KILLER PAINKILLERS: As the prevalence of prescription painkillers increases, the number of people hospitalized for overdosing on them appears to, too. High-profile celebrity deaths are just a few instances of this growing problem, say authors of a new study. Image: ISTOCKPHOTO/ZUZLIK
The number of deaths and hospitalizations caused by prescription drugs has risen precipitously in the past decade, with overdoses of pain medications, in particular opioids, sedatives and tranquilizers, more than doubling between 1999 and 2006, according to a new study.
In fact, by 2006, overdoses of opioid analgesics alone (a class of pain relievers that includes morphine and methadone) were already causing more deaths than overdoses of cocaine and heroin combined.
"Teens and others have different attitudes in using these drugs," often presuming the prescription substances are safer and less addictive than illegal drugs such as cocaine or heroin, says Jeffrey Coben, a professor of emergency and community medicine at the West Virginia University School of Medicine in Morgantown and lead author of the new study. "I think that's a false assumption. Aside from the fact they can be taken orally rather than injected…[many prescription drugs] really are every bit as powerful, addictive and dangerous as heroin," he notes, adding that, "when you combine them with other sedatives, that mix can become particularly lethal."
Using data collected by the Nationwide Inpatient Sample, which gathers hospital patient information for about 8 million people every year, Coben and his colleagues were able to assess what drugs were implicated in the majority of poisonings—and in many cases whether the poisonings were intentional or not. The team selected opioids, sedatives and tranquilizers as the focus of the analysis because these substances are "contributing the majority of prescription drug overdose deaths," Coben says. These categories of prescription drugs can kill and injure people by suppressing breathing, depriving the body of oxygen.
For prescription opioids, sedatives and tranquilizers—commonly prescribed for pain management—the number of hospitalizations for poisonings increased 65 percent between 1999 and 2006 (the first and last years, respectively, for which data were comparable and collected). The number of hospitalizations for all poisonings, including illegal drugs, other prescription medications and miscellaneous substances, increased during this time period as well, but that jump (33 percent) was about half the rate of those for the prescription pain drugs.
Unintentional poisonings from these drugs climbed 37 percent during the seven-year period, the researchers found. Intentional overdoses, in which people meant to inflict self-harm or death, jumped 130 percent (a far cry more than the 53 percent increase of intentional poisoning from other substances in the same time period). Intent was not listed in all cases and can be subject to reporting error. The results are detailed online April 6 in the American Journal of Preventive Medicine.
Poisonings, from prescription drugs and other substances, are classified in medical records as injurious or accidental deaths. But regardless of whether the incidents are listed as unintentional or intentional, they are rarely true mistakes, noted Leonard Paulozzi, a medical epidemiologist with the U.S. Centers for Disease Control and Prevention, in congressional testimony in 2007. "Most unintentional drug poisoning deaths are not 'accidents' caused by toddlers or the elderly taking too much medication," he noted. "These deaths are largely due to the misuse and abuse of prescription drugs."
Accidents overall were the fifth most common cause of death in the U.S. as of 2005 (accounting for 117,809 deaths—4.8 percent—that year), according to the National Vital Statistics Report [pdf]. Of injury deaths, poisoning is the second most common cause of death in the U.S., having doubled between 1985 and 2004, according to a 2007 Department of Health and Human Services analysis [pdf]. Among people 35 to 54 years old, poisoning is the most common accidental death—even more so than auto-related deaths.
Many experts think that the sheer prevalence of many of these drugs recently has contributed to the drastic increase in poisonings. Although growing illegal markets and distribution of these drugs might be a driving factor in their increasingly large role in poisonings and deaths, perfectly legal prescriptions are probably playing a role as well, Coben says.
"I think the whole issue of the availability of these drugs and whether they're being over-prescribed" should be investigated, says Susan Baker, a professor at Johns Hopkins Center for Injury Research and Policy, who was not involved in the new study but coauthored a 2009 report in the same journal about recent trends in injury mortality.