Prescription Pain Relief Drug Overdose Deaths a National Epidemic
In the U.S., the unintentional overdose deaths in teens and adults have reached epidemic proportions. In some 20 states in 2007 the number of unintentional drug poisoning deaths exceeded either motor vehicle crashes or suicides, two of the leading causes of injury death. Prescription opioid pain medications are driving this overdose epidemic.
A new report co-authored by CDC medical epidemiologist Leonard J. Paulozzi, MD, MPH; Richard H. Weisler, MD, adjunct professor of psychiatry at UNC and adjunct associate professor of psychiatry at Duke University Medical Center; and Ashwin A. Patkar, MD, associate professor in the psychiatry and behavioral sciences department at Duke University cites data noting that in 2007 unintentional deaths due to prescription opioid pain killers were involved in more overdose deaths than heroin and cocaine combined.
The commentary article has been published online ahead of the print version in the Journal of Clinical Psychiatry.
The report is aimed at helping doctors control the problem rather than simply describing the scope of the unintentional prescription opioid overdose epidemic.
There were almost 4.6 times as many deaths in the U.S. in 2007 due to unintentional drug overdose as there were deaths in both Operation Iraqi Freedom and Operation Enduring Freedom in Afghanistan from the beginning of both wars through Feb 20, 2011. In 2007 there were approximately 27,500 deaths due to unintentional drug overdoses.
The large number of 2007 unintentional drug poisoning deaths would be equivalent to losing an airplane carrying 150 passengers and crew every day for six months, which clearly would be totally unacceptable from a public health perspective.
The Centers for Disease Control and Prevention (CDC) sounded alarms regarding the issue in several reports last year. In June 2010 the agency announced that the 2009 National Youth Risk Behavior Survey (YRBS) found that 1 in 5 high school students in the United States have abused prescription drugs. Common among the abused prescription drugs were the opioid painkillers OxyContin, Percocet, and Vicodin.
The CDC reported last year that visits to hospital emergency departments involving nonmedical use of prescription narcotic pain relievers has more than doubled, rising 111%, between 2004 and 2008.
Paulozzi and colleagues note various reports citing some key factors linked to the problem: increased nonmedical use of opioids without a prescription “… solely for the feeling it causes” and that medical providers, psychiatrists and primary care physicians included, may fail to anticipate among their patients the extent of overlap between chronic pain, mental illness and substance abuse.
As many as 15% to 30% of people with unipolar, bipolar, anxiety, psychotic, non-psychotic, and attention deficit/hyperactivity disorders will also have substance abuse problems.
Dr. Patkar said, “Similarly, people with substance abuse are more likely to have another mental illness and a significant number of patients with chronic pain will have mental illness or substance abuse problems.”
Paulozzi and colleagues point out opioids, benzodiazepines, anti-depressants, and sleep aids are frequently prescribed in combination despite their potentially harmful additive effects. This same combination of drugs is frequently found in the toxicology reports of people dying of overdoses.
Paulozzi and colleagues, in their recommendations to physicians, suggest that before prescribing opioids, doctors should try non-narcotic medications as well as, when possible, physical therapy, psychotherapy, exercise, and other non-medicinal methods. These methods should be given an adequate trial before moving to opioids.
“It is very important to screen patients with chronic pain who may require opioid therapy for substance abuse and mental health problems, especially depression and other mood and anxiety disorders and address these problems adequately,” they state.
University of North Carolina School of Medicine, press release
Commentary: A National Epidemic of Unintentional Prescription Opioid Overdose Deaths: How Physicians Can Help Control It; Leonard J. Paulozzi, Richard H. Weisler, and Ashwin A. Patkar; J Clin Psychiatry, 10.4088/JCP.10com06560