Natural Health Remedies | Jon Barron's Health Blog

Date: 05/20/2010    Written by: Jon Barron

The Painful Truth about Pain-Killers

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!

:hc

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Comments

  •  
    Submitted by james Denny on
    June 13, 2010 - 10:47am

    You forgot to mention the 75% of the public that have used that method,to reclaim some kind of peace of mind and have made something of there life.that is the percentage that I am in ,before methadone I was a mess,turning every way but the rite way to live.the pain was hell.I havent abused drugs since 1992.and plan to stay away from those drugs that were ilegal,and still are,herion was the only relief that was out there.but the price was to high,like I said it was a living hell.then I found the program that changed my life for the best.I dont think of abusing drugs anymore.just a happy living life and doing it legal and pain free.I just wish you could understand how it was before,I am free now to live my life in peace.

  •  
    Submitted by Maralee Trotter on
    June 13, 2010 - 10:55am

    I found a lot of information in this blog to be correct, but, unfortunately, the inherent bias of the author is readily apparent to someone more intimately involved with physicians as partners in the patient care field. Physicians who were involved in pain management during the time frame of the study certainly did not look at methadone as being their favorite opioid. It was the opioid that was crammed down their throats by the insurance companies that had control of the prescribing process due to their control of what they would cover (this was especially true for the low-income patients). The use of any other, more appropriate and less dangerous opioid was only covered after a LENGTHY and usually UNSUCCESSFUL pre-authorization and exception process. Methadone is the most dangerous of all opioids and requires a physician who has lots of time to monitor a patient and special knowledge about the intricacies of methadone metabolism and its drug interactions. Due to the inappropriate mandates of so many insurance programs, many physicians found themselves forced into prescribing methadone if they were going to get any relief at all for their patients, because all of the alternative and complementary medicines and procedures that you mention were also denied by those same insurance programs. (That policy of not covering acupuncture and herbal remedies is still the norm for most insurance companies today.) Needless to say, many physicians who were trying their best to give adequate pain relief to their patients, did not have adequate monitoring time nor the proper training. That was why there were so many methadone deaths during that time frame and those deaths, the physician complaints and the public outcry were what finally brought some of the insurance companies to their senses. To write off the whole mess as due to the physicians having methadone as a ""favorite"" is incorrect and does a disservice to many caring physicians. It also points to a confrontational, aggressive bias against the mainstream medical practitioners.

    I also take exception to the comment that large numbers of people on pain killers are constantly zoned out and basically unable to function properly. That is simply not the case, even with large doses of opioids, IF the opioid dose is appropriate for the level of pain. Pain patients getting the correct dose of opioid do not get ""the narcotic buzz"" nor the euphoric ""zone out"" that opioid abusers receive. Nobody in the medical field is able to explain why, but that is what happens. It is as if the drug is ""used up"" fighting the pain and the patient does not get those particular side effects. In fact, if those side effects are encountered, it is considered an indication that the opioid dose should be decreased. The pain management physicians titrate the dose of opioids very carefully because it IS a balancing act between giving the patient adequate pain relief while minimizing the harmful effects that occur with any powerful prescription medication (be it pain killers or heart medicine, etc)

    I have been a pharmacist for a little under thirty years and a chronic pain patient for the last six years. I go to a pain management specialist who thoroughly believes in the value of alternative and complementary medicines and practices, including the value of proper nuitrition. Those avenues are to be tried FIRST and are to continue to be used to supplement medications if medications are necessary. I believe that my specialist's attitude is the one that should be adopted wholeheartedly by everyone interested in good health. So many people seem to think that you have to be on one side of the ""battle"" or the other. There should be NO BATTLE. Both sides of the equation have their own benefits and problems. Modern medical practioners are more and more beginning to see that alternative and complementary medicines and practices are very valuable and necessary to be utilized. We all just need to work together to decrease the lack of knowledge and the suspicion that often accompanies that lack of knowledge. Of course, a healthy lifestyle is the first place to start; but it is not the whole answer, especially for someone AFTER they are in pain and unable to function.

    Let's show respect for all types of care--self care, alternative and complementary care, and medical care.

  •  
    Submitted by Buy on
    July 8, 2011 - 10:59am

    Really very nice blog. I fount a lot of information from this blog. Thanks for sharing!

  •  
    Submitted by Natalie Mannering on
    December 19, 2013 - 11:43am

    I have been taking Tramadol for pain, though only when I absolutely have to. ( I know it's toxic to the liver.) I am really interested in the potential of cannabidiol and/or other cannabis derivatives from which the psychoactive properties have been eliminated, so that pain is eased but there is no "high". From what I have read, this seems to be a very promising alternative, though there are roadblocks due to legality issues. I would be very interested to know what Jon has to say about this. I understand it works for some, but not for others. What about those with fibromyalgia, joint pain? Thanks.

  •  
    Submitted by Bob Finizio on
    July 23, 2014 - 10:36am

    To Maralee Trotter: Yes there is a bias in Dr.Baron's article. It is the result of 60 years of main stream medicine poo pooing most natural and alternitive methods to deal with health care in general. Most big pharma deciples, which have made up the majority of our main stream doctors, have over prescribed antibiotics, dealt with symptoms rather than causes, and didn't and usually don't include patient feedback in there care. All this with an unwitting dedication of caring, and doing the best thing. And yes our insurance industry and federal government have trapped the dedicated MD's in a catch 22 of time/costs/and profits.

    So now that more physicians are finally discovering natural and alternative remedies, the bias you hear is from the previous 40 plus years of operating with blinders on when it comes to health care. Yes, their intentions are usually well meant, but the time has come to put big pharma and government in the secondary role they always should have been. RAF

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