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Beware of potent painkillers

Last updated: February 2011

Pain is one of the most common reasons people seek medical care. But potent opioid drugs that are being increasingly prescribed for relief carry serious risks that can be worse than the pain. Sold under familiar names such as Oxycontin (oxycodone), morphine, and methadone, a significant rise in fatal overdoses during the past several years has spurred nationwide concern. And a recent study suggests that opioids might be particularly risky for seniors.

Despite the dangers, opioids are one of the most widely prescribed drugs. More than 4 million Americans take them regularly for chronic pain and other conditions, and as many as 10 million might be taking them in any given week, according to a 2010 study published in the medical journal Pain.

Accidental overdose

Prescriptions for two of the most common opioids—hydrocodone and oxycodone—nearly doubled from 2001 to 2006.

As prescriptions for these drugs have risen, so have serious adverse events. Fatal overdoses of opioids rose from 4,000 in 1999 to 13,800 in 2006, according to the Centers for Disease Control and Prevention. Emergency-room visits for opioid-related problems jumped 111 percent from 2004 to 2008 (144,600 to 305,900 visits), with the highest number attributed to oxycodone, hydrocodone (Vicodin) and methadone. (The number also includes people who abused the drugs.)

A study in the Dec 13-27, 2010, issue of the Archives of Internal Medicine found that seniors who took opioids had a greater number of fractures of the hip, pelvis and other bones, hospitalization, and death than those taking other types of painkillers.

"It's important to be cautious with all medications, but it's especially important with opioids," said Daniel Budnitz, M.D., a medical epidemiologist and director of the CDC's medication safety program. "These are drugs that are easy to overdose on. One high dose pill can kill."

The main reason, Budnitz explained, is that over time, people can develop a tolerance for opioids and might need to increase the dose to relieve their pain.

Higher doses also increase the risk of developing physical dependence and addiction to the medication. Recreational abuse of opioids is another concern. Prescription drugs—including opioids—are the second most commonly abused substance after marijuana.

"Opioid overdoses are a significant public health problem," said Perry Fine, M.D., a professor of anesthesiology at the University of Utah and president-elect of the American Academy of Pain Medicine. "The availability of more prescription opioids is now contributing to the growing problem of substance abuse and misuse in the U.S.

Do you really need an opioid?

One way to avoid problems with opioids is to make sure you need them first. Other potentially less risky pain relievers—such as acetaminophen (Tylenol and generic), ibuprofen (Advil, Motrin, and generic), naproxen (Aleve, Naprosyn, and generic), or salsalate—can often provide enough relief.

"You always want to question anytime you're being prescribed a drug if it is the best thing for you," Fine said. It's important to ask your doctor how you can use the drug safely and whether there are other treatments that can provide the same benefit with less risk. "A responsible prescriber should and would want to talk about those things,."

Some kinds of chronic pain in particular—such as nerve pain, migraines, or fibromyalgia—are best treated with other types of medication, not opioids. Talk with your doctor about nondrug measures, too. Studies have found that they can ease chronic pain, either alone or with drugs. They include cognitive behavioral therapy, exercise, spinal manipulation, and physical rehab programs.

Medical evidence has found that while opioids are highly effective in relieving acute severe pain, they're only moderately effective in treating long-term chronic pain, and their effectiveness can diminish over time. They can also cause a number of side effects, and when taken in excessive amounts, they can suppress and even stop breathing. The long-term use of opioids has not been well-studied but has been linked to a loss of interest in sex and impaired sexual function; a decline in immune function; and, paradoxically, an increase in the body's sensitivity to pain.

If you must take an opioid, don't take more than recommended by your doctor, don't take it with alcohol, and don't combine it with other sedative or anti-anxiety medication unless otherwise directed by your doctor. Here are several other tips offered by Fine:

  • Read the labeling and use only as directed by your doctor.
  • Carry a list of all the drugs you take, as well as who prescribed them and for what reason, so when you visit a doctor he or she will know all the medication you are currently on. This is especially important for opioids, because drug interactions can be dangerous.
  • If you develop a cold, an asthma flare-up, bronchitis, or any other respiratory problem that makes breathing difficult while taking an opioid, let your doctor know because you might need to lower your dose until you recover.
  • If you snore loudly, you should be checked for sleep apnea. Opioids can make that condition worse or even fatal.
  • Put opioid medication in a lockbox to prevent children from taking them or others from using them for recreational purposes. You should be especially careful safeguarding this medication due to the potential for addiction and abuse. Your doctor or pharmacist might suspect there's a problem if you ask for an early refill or a new prescription due to lost or stolen medication.
  • If you have extra opioid pills, do not save them. You can give them back to your pharmacist if he or she participates in a drug take-back program. If there is no such program in your area, the Food and Drug Administration recommends that excess opioid medication be flushed down the toilet. You can read more about proper drug disposal here.

"If these things were done, that would make a huge difference and help reduce the problem of opioid overdoses," Fine said.

You might hear more about this issue in coming months. The FDA is currently developing a plan aimed at curbing the dangers these drugs pose. The plan—which would apply to fentanyl, hydromorphone, methadone, morphine, oxycodone, and oxymorphone—calls for educational programs for doctors to help ensure they prescribe opioids appropriately and advise patients about how to use them safely. But a panel of experts convened by the FDA in July 2010 voted against the plan, saying it needed to go further in combating the problem.

The FDA is now reviewing the panel's suggestions and says such a plan is in the works, according to a spokeswoman, Shelly Burgess.

To learn more about opioids, see our free Best Buy Drug report.

These materials were made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin.

If you think you have experienced an adverse event with this drug or any drug, especially if it is of a serious nature, it is important to 1) tell your doctor immediately and 2) report the event to the Food and Drug Administration via the FDA's MedWatch Web site at www.accessdata.fda.gov/scripts/medwatch/medwatch-online.htm or by calling 1-800-FDA-1088.

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