A new article just published in JAMA (see here) reports a strong relationship between high-dose opiate prescribing and accidental overdose deaths. The authors focused on a sample of Veterans and found that those prescribed more than 50mg of morphine per day, or the equivalent of other opiate drugs, we much more likely to die of such overdose than patients being prescribed lower doses. Fortunately, only about 20% of the patient-months (a measure of how many people were prescribed a specific dose for how long) were prescribed these high doses but the rate of overdose for this group was 3 to 20 times higher!
Another important finding of this paper that I think everyone needs to keep in mind is that the overall rate of overdose across all individuals in the sample who were prescribed opiates was a mere 0.04% or 0.0004. That's a small number, but with millions of individuals being prescribed opiates there are now about 12,000 annual accidental deaths from opiate overdose. That's the second leading cause of accidental death, right behind car accidents. We've all hear about the celebrity death of Heath Ledger, Michael Jackson, and Anna Nicole Smith, all likely related to opiate prescriptions. Those are but a small sampling of the annual deaths brought about by these drugs. That's obviously something we need to find a way to reduce.
The rate of addiction treatment entries specifically for opiate prescription addiction has multiplied by five since 1997 according to TEDS (the Treatment Episode Data Set), from 15,000 in 1997 to over 80,000 in 2007. Among teens, prescription drug abuse is the fastest growing problem, coming up right behind alcohol, marijuana, and nicotine. Part of the reason for all of this is that opiate analgesics are being prescribed at much higher rates than ever before.
Opiate analgesics (pain relievers) are very powerful and effective methods of controlling pain, which is why they are being prescribed so often. All of this makes sense, but we just need to be very aware of what we're doing. Physicians need to respect these drugs and use them when necessary, not whenever convenient. There are many other ways to control pain that include not only non-opioid medications but also non-pharmaceutical methods. That being said, when opioid medication are appropriate, they should be prescribed, especially since research has repeatedly shown that when taken as prescribed they are safe and not addictive though they certainly do produce physical dependence.
Good patients - preventing prescription opiate overdose
First of all, take your pills as prescribed and if you're thinking of stopping early, consult your doctor. If you have children, or relative strangers, living with you make sure to keep the drugs safe in a locked cabinet or room. One of the most common ways kids get a hold of these drugs is by raiding their own, or a friend's, parents medicine cabinet. Make sure to take care of your own pain without introducing your children to their next party favor.
Make sure to talk to your doctor about any other medications your using as well as any drug use - One of the most common ways people end up overdosing is by combining opiates with other medications (such as benzodiazepines) or with alcohol or other drugs. Lastly, when you're done with the drug, if you have pills left, get rid of them responsibly. This means not by dumping them down the drain, but instead follow the American Pharmacists Association's recommendations:
1) When tossing unused medications, protect children and pets from the potentially negative effects. APhA recommends that consumers:
- Crush solid medications or dissolve them in water (this applies for liquid medications as well) and mix with kitty litter or sawdust (or any material that absorbs the dissolved medication and makes it less appealing for pets or children to eat), then place in a sealed plastic bag BEFORE tossing in the trash.
- Remove and destroy ALL identifying personal information (prescription label) from the medication container.
- Check for approved state and local collection programs or with area hazardous waste facilities. In certain states, you may be able to take your unused medications to your community pharmacy.
2) Talk To Your Pharmacist. Research shows that pharmacists are one of the most accessible healthcare professionals. As the medication experts on the healthcare team, pharmacists are available to guide you on how to properly dispose of your unused medications.
Remember, the key is to keep yourself and those around you safe while getting the maximum benefit from the appropriate opiate medication. With a little more care and responsibility we can reduce the burden of those 12,000 annual accidental overdoses and still make use of a very helpful type of medication.
© 2010 Adi Jaffe, All Rights Reserved
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