Overdoses are Linked to Higher Dose

It probably doesn’t come as any surprise that higher dose prescriptions will cause an increase in painkiller overdose (and most likely an increase in painkiller addiction as well).

Patients that suffer from long-term pain not caused by cancer have been increasingly prescribed opioids, like Oxycontin and Vicodin.  As more have been receiving these medications, as recommended and prescribed by their doctor, the risk of overdose is increasing.  It was widely believed that abuse and overdose of pain medication occurred mostly with non-prescribed or illegal usage, but a recent study that looks at patients who had doctor’s prescriptions found that there is a strong link with fatal and nonfatal overdose and medically approved usage.

The number of adults in the United States prescribed opioids for long-term chronic pain is estimated to be about 8 million (3% of all adults in the US).  In recent years, deaths involving prescription opioids are on the rise.  The Centers for Disease Control and Prevention reported that about 14,000 deaths in the US involved prescription opioids in 2006.  That amount is triple the number from 1999.  In total, about 65,000 US drug overdose deaths due to opioid usage were reported between 1999 and 2006.

The Study

Michael Von Korff, ScD, led a team that studied the risk of overdose in patients that were prescribed opioids.  These patients did not have cancer, but suffered from long-term chronic pain, such as that stemming from osteoarthritis and back pain.  This first-ever study of its kind involved about 10,000 patients and was published recently in Annals of Internal Medicine.

The team found that a correlation exists between the prescribed dose and the risk of overdose.  Patients that were prescribed higher doses of medication were 9 times more likely to overdose compared to those given low doses.  Because most patients received low to medium doses though, most overdoses that were reported occurred at those levels.

The results of the study are significant because it goes against the belief that fatal overdoses happen mainly to those who abuse prescription pain medication and acquire them fraudulently or illegally, without a prescription.   This study suggests that overdoses do occur in large number to those who are legally prescribed the medication by their doctor.  Dr. Von Korff could not conclude that higher doses are a cause of overdose, using the data in the study, but urge doctors to carefully monitor and evaluate patients whom they prescribe opioids for long-term use.

According to the study, age did not play a factor in overdoses, since they occurred at similar rates throughout all ages.  Potential contributing factors such as suicide attempts or accidental ingestion of doses higher than that prescribed was not controlled for in the study.   They were noted in only a small number of overdoses.  However, opioid overdoses did occur more among patients that suffered from depression or had a history of substance abuse.  Chronic pain patients that use opioid pain medication long-term commonly had depression.

Lessons Learned From This Study

The study shows that there is a lot that can be improved upon when prescribing pain medication to patients long-term.  With so many overdoses reported at an alarmingly increasing rate, there is a considerable opportunity to improve the safety of using the medication and also through looking at the risk-benefit profile of each patient by more attentive and cautious prescribing.

It also shows that even though you may be prescribed opioid pain medications such as Vicodin or Oxycontin, you are at great risk of overdose and even addiction and dependency, no matter what the dosage prescribed.  Those are things that do not happen only to those who acquire the drugs through non-prescribed means.  If you feel you may be abusing prescription drugs and want to get help before it is too late, give us a call to have all your questions answered and concerns addressed.

 – article by Khoi Nguyen

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