Painkillers Linked to Increase in Overdose Deaths
TUESDAY Dec. 9, 2008 -- Deaths from overdoses of prescription drugs, primarily pain relievers, appear to be on the rise throughout the United States, new research suggests.
West Virginia, in particular, has seen a large increase in such unintentional deaths, say government researchers, who have uncovered patterns of "doctor shopping" for drugs and overdosing on medications not used as prescribed.
"We found that two-thirds of these deaths involved prescription drugs that had not been prescribed to the individuals who died," said the lead researcher, Dr. Aron J. Hall, an epidemic intelligence service officer for the U.S. Centers for Disease Control and Prevention.
In addition, one in five had "doctor shopped," looking for physicians to prescribe pain medications, particularly opioids like methadone, hydrocodone and oxycodone, Hall said.
"This epidemic of prescription drug overdose involves a substantial amount of substance abuse, and it affects not just West Virginia, but particularly rural areas of the country," Hall said. "It's been a problem throughout the country. Our study focused on West Virginia as the tip of the iceberg."
Hall's group thinks that doctors and pharmacists have a critical role in preventing the misuse of these drugs. "It is essential that they counsel patients not only about the risk of overdose to themselves, but about the risks to those with whom they might share their drugs," he said.
In addition, Hall advises doctors to use prescription monitoring programs, which can tell them if patients are getting drugs from other doctors.
The report is published in the Dec. 10 issue of the Journal of the American Medical Association.
For the study, Hall's team looked at deaths from unintentional overdoses in West Virginia in 2006. From 1999 to 2004, deaths from unintentional poisoning in the state increased 550 percent, the greatest increase for any state in the country.
To determine the size of the problem in West Virginia, the researchers collected data from medical examiners, prescription drug-monitoring programs, and opiate treatment program records.
In 2006, 295 West Virginians died from unintentional overdoses of pain killers, Hall's group found. Of these, 67.1 percent were men and 91.9 percent were between the ages of 18 and 54.
Most on those who died (63.1 percent) used painkillers, but did not have a prescription for them. And 21.5 percent had prescriptions for these drugs from at least five doctors in the year before their death, the researchers found.
Women were more likely to doctor shop than men (30.9 percent vs. 16.7 percent), and younger people used painkillers for non-medical purposes more than their older counterparts did, according to the report.
In 79.3 percent of the deaths, people had used several medications. Opioids were the most common drugs used, accounting for 93.2 percent of the deaths. Of these deaths, only 44.4 percent of the victims had any evidence of having a prescription for these drugs, Hall's group noted.
Methadone was the most common drug linked to fatal overdoses, accounting for 40 percent of the deaths. People who died from a methadone overdose were less likely to have a prescription for the drug than people who overdosed on hydrocodone or oxycodone, the researchers found.
In 1997, two reports called for better management of chronic pain and encouraged the use of opioid pain medications. Since that time, the sales of these painkillers has gone up dramatically as have overdoses, deaths and recreational use linked to these drugs, Hall said.
Dr. Adam Bisaga, an associate professor of clinical psychiatry in the division on substance abuse at Columbia University College of Physicians and Surgeons in New York City, thinks that improved guidelines for appropriate prescribing, along with training to detect substance use disorders in patients, might reduce the unintended consequences seen in this study.
"This finding is not surprising. Opiates are generally very safe if used appropriately, but opiate abuse/dependence is an illness with high mortality rates," Bisaga said. "So the issue is not with the medication, but rather the detection and treatment of those who abuse and become addicted to opiates."
In addition, there is a need to expand access to addiction treatment, particularly in high-risk populations, Bisaga said.
"I strongly believe that present results could be directly used to justify implementing changes in practice and treatment to promptly reverse this worrisome trend that is likely to be occurring throughout the country, not just in one state," Bisaga said.
For more on prescription drug abuse, visit the U.S. National Institute on Drug Abuse.
Posted: December 2008
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