Deaths from prescription narcotic painkillers have soared as the opioid drugs became more popular and powerful, a new federal study found.
171. And (remember) when We
raised the mountain over them as if it had been a canopy, and they thought that
it was going to fall on them. (We said): "Hold firmly to what We have
given you [i.e. the Taurat (Torah)], and remember that which is therein
(act on its commandments), so that you may fear Allah and obey Him."
172. And (remember) when your
Lord brought forth from the Children of Adam, from their loins, their seed (or
from Adam's loin his offspring) and made them testify as to themselves
(saying): "Am I not your Lord?" They said: "Yes! We
testify," lest you should say on the Day of Resurrection: "Verily, we
have been unaware of this."
173. Or lest you should say:
"It was only our fathers afortime who took others as partners in worship
along with Allah, and we were (merely their) descendants after them; will You
then destroy us because of the deeds of men who practised Al-Batil (i.e. polytheism and
committing crimes and sins, invoking and worshipping others besides
Allah)?" (Tafsir At-Tabari).
174. Thus do We explain the Ayat (proofs, evidences, verses,
lessons, signs, revelations, etc.) in detail, so that they may turn (unto the
truth).
175. And recite (O Muhammad ) to them the story of him to whom We
gave Our Ayat (proofs, evidences, verses,
lessons, signs, revelations, etc.), but he threw them away, so Shaitan (Satan) followed him up, and he
became of those who went astray. 7. Surah Al-A'raf (The Heights)
Four out of five people who used a prescription narcotic painkiller in 2011 to 2012 took pills equal to or stronger than morphine, according to statistics made public Wednesday by the Centers for Disease Control National Center for Health Statistics. The percentage of people who took painkillers stronger than morphine, which include such drugs as fentanyl, hydromorphone, methadone and oxycodone, grew from 17% in 1999 to 37% in 2012, the study found.
Use of narcotic painkillers, such as Vicodin and OxyContin, has also grown. In 1999, 5% of adults 20 and older reported using a narcotic painkiller. Four years later, that number grew to 7%, where it has remained, Sales of the drugs quadrupled between 1999 and 2010, the report said.
The CDC has called prescription painkiller abuse an epidemic. In 2012, 16,007 people died i from overdoses involving opioid painkillers, triple the number who died in 1999, a 5% decrease from 2011 when 16,917 people died, the CDC reported last year.
In September, Attorney General Eric Holder expanded a prescription drug return program that allows hospitals and pharmacies to accept excess drugs, including narcotic pain relievers. Last year, the government also placed new restrictions on medicines that contain the highly addictive painkiller hydrocodone, such as Vicodin and Lortab, which limited patients to a 90-day supply per prescription.
There are a variety of strong pain relievers, including narcotic drugs, that your doctor may prescribe to help relieve arthritis pain.
Often, these pain relievers are combined with acetaminophen (Tylenol). They include:
- Tylenol with Codeine
- Lorcet, Lortab, Vicodin (hydrocodone)
- Morphine
- OxyContin, Roxicodone
- Percocet
Narcotics for Arthritis Pain
If you're taking a narcotic for arthritis pain, keep in mind that alcohol and drugs containing acetaminophen or Tylenol don't mix. The combination can greatly increase your risk of severe liver damage.
When you take narcotic drugs, you also run the risk of developing a tolerance to the drugs. That means you need more and more of the drugs in order to get the same effect. You also run the risk of becoming dependent or even addicted. In addition, narcotic drugs can cause side effects such as constipation, drowsiness, dry mouth, and difficulty urinating. The drugs methylnaltrexone (Relistor) and naloxegol (Movantik) are approved to treat constipation due to opioid use in those with chronic pain.
How Do Narcotics Relieve Arthritis Pain?
Unlike ibuprofen, Motrin, Aleve, or other NSAID drugs, narcotics do not decrease the inflammation that occurs with arthritis. Narcotic drugs work on pain receptors on nerve cells to relieve pain.
If you have pain that isn't relieved by a narcotic drug or NSAID alone, speak to your doctor about combining the two. In some cases, an NSAID/narcotic combination may relieve pain better than either alone.
The proportion of women dependent on drugs such as narcotic painkillers or heroin duringpregnancy has more than doubled in the past decade and a half, a new study finds, though it still remains below a half-percent of all pregnancies.
The study covers a class of drugs known as opioids, which include prescription painkillers such as oxycodone (Oxycontin) and Vicodin; morphine and methadone; as well as illegal drugs such as heroin.
Dependence on these drugs during pregnancy is linked to several increased risks during delivery, even when compared to women abusing or dependent on non-opiate drugs, explained study senior author Dr. Lisa Leffert, chief of the Obstetric Anesthesia Division at Massachusetts General Hospital in Boston.
Over recent years, experts have noted an alarming rise across the United States in abuse of narcotic prescription painkillers.
"This increase in opioid abuse and dependence in the pregnant population is happening along with that in the general population," Leffert said. "These women were more likely to deliver by cesarean and have extended hospital stays" compared to other pregnant women, she said.
The researchers analyzed national hospitalization data on nearly 57 million deliveries between 1998 and 2011. They looked specifically at pregnancy outcome risks linked to dependence on opioids. They accounted for differences in age, race, payer type (insurance), having multiple births, mothers' preexisting conditions and a past history of cesarean section.
Preexisting conditions included depression, which was five times higher among those with an opioid dependence, as well as alcohol dependence and non-opioid drug dependence, both of which were more than 20 times higher in women dependent on opioids.
According to the new analysis, the percentage of women dependent on opioids during pregnancy more than doubled during that time, from 0.17 percent in 1998 to 0.39 percent in 2011.
The increased risks for mothers dependent on methadone ranged from preterm labor and poor growth in the fetus to an increased risk of stillbirth and maternal death, though the latter were still very rare.
However, the study has several limitations that should be considered, said Dr. Robert Newman, director of The Baron Edmond de Rothschild Chemical Dependency Institute at Beth Israel Medical Center in New York City.
"The study makes no distinction between dependence on appropriately prescribed, medically indicated opioids and that associated with self-administered opioids taken under potentially very hazardous circumstances," he said. "The different consequences for the expectant mother and unborn child are enormous."
For example, methadone or buprenorphine are both opioids that can be safely used in treatment of addiction, Newman pointed out. In fact, he said, methadone maintenance is the most effective known treatment for heroin addiction, including in pregnant women.
The study authors agreed that "we were not able to distinguish between women who were dependent on or abuse prescription opioids, those who were enrolled in opioid maintenance programs [e.g., with methadone or buprenorphine], and those who abused heroin."
However, women dependent on opioids were twice as likely to go into labor early, with 17 percent experiencing preterm labor versus 7 percent among those without opioid dependency. Women dependent on opioids were also 20 percent more likely to require a C-section and 40 percent more likely to have their water break early.
Two types of complications, intrauterine growth restriction and placental abruption, were also more likely -- though still rare -- in women dependent on opioids than not. Intrauterine growth restriction refers to a baby's poor growth in the womb and occurred in about 7 percent of those dependent on opioids and 2 percent of those without a dependency. Placental abruption, in which the placenta comes off the uterus wall before delivery, occurred in about 4 percent of women with opioid dependency and 1 percent of women without dependency.
The risk of stillbirth was also higher among those dependent on opioids, at a rate of 1.2 percent compared to 0.6 percent of stillbirths among mothers with an opioid dependency.
The risk of maternal death during delivery was also higher for mothers dependent on opioids. Although the risk remained very rare (20 of over 60,000 opioid-dependent pregnant women died), the risk was still more than four times that of nonaddicted pregnant women. Similarly, the risk of maternal heart attack was four times higher among women dependent on an opioid, the study found.
Long-term use of opioids during pregnancy can lead to dependence or withdrawal symptoms in newborns in the first few days after birth, noted Dr. Ted Yaghmour, an associate professor of anesthesiology at Northwestern University's Feinberg School of Medicine.
"Importantly," he added, however, "untreated severe pain in the mother may also be harmful to the unborn baby. [So] when a mom has pain during pregnancy, consultation with an anesthesiologist who specialized in pain management may help them plan an opioid-limiting treatment plan," he said.
Both Yaghmour and Leffert said more research is needed to understand possible long-term effects on children whose mothers were dependent on opioids during pregnancy. However, Newman said the "overwhelming conclusion of published studies is that there are no long-term effects" on these children.
Newman also emphasized the importance of treatment for pregnant women with addictions.
"What is absolutely contrary to the interests of all concerned is to vilify the opioid-dependent pregnant woman," he said. "Most importantly, recognize opioid dependence as a chronic medical condition and treat it as such, and treat the patients the same way others who have chronic illnesses are treated."
To make it harder to get certain prescription drugs illegally, the government is making it harder to get them legally.
A rule from the U.S. Drug Enforcement Agency, which takes effect Monday, reclassifies hydrocodone-based drugs — which include widely prescribed painkillers such as Vicodin and Lortab — into a new, more restrictive category.
The change means that doctors will be allowed to only prescribe the drugs in intervals of 30 days or less, for no longer than 90 days total. If patients need more medication they must visit their doctors for a new prescription, as opposed to the current practice of having refills called in to a pharmacy.
DEA officials say the new rule will more closely regulate hydrocodone-based medications, which are easily converted to street drugs in what has become a national epidemic of prescription drug abuse.
But some worry that the result for patients will be more pain, greater inconvenience and higher costs.
“It’s done with good thoughts, but unfortunately you’re going to have patients who legitimately need their medications who are going to run into barriers,” said Tim Musselman, executive director of the Virginia Pharmacists Association, which opposed the new classification.
Before the rule took effect, patients could have their pills refilled automatically as many as five times, covering up to six months.
Last year, health care providers wrote nearly 128 million prescriptions for hydrocodone-based drugs, making them the most frequently prescribed medications in the United States, according to IMS Health, a global information and technology services company.
However, what is a popular pain reliever for everything from toothaches to wrenched backs is also an easy way for abusers to get high, who sometimes crush the tablets and snort the powder on the way to becoming hooked.
In Western Virginia, police say misuse of prescription painkillers is a major source of crime and addiction.
The region saw 185 deaths from prescription drug overdoses in 2012, the most recent year for which numbers are available from the state medical examiner. Hydrocodone played a role in 77 of the deaths.
“Almost seven million Americans abuse controlled-substance prescription medications, including opioid painkillers, resulting in more deaths from prescription drug overdoses than auto accidents,” DEA Administrator Michele Leonhart said in a written statement when the new rule was announced in August.
In Southwest Virginia and elsewhere, prescription drug abuse has been linked to a rising problem with heroin, which is a cheaper alternative to pills that addicts often turn to when their money runs low.
Authorities say many of the prescription painkillers on the black market get there through doctor shopping, a practice in which abusers go to multiple physicians and feign injury or illness, accumulating a cache of ill-gotten pills.
Against that backdrop, the new rule makes sense to Dr. Trevar Chapmon, a Roanoke physician and board member of the Roanoke Valley Academy of Medicine.
“There’s always a concern that when you start making regulations that have broad effects, you’re going to have some unintended consequences,” Chapmon said. “However, with the problems we have in Southwest Virginia with opioid abuse, and overprescribing, I think it’s a necessary move.”
Still, he acknowledged that “it’s going to be a headache for some patients. It’s going to be a headache for some physicians.”
In a letter to the DEA written when the rule was still under consideration, the Virginia Pharmacists Association wrote that it would “complicate the care of patients that are in need of proper pain management while having little impact on those who abuse the system.”
Among the concerns: Patients will be forced to endure pain while waiting for an doctor’s appointment for a new prescription, some physicians might balk at prescribing hydrocodone after it’s grouped with more potent drugs by the DEA, and lower-income patients will struggle to pay more co-payments and travel costs for additional doctor appointments.
And with an existing shortage of primary care physicians, the new regulations “may cripple an already overtaxed system,” seven national pharmacy associations wrote in a letter to the DEA.
DEA officials counter that the new rule means, at most, that someone who has been seeing their doctor twice a year must now go four times a year to maintain the same regimen of painkillers.
“It’s really a misunderstanding on the doctors’ part if they say, ‘I can’t do this anymore,’ ” said Barbara Carreno, a DEA spokeswoman.
After taking public comments on the proposed rule change and getting support from the Food and Drug Administration, which had previously opposed the move, the DEA moved forward in August after nearly a decade of deliberations.
The change it made was to a part of the Controlled Substance Act that ranks drugs in five categories, or schedules. Schedule I drugs are those that have no federally approved medical use and are considered the most dangerous, such as heroin, LSD and marijuana.
Schedule II drugs include illegal narcotics such as cocaine and methamphetamine, as well as medications with the highest potency and potential for abuse — oxycodone, Dilaudid, Demerol and fentanyl among them.
It is in this category that the new rule puts hydrocodone-based drugs, which previously had been Schedule III drugs. (Pure hydrocodone was already a Schedule II drug, but smaller amounts of hydrocodone mixed with acetaminophen or other non-narcotic ingredients had appeared one level down in the five-schedule list.)
In addition to restricting prescribing practices for hydrocodone-based drugs, their reclassification to Schedule II increases the possible criminal penalties for those convicted of abusing them.
Having hydrocodone-based drugs in the same category as OxyContin, which has been blamed for rampant abuse and addiction in Southwest Virginia, might give some physicians pause.
“It puts the physician in an awkward situation of wanting to treat pain, but not wanting to get in trouble or be labeled as an over-prescriber,” said Dr. Edwin Polverino, president of Primary Care Associates, an independent medical group with offices in Roanoke and Salem.
“You could argue that you are setting up an adversarial relationship with every patient who walks into the office,” he said. “They [physicians] have to look at every patient seeking chronic pain medication as if they are a drug seeker.”
But patients at PCA should not notice any changes under the new rule, Polverino said, because doctors in his practice have been treating hydrocodone-based drugs as if they were in the Schedule II category for the past decade, ever since OxyContin hit the market.
Whether it’s a Schedule II or III, he said, “Every one of us who is conscientious has a little anxiety when we prescribe these drugs.”
The number of Americans dying from accidental overdoses of narcotic painkillers jumped significantly from 1999 to 2011, federal health officials reported Tuesday.
Deaths from overdoses of drugs such as hydrocodone (Vicodin), morphine and oxycodone (Oxycontin) climbed from 1.4 per 100,000 people to 5.4 per 100,000, according to the U.S. Centers for Disease Control and Prevention.
That means about 3,000 people died in 1999 from unintentional overdoses. By 2011, that number was up to nearly 12,000 deaths, the report said.
Despite the rising number of deaths, the rate of the increase has actually slowed since 2006, according to report co-author Dr. Holly Hedegaard. She's an epidemiologist at CDC's National Center for Health Statistics (NCHS).
"Although the rate is still increasing, it is not increasing quite as fast as it did between 2000 and 2006," Hedegaard said. "From 1999 to 2006, the rate of deaths increased about 18 percent per year, but since 2006 it's only increasing about 3 percent per year."
Hedegaard thinks the slowing rate might be due in part to fewer deaths from methadone and some painkillers. Deaths from these drugs have leveled off or declined, she said.
However, in 2011, benzodiazepines -- sedatives used to treat anxiety, insomnia and seizures -- were involved in 31 percent of the narcotic painkiller deaths up from 13 percent in 1999, according to the report published Sept. 16 in the NCHS Data Brief.
From 2006 to 2011, deaths involving benzodiazepines increased an average of 14 percent per year, while deaths from painkillers not involving benzodiazepines did not change significantly, the investigators reported.
The report also found a striking increase in the number of deaths in people aged 55 to 64. In 1999, the rate was 1 per 100,000 people. By 2011, that number had jumped to more than 6 per 100,000, the findings showed.
There was also a dramatic rise in the number of deaths in white people from opioid use; it was 4.5 times higher in 2011 than it had been in 1999. The increase in the number of deaths from opioids doubled during the same time period for blacks, and increased just slightly for Hispanics, the study authors said.
Dr. Andrew Kolodny, president of Physicians for Responsible Opioid Prescribing and chief medical officer of the Phoenix House Foundation in New York City, said this "epidemic" can be brought under control. "We have to stop creating new cases of addiction. That boils down to getting the medical community to prescribe more cautiously," he said.
"It's not that doctors are intentionally causing an epidemic, but they are overprescribing painkillers, particularly for common chronic problems like lower back pain and headaches," he explained.
Kolodny said these painkillers are intended for use in the days following surgery or an accident, or as palliative care for cancer patients. The bulk of the prescribing, however, is for chronic conditions. "That's what's really fueling the epidemic," he said.
The racial difference in the pattern of prescribing is also a large part of the problem, Kolodny said.
"Doctors prescribe narcotic painkillers much more cautiously to their non-white patients," he said. "When doctors have a black or Latino patient, they are more concerned about the possibility of addiction or diversion of the drug -- patients selling the medication -- so they prescribe more cautiously. Stereotyping is having a protective effect on minorities," Kolodny said.
The idea that a white, middle-class person could become addicted to these pills is far from their minds, he said.
Kolodny added that to address the problem, addicts need better access to treatment. "We need a vast expansion of treatment."
While a major public health campaign has had some success in reducing the number of people who take potentially addictive narcotic painkillers, those patients who are prescribed the drugs are getting more of them for a longer time, according to a new study.
Nearly half the people who took the painkillers for over 30 days in the study’s first year were still using them three years later, a sign of potential abuse.
The report, released on Tuesday by the pharmacy benefits managerExpress Scripts, found that nearly 60 percent of patients taking the painkillers to treat long-term conditions were also being prescribed muscle relaxants or anti-anxiety drugs that could cause dangerous reactions.
The study looked at the pharmacy claims of 6.8 million Americans who filled at least one prescription for an opioid between 2009 and 2013. Opioids include commonly used drugs like codeine, morphine, oxycodone and hydrocodone.
“Not only are more people using these medications chronically, they are using them at higher doses than we would necessarily expect,” said Dr. Glen Stettin, a senior vice president at Express Scripts. “And they are using them in combinations for which there isn’t a lot of clinical justification.”
Overdoses involving prescription drugs are a leading cause of accidental death in the United States, and opioid painkillers play a role in about 70 percent of such cases, according to the federal Centers for Disease Control and Prevention. Opioid overdoses led to 16,000 deaths in 2012, the agency said.
In addition, people who abuse or misuse opioids often take benzodiazepines like the anti-anxiety drug Xanax, C.D.C. data shows.
With few exceptions, patients who are taking an opioid painkiller should not be prescribed other drugs with a sedative effect, such as muscle relaxants or benzodiazepines, because of a risk that the combined drugs could slow down the respiratory system.
The study found that nearly one-third of patients were prescribed an opioid and a benzodiazepine in the same month, and around the same percentage were prescribed a muscle relaxant and an opioid at the same time. About 8 percent of patients were taking all three types of drugs — a combination known as a “Houston cocktail,” which gives a heroinlike high — during the same period. And 27 percent were taking more than one opioid at a time, another hazardous combination.
Of the patients taking the mixtures, two-thirds were being prescribed the drugs by two or more doctors, and nearly 40 percent filled their prescriptions at more than one pharmacy, which could be a sign of poor coordination of medical care or an indication that a patient was shopping around for a doctor willing to prescribe a drug inappropriately, Dr. Stettin said.
“It begs for the use of active monitoring and also for better coordination of care,” he said.
Dr. Andrew J. Kolodny, chief medical official of Phoenix House, a drug treatment organization, said that the drop in overall opioid prescribing was a good sign. However, he said he was disturbed that doctors were continuing to give opioids to many patients for long periods of time.
“It suggests that we still have a lot more work to do in better informing the medical community that opioids may not be safe or effective for long-term chronic pain,” said Dr. Kolodny, who has been critical of opioid prescribing practices.
Most experts now believe that while helpful in treating pain from injuries and surgery, opioids should be discontinued as quickly as possible. However, the Express Scripts study found that a large percentage of patients, nearly half, who took an opioid for 30 days or more continued to use the drug long term. Dr. Stettin said patients with chronic pain should be receiving longer-acting drugs that work round the clock. But the study found that about half of those patients were taking short-acting opioids.
“It’s just not the proper way to manage chronic pain,” he said. “That’s a red flag that they are either not being managed correctly, or something else is going on.”
Other aspects of the report mirrored previous research on opioid painkillers. Their use is more prevalent among women and the elderly. Opioid use also varies greatly by geography: people in the Southeast — particularly those living in small cities in Kentucky, Alabama, Georgia and Arkansas — tended to use opioids in greater concentrations than in other regions of the country, especially large cities.
Dr. Stettin said he was heartened that overall use of opioids had fallen, especially for people using them to treat short-term ailments.
Given their addicting potential, he said, “It’s our hope that physicians remain reluctant to start people on an opioid pain medication when they’re not necessary, and that there’s an increase in public awareness that people shouldn’t want to get involved with these medications if they don’t need them.”
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