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See Inside Scientific American Volume 307, Issue 4

Worrying Trends Confronted in Prescription Drug Abuse

Physicians struggle to curb the growing number of lethal overdoses
prescription drugs, prescription drug abuse



BARTHOLOMEW COOKE Trunk Archive

The two young men who showed up retching and wild-eyed in an emergency room in Portland, Ore., last summer insisted they had swallowed nothing but an ordinary soft drink before one collapsed. Yet their odd coloring suggested otherwise. Fifteen minutes after they had downed the drink, their lips and skin turned a startling blue. Their blood was as dark as chocolate.

Eventually one of the men confessed: they had spiked their soda with a bitter liquid they bought online. They meant to order “2C-E,” a man-made hallucinogen that they heard was similar to Ecstasy or LSD. What they received instead from a chemical company in China was aniline, an industrial solvent that ruptured their red blood cells, starved their tissues for oxygen and nearly killed them. Whether the substitution was their mistake or the company's, no one knew. “For quite a while after they got to the ER,” says Zane Horowitz, medical director of the Oregon Poison Center, “we didn't know what exactly they had taken, and neither did they.”

Horowitz and other toxicologists say the range of legal and illegal drugs now available to anyone with a credit card or well-stocked family medicine chest is broader and, in some ways, more dangerous than ever before. Bored teens seeking the latest high are only part of the problem. Patients who double down on long-acting prescription narcotics or mix some medicines with one another or with alcohol are vulnerable, too. The escalating death toll from drug use in the U.S. is startling, as a recent overview from the Centers for Disease Control and Prevention has confirmed. Accidental poisoning has now replaced car crashes as the nation's leading cause of fatal injury, and 89 percent of those poisonings result from drugs.

The magnitude of the problem has legislators, doctors and public health experts searching for solutions. Last July, President Barack Obama signed into law the Synthetic Drug Abuse Prevention Act of 2012, nationally outlawing the manufacture, sale and possession of 2C-E and 25 other “designer” recreational drugs. To try to rein in prescription drug abuse, at least 49 states have authorized funding for electronic databases that ultimately aim to identify physicians who overprescribe narcotics, as well as addicts who “doctor shop” to load up on pain relievers or stimulants.

Meanwhile medical toxicologists have surprising advice for emergency room teams treating overdoses: rely less on standard blood and urine tests when trying to identify drugs of abuse because those lab tests can be grossly misleading. Instead, these medical sleuths say, asking sharper questions will likely save more patients.

New Narcotics

Despite the recent increase in deaths from designer drugs—recreational compounds that are chemically tweaked to stay ahead of the law—a less exotic threat accounts for the most common type of drug poisoning. In the most recent analysis of all overdose deaths in the U.S., more than 40 percent involved prescription narcotics. Sales of these strong painkillers, including oxycodone, hydrocodone and methadone, have climbed, too, jumping by 300 percent between 1998 and 2008, according to the CDC, as doctors have prioritized alleviating the severe pain of cancer, surgery and serious injury.

In the past decade research has firmly demonstrated that a short course of prescription narcotics can safely reduce suffering. But the abuse of these potentially addictive drugs, alone or in combination, is particularly deadly. A 2008 study in the Journal of the American Medical Association profiled the problem in West Virginia: 56 percent of 275 people who overdosed on prescription narcotics had not been prescribed the medication that killed them. Another 21 percent had received prescriptions for narcotics from five or more doctors in the year before they died, a pattern that suggests they had doctor shopped to obtain more pills than any one physician would supply. National statistics underscore the risk: legal narcotics now kill more people every year than heroin and cocaine combined.

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