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.

No accident
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.

14 Comments

1. 1. LindaSW 06:22 AM 4/6/10

   Great article. Given the 2006 ONDCP mandate to reduce prescription drug 'abuse' by 15% by 2008, I would say we, as a s asociety, have failed. Indeed, poisonings are one horrible consequence, but there are so many others -- addiction, trauma, DUI, loss of productivity, medical and social costs -- yet we as a society spend much of our resources on the lesser used substances of use -- cocaine, heroin, meth.
   
   There's no one solution, but perhaps reducing the sheer availability at the point of the prescriber -- are a month's worth of CII opioids really necessary for a tooth extraction? what IS the evidence for prescribing opioids for arthritis? lower back pain?
   
   Of course, at the other end, treatment for addictions of all kinds is inadequate, and even more so in the new economy.
   
   Linda Simoni-Wastila

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2. 2. Richieo 08:54 AM 4/6/10

   Reducing the availability of legal drugs will not cure the problem, it will only send it to the black market...

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3. 3. candide 10:08 AM 4/6/10

   Education is the answer.
   
   For example, APAP (acetaminophen - Tylenol, most of Vicodin) can easily be taken to overdose levels (destroys the liver), yet most people do not know this.

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4. 4. jgrosay 06:56 PM 4/6/10

   Drugs do produce harm sometimes as they are active products, not inert dummys such a placebo, and this is the reason why you have to work long and hard to obtain a permit to write prescriptions from Health Regulatory Authorities. If you endorse a situation as in Spain, where pharmacists do openly sell almost all prescription only drugs under the sole buyer request; who has the moral strenght to discourage people from bought and use of addiction drugs, and end as in the China under british rule, when they were several million opium dependents?

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5. 5. Hermit 08:38 PM 4/6/10

   1) How many OD's included alcohol? "DO NOT USE WITH ALCOHOL" is printed under,"Warnings."
   
   2) How many doctors who know their patients can't tell hypochondriacs and recreational users from real sufferers of pain? My doctor says he can see it in my face.
   
   3) How many severe pain sufferers have lived in agony after being denied pain relief because some stranger misintrepreted their desperate plea for relief as drug withdrawel (which may have also been included?)
   
   4) How many OD's would occurr if realistic drug education included how to use drugs (alcohol too, if you're going to use it) more safely and sanely rather than the archaic religious message of, "Just Say No."
   
   When an unaccountable military government agency gets to make it's own rules and set it's own budget and keep confiscated property of the disobedient, it is a rogue agency. Without health or safety data they are selling fear of substances in replacement of a system where adults make those decisions and learn to handle or avoid problems.

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6. 6. Hermit 08:50 PM 4/6/10

   1) How many OD's included alcohol? "DO NOT USE WITH ALCOHOL" is printed under,"Warnings."
   
   2) How many doctors who know their patients can't tell hypochondriacs and recreational users from real sufferers of pain? My doctor says he can see it in my face.
   
   3) How many severe pain sufferers have lived in agony after being denied pain relief because some stranger misinterpreted their desperate plea for pain relief as drug withdrawal (which may have also been included?)
   
   4) How many OD's would occur if realistic drug education included how to use drugs (alcohol too, if you're going to use it) more safely and sanely rather than the archaic religious message of, "Just Say No?"
   
   When an unaccountable military government agency gets to make it's own rules and set it's own budget and keep confiscated property of the disobedient, it is a rogue agency. Without health or safety data they are selling fear of substances in replacement of a system where adults make those decisions and learn to handle or avoid their own problems. Prohibition creates the problems and then milks us for money to "solve" them by assaulting
   our own citizens.
   
   What a racket.
   

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7. 7. Wizard 01:39 AM 4/7/10

   When we will realize that the "science" of medicine defined efficacy of treatment by the elimination or reduction in specific symptoms, even if these symptoms are themselves defenses of the body. This "efficacy" is akin to unscrewing a warning light in your car and asserted that you've a "scientifically proven" method of treating cars that are sick.
   
   "Side effects" are not really "side effects." They are the result of the effective suppression of a symptom and of the disease, creating a more serious illness. An increase in death rates is totally predictable...and will be getting worse as a result of an increase in polypharmacy.

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8. 8. l.kost 05:07 AM 4/7/10

   around the ansyogen break in your life, regressive's effect of cannabis use can delivery in the time, ecocerebral time-defect
   or progressive delucidation...
   

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9. 9. jack.123 07:13 AM 4/7/10

   Did any body notice if the ones that overdosed were the ones prescribed the medication?People lIke myself who have cronic pain don't abuse ,because when you over use there isn't enough left for when you need it,being given just enough to subdue the pain is is the usual treatment,the pain isn't gone just reduced so it becomes bearable,people stealing these kind of drugs don't understand that the pain doesn't stop completely and keep taking more untill an overdose happens.You must keep theses kind of drugs under lock and key to protect freinds and family who don't unerstand the dangers!!!

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10. 10. pyramus33 08:20 AM 4/7/10

    Many people who suffer from chronic pain do not "abuse" the prescription drugs but they are at very high risk of becoming dependant on these pain killers. What I don't understand is how the government can continue to label marijuana users as criminals and the dealers that supply these users as scumbags when studies such as this show how extremely harmful the drugs the government is selling can be. Even today many senior politicians in the U.S still refuse to agree with the legalization of medicinal marijuana because they say we have "less harmful alternatives". Really? These drugs are less harmful or habit forming then marijuana? If so, why are many people going through rapid detoxification processes just to get off these "safe" drugs? The most recent example of this arrogance in the media was senator John McKain during the 2008 election. I think it's time we looked at some of these prescription drugs and decided what should be classified as truly harmful. I can still remember a number of years ago when pharmacies were being broken into almost every week by oxycontin addicts.

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11. 11. kathyo894 11:31 AM 4/7/10

    Has anyone found the American Journal of Preventive Medicine study which indicated an increase in the rate of unintentional poisonings? I can't seem to find it online...

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12. 12. wouldliketosmile in reply to pyramus33 09:10 AM 4/20/10

    I agree! Toay there are rallies for the reform of medical marijuana law going on in Philadelhia, Pittsburgh & Harrisburg (NOT ADDICTING) and which provides tremendous relief for chronic pain victims Of course, nothing was on our local news stations!

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13. 13. insanepain 10:23 PM 3/8/11

    I have been going to pain management for over 10 years with intractable pain in my neck and mid back. When I first started going the doctor wanted to give me an epidural injection said it would take down the swelling so my body would heal. I did let them do it after telling her I didn't do well with steroids after all she was in control of whether or not I received anything to control the pain. Don't do it without your research. I had a very bad reaction I didn't know it then but I now know it cause me to have a stroke all I knew I wI have been going to pain management for over 10 years with intractable pain. When I first started going the doctor wanted to give me an epidural injection said it would take down the swelling so my body would heal. I did let them do it after telling her I didn't do well with steroids after all she was in control of weather or not I received anything to control the pain. Don't do it without your research. I had a very bad reaction I didn't know it then but I now know it cause me to have a stroke all I knew I was so sick I wanted to die and still and always will have lasting pain and suffering from it. It is my opinion that ever one would it is a mixture of steroids and polyethylene glycol, a neuro toxin, clinical antifreeze. People are dieing on the table from this injection massive heart attacks and strokes. Research it it is much worse if you die on the table you might die the slow death.Back to the subject at hand! 4 months ago my Dr was raid by the DEA, state and local law at gun point with patients there. They told him to surrender his DEAas so sick I wanted to die and still and always will have lasting pain and suffering from it. It is my opinion ever one would it is a mixture of steroids and polyethylene glycol, a neuro toxin, clinical antifreeze. People are dieing on the table from this injection massive heart attacks and strokes. Research it it is much worse if you don't die on the table you might die the slow death .Back to the subject at hand! 4 months ago my Dr was raid by the DEA, state and local law at gun point with patients there. They told him to surrender his DEA license or they would arrest him. To this day they have not charged him or returned his license to dispense class drugs. Therefore leaving him little way to help his patients. They left him with his state license so he can be a Dr but can't help his patient what the heck. He doesn't give the injection could this be the reason for this injustice? I don't know? This is not the only Dr. in Appalachia that has been done this way we have been left with NO help! WE are looking for doctors over a hundred miles from home and having to pay extreme prices for it. Understand the majority of us are not of large financial means and we are in extreme pain and withdrawing from a medication we have no choice but to take or your body reeks of pain and your family and friend suffer with you. Found one Dr. that moved to a fairly central area. Took insurance, got to his office and he only does the injection and short term pain meds. I choose neither what's the since. Also they want to take a urinalyses before you see the dr. stating it is the state law. I look up the law and it states that the dr must see signs of addictive behavior before they can ask for a urinalyses. How could they notice addictive behavior if they haven't ever set their eyes on you. They have left 100's if not 1000's of people with No help for their pain. Could this cause an epidemic of suicide and/or many more on the streets looking for relief? This is a cruel way to treat your fellow human being! Should this 50 year old grammy of 4 be in pain be subjected to this war on prescription pain meds? I never sold or gave my meds away I needed them. I still need them but have No way of getting them without losing my home. Remember there are hundreds maybe thousand of stories like this just in southern Appalachia.

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14. 14. DougJohnson 07:43 PM 9/21/11

    What the pharmaceuticals don't want anyone to know is that there are other answers to so many of our health challenges.
    
    I suffered off-and-on with depression from my teens to my late 20's. When I was 27 it got to the point I was having a hard time functioning. Unwilling to continue living like that and unwilling to die I put all of my goals aside - quite a task itself - and committed to doing whatever it would take to find true healing.
    
    I soon began what would be the most important journey of my life, a healing journey lasting over three years. This journey profoundly changed the rest of my life and slowly, healing episode by healing episode, brought complete healing to my depression as well as several other things, such as an eight-year lower-back problem.
    
    I was on Prozac for a year of this journey and it stabilized my mind so I could do the work I needed to do to truly heal. When I went off the prozac the depression returned but by that time I new how to get to the true roots of my depression and heal them.
    
    I have an essay on my website about the journey. Please check it out: http://www.dougthedrummer.com/content/view/9/38/
    

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