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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Phillipa on December 14, 2008, at 0:49:34
Thought this was interesting as opiods seem to relieve depression in so many including me. Phillipa
Epidemic of Overdose Deaths Linked to Nonmedical Use of Prescription Opioids
December 11, 2008 Up to 93% of unintentional overdose deaths in West Virginia, 1 of the poorest US states, are due to nonmedical use of prescription pharmaceuticals, primarily opioid analgesics, new research shows.A population-based, observational study by investigators at the Centers for Disease Control and Prevention (CDC), in Atlanta, Georgia, shows nearly two-thirds of all drug-overdose deaths involved prescription diversion, meaning those who died did not have prescriptions for the drugs that killed them.
"We had anticipated that drug diversion would be an important contributor to these [overdose] deaths. However, the finding that nearly two-thirds of the deaths involved prescription drug diversion was particularly noteworthy," principal investigator Aron J. Hall, DVM, told Medscape Psychiatry.
Furthermore, investigators found that "doctor shopping" was a major contributor to unintentional drug-overdose mortality. "Roughly 1 in 5 of those who died had evidence of doctor shopping, which was defined as an individual who had 5 or more health providers in the previous year writing prescriptions for controlled substances," he said.
The study is published in the December 10 issue of the Journal of the American Medical Association.
Dramatic Increase in Opioid Sales
Since 1997, when 2 expert panels in the United States introduced clinical guidelines for the management of chronic pain, which included expanded use of opioid pain medications, per capita retail sales of methadone, hydrocodone, and oxycodone have skyrocketed.
From 1997 to 2007, purchase of methadone, hydrocodone, and oxycodone in the United States increased 13-fold, 4-fold, and 9-fold, respectively.
The increase in sales of these agents paralleled a dramatic rise in emergency-department visits and unintentional drug-overdose deaths. Between 1999 and 2004, West Virginia experienced a 550% increase in such deaths the highest in the United States.
Dr. Hall pointed out that drug overdose is a leading cause of unintentional injury in the United States, second only to motor-vehicle accidents.
According to study author Leonard J. Paulozzi, MD, from the National Center for Injury Prevention and Control, these findings highlight a need for better management of prescription opioid medications.
"I think it has been a good thing that people in chronic pain who need opioids are better able to get them. But we need to come up with good ways to manage the increased use of this powerful tool, so that we don't run into problems like this, which is basically an epidemic of prescription overdose," he told Medscape Psychiatry.
Greatest Increase in Drug Overdose in West Virginia
The investigators undertook the study based, in part, on a previous CDC report that highlighted specific states where overdose death rates were most pronounced and showed a strong association between overdose mortality in the more rural states.
"West Virginia in particular experienced the greatest increase in drug-overdose mortality between 1999 and 2004, so it seemed to be an important state to focus our attention on, with the recognition that it may have potential broader implications for the epidemic elsewhere," he said.
The study's objective was to evaluate the risk characteristics of individuals dying of unintentional pharmaceutical overdose in the state and identify the types of drugs involved and the role of drug abuse in the deaths.
Using data from medical-examiner, prescription drugmonitoring program, and opiate-treatment program records, the investigators identified all state residents who died of unintentional pharmaceutical overdoses in West Virginia in 2006.
A total of 295 individuals died of unintentional pharmaceutical overdose, a death rate of 16.2 per 100,000. Of these, 63.1% were had used pharmaceuticals that contributed to their death without documented prescriptions, and doctor shopping was a factor in 21.4% of deaths. Women were significantly more likely to have evidence of doctor shopping than men 30.9% vs 16.7%.
Methadone Most Common Drug
The prevalence of diversion was most common among individuals aged 18 to 24 years. In addition, relative to all other age groups, the group aged 35 to 44 years had a significantly greater rate of doctor shopping than any other age group 30.7% vs 18.2%. Of the total study population, 94.6% had at least 1 indicator of substance abuse.
Compared with deaths involving prescribed pharmaceuticals, those involving diversion were associated with a history of substance abuse, nonmedical route of pharmaceutical administration, and a contributory illicit drug.
In contrast, those with evidence of doctor shopping were significantly more likely to have had a previous overdose and significantly less likely to have used contributory alcohol compared with those who died of overdose but had no evidence of doctor shopping.
Multiple contributory substances were implicated in 79.3% of deaths, and opioid analgesics were the most prevalent class of drugs, contributing to 93.2% of deaths. Methadone was the most common drug identified and was involved in 40% of all deaths.
"Practicing physicians need to counsel patients not only on the risk of overdose when prescribing narcotic pain killers specifically, but about the risk of sharing their medications with others. They need to also need to reinforce to their patients the importance of maintaining control of their medication to prevent theft or intentional diversion," said Dr. Hall.
Lack of Awareness
While most clinicians are familiar with starting doses of opioids, the fact is there is not a great deal of exposure in medical school or residency programs to information about prescription drug dependence, said Dr. Paulozzi.
Therefore, he said, it is critical that physicians read and adhere to recently published practice guidelines for the management of chronic pain and refer patients as needed to pain-management specialists.
They also need to make use of state prescription drug-monitoring programs to determine whether their patients are getting scheduled drugs from other clinicians.
In an accompanying editorial, A. Thomas McLellan, PhD, from the Treatment Research Institute, and Barbara Turner, MD, from the University of Pennsylvania School of Medicine, both in Philadelphia, say the study will undoubtedly raise the question of whether access to opioid medications should be restricted.
However, they point out that opioids have demonstrated effectiveness in relieving pain and therefore physicians should consider strategies to reduce the likelihood of fatal overdose and intentional diversion.
These include consideration of an "opioid agreement with the patient, stipulating the frequency of obtaining medications, timely refills but no early replacements for lost prescriptions, safe storage, no sharing, single-source prescribing, monitoring through urine screens, and adherence to monitoring visits. The agreement should be presented as a way of simultaneously protecting the patient from adverse events and promoting a collaborative, responsible relationship," they write.
The authors report no relevant financial disclosures.
JAMA. 2008;300:2613-2620 Abstract, 2672-2673. Abstract
Posted by Phillipa on December 14, 2008, at 0:51:35
In reply to Prescription opiods leading cause of Accidental OD, posted by Phillipa on December 14, 2008, at 0:49:34
I don't get it though as it's next to impossible to get a prescription for opiods even after my surgery it was a lidocaine pump and about 4 days of an opiod???? Phillipa
Posted by rjlockhart04-08 on December 14, 2008, at 1:46:01
In reply to Re: Prescription opiods leading cause of Accidental OD » Phillipa, posted by Phillipa on December 14, 2008, at 0:51:35
Yup! i wrote about it on facebook. An Article.
Posted by yxibow on December 14, 2008, at 6:00:39
In reply to Re: Prescription opiods leading cause of Accidental OD » Phillipa, posted by Phillipa on December 14, 2008, at 0:51:35
> I don't get it though as it's next to impossible to get a prescription for opiods even after my surgery it was a lidocaine pump and about 4 days of an opiod???? Phillipa
I personally think that if you can't treat other symptoms in a situation, pain is really the humane thing to be treating.
Its unfortunate that the focus on OxyContin and its diversion among other things has lead MDs to be much more cautious in writing any prescription with the DEA watching their medical license.
That being said, obviously opiods are habit forming and become addictive pretty soon, so that the use of them for post-trauma pain is generally kept to a short term use unless longer hospital stays are necessary in serious and possibly terminal situations.
There wasn't so much of this problem more than a decade ago when I had my wisdom (all four and I think at least one impacted) teeth taken out under local (I didn't like the idea of being put out, although it was 50 minutes of something that is a bit too unsavory to describe here -- would have been nice to have one of the teeth as a souvenir, never asked for it... okay that's odd, but anyhow).
I had I think most of a week's worth of percocet although I only used about 3 days -- after all that I deserved to find cartoons incredibly amusing. About the only legal (not that I've done otherwise) high I've had.
-- Jay
Posted by Sigismund on December 18, 2008, at 20:15:21
In reply to Re: Prescription opiods leading cause of Accidental OD » Phillipa, posted by yxibow on December 14, 2008, at 6:00:39
They throw them at you if you get cancer, pain or no pain.
Some voodoo thing, I guess.
Posted by yxibow on December 19, 2008, at 1:19:57
In reply to Re: Prescription opiods leading cause of Accidental OD, posted by Sigismund on December 18, 2008, at 20:15:21
> They throw them at you if you get cancer, pain or no pain.
>
> Some voodoo thing, I guess.It was a veiled reference to something morbid like that when I was saying if you can't treat anything else, you treat the pain. And the pain from bone cancer and other things that I'd rather not think about right now can be basically a terminal morphine drip.
But I mean, yes, if there's no pain, I would think someone with a serious condition like that would like to be awake to see and interact with their family.
The arguments against medical marijuana are appalling as though it could increase cancer rates when a patient is already in a medical state that could very well be life-threatening or ending.
This also doesn't mean that further novel pain relief methods shouldn't be continued to be researched upon.
-- Jay
Posted by elanor roosevelt on December 21, 2008, at 12:45:02
In reply to Re: Prescription opiods leading cause of Accidental OD » Sigismund, posted by yxibow on December 19, 2008, at 1:19:57
this phobia is bad for the elderly here
i have been told by many of my friends that dying parents didn't want to take morphine because "I might get addicted"
how sad is that
but my middle aged friends can't get the pain relief they need after major replacement surgeries
i do not believe in chronic pain
the medical industry needs some sort of monitoring system--for the MDs
Posted by Phillipa on December 21, 2008, at 19:30:55
In reply to Re: Prescription opiods leading cause of Accidental OD, posted by elanor roosevelt on December 21, 2008, at 12:45:02
Eleanor I couldn't agree with you more!!!!!! Love Phillipa
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