April 6, 2011— -- 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 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."
Medicated Americans: High Dose Leads to Overdose in Some Cases
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.
Tuesday's study only adds to the concern that these drugs are not being properly managed and patients not properly monitored. The study, published in the Journal of the American Medical Association, looked at more than 150,000 veterans on opioid prescription painkillers and found a link between those who were given high doses and those who suffered accidental fatal overdoses.
"Until recently, many have taught that there is no unsafe maximal dose of opioids, as long as doses are increased gradually. However, there is growing evidence that this is often not a terribly effective approach, and the safety concerns are growing," says Deyo.
"In the past, patients and physicians thought that the solution to pain was to give ever increasing doses of opioid medications [and] the risk of higher doses has been viewed as 'only' sleepiness or sedation, and rarely respiratory problems," says Dr. Timothy Collins, assistant professor of Medicine/Neurology at Duke University.
This research suggests that adverse outcomes, especially accidental overdose, could be in part related to the high doses given to some patients, which should cause physicians to reconsider whether higher doses are really the answer to patients' pain complaints, he says.
Unhooked on Drugs: Getting Off Opiates
For Rain, the escalating doses of painkillers and other meds were not the answer to her chronic pain. After 25 years on multiple medications, the breaking point came when her doctors, in hopes of finally managing her constant pain, suggested a morphine pump to deliver powerful painkillers directly and regularly into her spinal cord fluid.
"I was already on so many pills, so I'm not sure why this was where I drew the line, but I went cold turkey," she says. Eight years ago Rain checked herself into a drug rehab center where she would be supervised while she went through withdrawal. She also went through years of intensive physical therapy to treat the many musculo-skeletal problems she had developed from her injuries, contributing to her pain.
Today, she says she has no pain, and has started a nonprofit, Point of Return, in California in hopes of helping others kick their dependence on painkillers.
If opioids are not improving the pain at a reasonable dose, another treatment should be discussed, adds Collins.