painkillers, often snorting or injecting crushed pills, before starting to use heroin. Of all persons who use heroin, 23% become addicts.
The abuse of prescription painkillers has brought drug addiction into rural towns, the suburbs, and urban affluent neighborhoods. While men and middle-aged Americans have the highest overdose rates, women, teenagers and the elderly are becoming fast users, addicts and victims of accidental overdoses. Studies have shown that women are more vulnerable to painkillers for many reasons. Women are more likely to suffer from chronic pain, be prescribed a painkiller, be prescribed a higher dose, and become dependent on painkillers faster than men. At Emergency Departments nationwide, every 3 minutes a woman seeks treatment for prescription painkiller misuse or abuse. Yet, only one in 10 Americans with a substance abuse disorder currently receives treatment.
Why are there so many painkillers in the community? The rise in deaths closely mirrors the rise in the prescribing of painkiller by physicians. Over the last decade, in an attempt to treat their patients’ pain better, practitioners have greatly increased their rate of prescribing opioid-based painkillers. Almost all of the prescribed drugs involved in overdoses come from a prescription originally, rarely are the drugs purchased from a drug dealer, on the Internet or as a result of a pharmacy theft. The two populations at the highest risk for overdose are the 9 million Americans with long-term medical need for painkillers and the 5 million people who use painkillers recreationally. Among people who overdose, 20% are prescribed low-dose painkillers by a single doctor, 40% are prescribed high-dose painkillers by a single doctor, and 40% of patients receive multiple high-dose prescriptions by seeking out care from multiple doctors. The last group of patients who “doctor shop” account for only 10% of all patients but are the greatest concern as they are at the highest risk for overdose and are also diverting drugs into to the community. Of all recreational users, 76% report that they got them from a friend, who originally had a prescription from a doctor.
The nation’s drug epidemic is a public health crisis that requires cooperation from the health care industry, lawmakers, communities and individuals. Doctors need to continue to effectively treat pain but to cut down on the overuse of opiate prescriptions. Prescription Drug Monitoring Programs are one way to help doctors identify patients who are obtaining excessive doses or doctor shopping. Increased access to effective treatment for addiction is another important step. Lawmakers in Massachusetts took an important step in a positive direction last month, as it became the first state to successfully block sales of a new painkiller, Zohyro. The new painkiller is designed to treat chronic pain, but it is not available in a tamper resistant form and with a potency 5 to 10 times greater than Vicodin the potential for abuse and accidental overdose is great. Lawmakers in Congress, Kentucky and West Virginia are working to revoke the FDA approval of Zohydro after it recent FDA approval against recommendations of an expert advisory committee.. As a nation and in our communities, we need to understand that drug addiction affects everyone from celebrities at the height of their career to mothers in rural small towns. By removing the stigma surrounding drug abuse, we can help people get the treatment they need.
What can you do?
Take medications only as prescribed. Read labels carefully in bright light. Do not take larger or more frequent doses of medications. If you are going to be taking multiple medications together, discuss the interactions with your doctor or pharmacist.
Never share or sell any medications. Only take medications prescribed for you by a healthcare provider. The majority of prescription drugs involved in overdoses come from prescriptions originally.
Follow disposal guidelines. Follow specific drug disposal instructions on your prescription medication. Do not flush away medications unless specifically instructed to do so. When in doubt about disposal, talk to your pharmacist.
Seek help for signs of dependence or addiction to medication. If you or a loved one needs help with substance abuse, find a treatment center in your area at http://findtreatment.samhsa.gov/TreatmentLocator/faces/quickSearch.jspx.
Stay tuned next for Part 3 of Changing Risks For Injury in the US next Wellness Wednesday at Well+True, MD… Have a safe & healthy week!
Figure 1. Data from CDC WISQARS, 2009-2010.
Figure 2. Source: CDC. Vital Signs: Overdoses of Prescription Opioid Pain Relievers—United States, 1999-2008. MMWR 2011; 60: 1-6.