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Sunday, August 1, 2010

Oh, Oh, Oh -- Opioids

About 2,900 deaths from opioid drug overdose occurred in the United States in 1999, compared to almost 14,000 in 2006. (National Vital Statistics System, Center for Disease Control and Prevention, 2010)  Since these statistics are several years old, they do not show the additional increase in the last several years. Among those victims, the middle-aged are dying on Oxycontin, Lorcet, and other opioids created for pain control but often diverted into the lucrative black market. CDC epidemiologist Leonard Paulozzi reported the following to the House Oversight and Investigations Committee: "Studies consistently report that a high percentage of people who die of prescription drug overdoses have a history of substance abuse."

In total, all drug overdoses killed more than 33,000 people in 2005, the last year for which firm data are available. (Center for Disease Control and Prevention, 2008)  "The death toll is equivalent to a hundred 757s crashing and killing everybody on board every year, but this doesn't make the news," said Dan Bigg of the Chicago Recovery Alliance, a harm reduction organization providing needle exchange and other services to drug users. "So many people have died, and we just don't care." (Philip Smith, "Drug Overdose Deaths Are Going Through the Roof -- Is Anybody Watching?", March 21, 2008)

Despite the apparent low profile of drug policy reform groups, they have been fighting on the overdose front. "We worked to pass groundbreaking overdose prevention bills in California and New Mexico," said Bill Piper, national affairs director for the Drug Policy Alliance.

"We're working to advance overdose prevention bills in Maryland and New Jersey. We had a bill in 2006 in Congress that would have created a federal grant program for overdose prevention," he said, pointedly adding that not a single federal dollar goes to overdose prevention. "We've tried to introduce that in the new Congress but can't find someone to take a lead. To be frank, few politicians care about this issue. Their staff care even less." (Philip Smith, "Drug Overdose Deaths Are Going Through the Roof -- Is Anybody Watching?", March 21, 2008)

Doctors today are also more apt to prescribe pain pills in an effort to relieve real suffering, says James Garbutt, a UNC addiction specialist. (Liz Szabo, "Prescriptions Now Biggest Cause of Drug Overdoses," USA Today, October 2, 2009)

Of course, many people take painkillers legally and carefully follow their doctors' prescriptions. The medical profession has paid more attention to adequate pain relief for terminal cancer patients, for example, who aren't in danger of addiction, said David Zvara, chair of anesthesiology at University of North Carolina Hospitals. Zvara also noted as Americans age and carry extra pounds, more are asking for pain relief to cope with joint problems, back pain and other ailments. He says he has seen a huge increase in the number of patients seeking care for chronic pain.

But some people are genetically susceptible to addiction, especially if they have a family history of it, says Nora Volkow, director of the National Institute on Drug Abuse. And, addicts can easily overdose. Although these drugs are safe when taken as directed, taking high doses can make people stop breathing. "At the high doses used by drug abusers, the margin of safety is small," Leonard Paulozzi of the Center for Disease Control and Prevention says. "Combining such drugs on your own or using them with alcohol increases the risk." (Liz Szabo, "Prescriptions Now Biggest Cause of Drug Overdoses," USA Today, October 2, 2009)

A team led by Michael Von Korff, ScD, a senior investigator at Group Health Research Institute, studied nearly 10,000 patients who received multiple opioid prescriptions for common chronic pain conditions like back pain and osteoarthritis. The team found that patients who received higher opioid doses were 9 times more likely to overdose than were those receiving low doses. Still, most of the overdoses occurred among patients receiving low to medium doses, because prescriptions at those levels were much more common. ("Higher Opioid Dose Linked to Overdose Risk...," Science Daily,, January 19, 2010)

There's a misconception that if it's a prescription drug, it's okay. "Although you develop tolerance to the euphoric effects [of the opioids] relatively rapidly, you need more of that drug to get back to that same place you were the last time you used drugs, you don't develop tolerance to the respiratory effects as well," said Dr. Lewis Nelson of the NYU Langone Medical Center. (Jeanna Bryner, "Overdose Epidemic: Not Just For Celebrities, Live Science, July 29, 2009)

Hazelden chief medical officer, Marvin D. Seppala, MD ("A Look At the Problem of Prescription Drug Abuse," Behavioral Health Central, July 1 2009) offered this insight into the influence of media and celebrity:

"I mean it's unfortunate, but I think in the media in general there's been, especially in TV shows I've seen, mention of people using vicodin casually and recreationally. And so that normalizes the activity for our youth and they don't recognize the danger of these drugs - primarily because they're prescribed, so they lack the stigma of heroine or methamphetamines. To them, they seem safe and they don't recognize that if you use enough of any opioids, enough vicodin, enough oxycodone, you're basically doing the same thing as heroine. And they are exactly in the same class, they do exactly the same thing biologically and so I think this sort of casual mention of that is problematic for our youth."

Famous People and Alleged Causes of Death

Michael Jackson  (lethal dose of propofol along with two sedatives)

Anna Nicole Smith  (prescription pills, including opiates and benzodiazapines)

Heath Ledger  (combined drug intoxication of various prescription drugs, including oxycodone, hydrocodone and temazepam)

Elvis Presley  (barbiturates, tranquilizers and amphetamines)

Keith Moon  (prescription drug Heminevrin to combat alcohol withdrawal symptoms)

Ken Caminiti  (acute cocaine and opiates intoxication)

Bruce Lee  (acute cerebral edema due to a reaction to compounds present in the prescription pain killing drug Equagesic)

The Bottom Line

According to Philip Smith, people continue to worry about athletes on steroids and teens smoking marijuana while bodies from opioid deaths "pile up like cordwood."
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