The Painful Truth about Pain-Killers
When Bill Clinton said, "I feel your pain," a large segment of his audience undoubtedly missed the point, given the numbers who are constantly zoned out on pain killers like oxycontin, percocet, methadone, and the like. Dulling pain is big business. Opioid painkiller prescriptions increase exponentially each year, as does the illegal use of these drugs. In fact, according to a report published in the Journal of the American Medical Association, in the seven years between 1999 and 2006, the use of prescription opioids increased nearly fourfold nationwide. While many of those who got relief from pain (plus perhaps a narcotic buzz) may have felt a whole lot better after popping their pills, a worrisome percentage weren't so lucky and, in fact, were put out of pain permanently -- and not because they were cured. Rather, along with the increase in prescriptions came a near doubling in poisoning deaths in the U.S. (from 20,000 to 37,000) largely because of overdose deaths involving opioid painkillers. You read that right -- pain relief can kill.
A recent study has confirmed that prescription painkillers are now the leading cause of drug overdose deaths. And you thought heroin was a killer! Dr. Jeffrey H. Coben of West Virginia University School of Medicine in Morgantown and his colleagues took a comprehensive look at the US Nationwide Inpatient Sample, a database that contains records for roughly eight million Americans hospitalized annually. They found that between 1996 and 2006, hospitalizations due to poisoning by prescription opioids, sedatives, and tranquilizers rose from approximately 43,000 to about 71,000 -- an increase of 65%. In fact, as Coben and associates note in their report, unintentional poisoning is now the "leading cause of unintentional injury death in the U.S.," and 90 percent of those poisoning deaths come from prescription drugs. This means that unintentional poisoning surpassed motor vehicle crashes as the leading cause of accidental death among adults, 35 to 54 years-of-age.
While the dangers of recreational use may be somewhat obvious, at least to those paying attention, and while illegal use certainly plays a significant role in the rising number of deaths related to painkillers, legal prescriptions also pose a hazard. The likelihood of overdose is significant. An earlier study followed nearly 10,000 adults who had received at least three opioid prescriptions within 90 days to treat chronic pain such as backache. Of these, 51 experienced at least one overdose, and six died as a result. In fact, unintentional overdoses of opioids, including mainstays like Vicodin and Percocet, and sedatives like Valium and Ativan (in other words, overdoses caused by taking prescription drugs to alleviate pain, under a doctor's orders) jumped 37% between 1999 and 2006.
Dr. Coben says, "This is a problem that is dramatically on the rise throughout the country, and it's very important that people understand that prescription drugs are very powerful, potentially life-threatening …We do need to work with physicians and pharmacists to make sure there are better procedures in place to monitor who's getting what and how frequently…There's also a need to educate people better about the dangers associated with these meds and about how to use them and not to use them, and what to do when you're finished using them."
The problem of "what to do when finished using" painkillers is a big one, given the issue of illegal abuse. When people leave their pills in the medicine cabinet, kids can find them. Among teens aged 12-17, illegal prescription drug use now equals marijuana use, favored above so-called street drugs like heroin because they're so easy to obtain. In fact, in this age group, experts estimate there are two million illegal users in the US. Tranquilizer use increased nearly 50 percent among teens in just one year, between 1999 and 2000. But it isn't just kids who abuse prescription drugs -- not by any means. In fact, the NIH estimates that 20 percent of the US population has used prescription drugs recreationally. While deaths from legitimate use of painkillers present cause for concern, the death rate from recreational use is absolutely alarming. In that same seven-year window between 1999 and 2006, deaths from recreational use have increased by a stunning 130%.
Among prescription painkillers, methadone is the Son of Sam. During the study period, the biggest increase in hospitalizations for poisoning by a specific drug was associated with methadone, which is a powerful synthetic opioid. Hospitalizations for methadone poisoning increased by five times, while retail sales of methadone increased 12-fold. It's a favorite among both physicians and on the street because it's cheap and powerful.
While narcotic painkillers offer a godsend to those suffering unbearable pain, some believe that physicians prescribe them too easily for those with manageable discomfort. It should be noted that there are alternatives to pain management, such as acupuncture, and topical herbal remedies that can provide deep tissue relief, especially if that pain isn't extraordinary. Plus, there's a lot of ignorance about just how addictive and dangerous these drugs are. As Dr. Coben says, "There is increasing availability of powerful prescription drugs in the community, and attitudes toward their use tend to be different than attitudes toward using other drugs, especially among young people, who report that prescription drugs are easy to obtain, and they think they are less addictive and less dangerous than street drugs like heroin and cocaine."
How can the death rate from painkiller poisonings be reduced? For one thing, doctors might be a bit less cavalier with the prescribing pen. And pharmaceutical companies might be a bit less cavalier pushing their narcotic wares to the medical community as well as to consumers. Consumers need to be educated about the potential dangers of these drugs, including the real risk of death. And, as Coben points out, "There's a role for the legal system in going after rogue pharmacies and Internet distribution of these medications."
Meanwhile, as always, the best route is living a healthy lifestyle so you don't have pain and don't need help from narcotic friends.
And for those of you living outside the United States, it's worth keeping in mind that where the United States leads in terms of drug use and diet, the rest of the world soon follows. In other words, this is a problem coming to your neighborhood soon!