According to statistics recently released by the Centers for Disease Control (CDC), the number of overdose deaths from prescription pain killers has more than tripled since 1999. There were 13,800 people last year who lost their lives to prescribed opiod analgesics such as codeine, Vicodin, oxycodone, and Percocet.
Pain Pills Are Now More Deadly Than Heroin or Cocaine
Prescription painkillers have now surpassed illegal narcotics for overdose deaths, reported Leonard Paulozi of the CDC. In the past, more people died from heroin and cocaine and most of the deaths were in larger cities. Addiction to prescription pain killers has become a little-recognized epidemic; thousands die each year. Paulozi says that the 7.8 deaths per 100,000 people now occur in rural areas, almost as many as the 7.9 deaths per 100,000 people that are expected in urban areas.
Many people don't set out to abuse painkillers and most of the overdoses are accidental, according to Nora Volkow, director of the National Institute on Drug Abuse. Most are unprepared for how quickly tolerance builds to these medications, and more and more is needed to manage chronic pain. A person who is depressed or under stress is more vulnerable to addiction because narcotics give them a feeling of well being. A quick progression to combining drugs, sometimes with alcohol, and drug-seeking behavior to obtain more prescriptions can follow.
Care Providers Face Dilemmas
Police recently traced the pills that killed a teenager to a prescription written by a nurse-practitioner. Her patient sold the pills to high school students. Elsewhere, a physician was arrested and charged with drug trafficking after he prescribed controlled substances to known drug dealers.
Undertreating pain has been called to question largely because of care providers who fear being scrutinized for writing too many opiod prescriptions. Professional associations do offer guidelines for treatment of chronic, non-cancer, or cancer-related pain. Clinicians must satisfy both their licensing boards and, in the U.S., the Drug Enforcement Agency (DEA).
The DEA takes a position that is aimed at reassurance: "...the longstanding requirement under the law that physicians may prescribe controlled substances only for legitimate medical purposes in the usual course of professional practice should in no way interfere with the legitimate practice of medicine or cause any physician to be reluctant to provide legitimate pain treatment."
Clinicians protect themselves by meeting standards of care, such as taking a thorough history and assessment of pain, trying a course of nonopiod medication first, scheduling frequent follow-ups, and asking patients not to seek prescriptions elsewhere. Referral to pain management specialists is a responsible approach.
The CDC reports overdoses on prescribed opiod pain medicines is responsible for more deaths than illegal drugs. The increasing problem of addiction to pain medications is made worse by stress and depression. Doctors and clinicians may overreact to enforcement measures by undertreating pain. Sensible precautions and appropriate referrals can increase doctor and patient comfort levels.
References:
Liz Szabo, "Prescriptions Now Biggest Cause of Fatal Drug Overdoses," USA Today, 9/30/2009 www.usatoday.com
Carolyn Buppert, NP, JD, "The Legal Pitfalls in Prescribing Opiods," MedScape Nurses, www.medscape.com
Mary Earhart - Mary Earhart, RN, BSN, is a Licensed Midwife. She has written articles for professional journals and grants for non-profit agencies as ...
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