Prescription painkillers may be FDA-approved and doctor-recommended, but that doesn't protect patients from the risk of lethal, accidental overdose, especially for those prescribed high doses.
Adding to the growing concern over abuse and over prescribing of painkillers, a new study published Tuesday finds that those on high or maximum doses of prescription opioid pain relievers are at a significantly increased risk of accidental, lethal overdose.
A high-dose cocktail of prescription pain killers, sedatives, mood regulators and muscle relaxants meant to help Alesandra Rain, 53, cope with chronic pain left her on the verge of overdose for years.
"I was liberally prescribed painkillers and anxiety meds and nearly died from the combination of pills. Several times I OD'ed inadvertently, once [while] in the hospital [and] my breathing stopped," she says.
"You lose track of what you're taking because a lot of the time I was advised to 'take as needed.' My sister says she would stay up all night with me to make sure I kept breathing" when it appeared she had taken too much, Rain says.
After surviving a car crash at age 19, Rain underwent 34 surgeries in attempts to fix injuries to her crushed legs and spine. As time when on and her pain persisted, she was prescribed higher and higher doses of painkillers, but the pain persisted. She became so desperate that she had a device implanted in her spine to help control the pain.
The abuse and overuse of prescription painkillers and sedatives have become a major medical issue as the rate of Between 1999 and 2007, the rate of unintentional overdose deaths from these drugs increased by a staggering 124 percent, according to the Centers for Diseases Control and Prevention. From 2004 to 2008, emergency room visits associated with prescription drug overdose more than doubled, and among those aged 45 to 54, these overdoses are now the second leading cause of accidental death, according to the Substance Abuse and Mental Health Services Administration.
"Based on recent evidence, it seems we have been guilty of promiscuous prescribing in the context of non-cancer pain," says Dr. Richard Deyo, professor of Family Medicine and Internal Medicine at Oregon Health and Science University.
"[The] CDC now estimates that there are 13,000 deaths a year related to unintentional overdoses involving opioids."
When it comes to chronic and/or severe pain, opioid painkillers, including morphine and morphine-like drugs such as OxyContin, Codeine, and Vicodin, are among the most powerful tools in a doctor's arsenal. They are also among the most addictive and potentially dangerous, doctors note.
Because they are more likely to lead to addiction and abuse than other non-opioid painkillers, many physicians are reticent to prescribe them at all, referring patients instead to pain specialists, says Dr. Lloyd Saberski, medical director of Advanced Diagnostic Pain Treatment Centers in New Haven, Conn.
At the same time, other physicians are prescribing these painkillers without proper monitoring tactics such as requiring regular office visits, timely (not early) refills, and urine drug testing, according to a study published last month in the Journal of General Internal Medicine.