Who Is Most Likely to Overdose on a Painkiller?
by Arthur Robinson Williams, MD, MBE on August 31, 2015 in Drug Addiction Expert Blogs 2Unintentional overdose deaths in the U.S. have been skyrocketing in the past decade, largely due to the widespread increase in long-term use of opioid pain pills like OxyContin, Vicodin, Percocet and others used to treat chronic pain. More recently, there has also been an upswing in heroin-related overdose deaths as people move from expensive pharmaceuticals to cheaper heroin. Because heroin is traded in the black market, its potency is unknown and it’s often contaminated with adulterants. People who progress to using heroin are also more likely to start injecting drugs, which carries additional risks such as disease transmission (hepatitis C, HIV), skin infections and abscesses, and, again, overdose. An overdose from opiates (which includes narcotic painkillers and heroin) is when someone stops breathing and loses oxygen to the brain, potentially causing death.
Who is most likely to die from an overdose specifically related to pain pills? There are a few indicators that are now known to portend bad outcomes, namely:
Aside from the total dose (number of milligrams) taken over the course of each day, the duration of action can also increase risk for overdose. Namely, extended release (“XR”), controlled release (“CR”) and long-acting (“LA”) formulations tend to be associated disproportionately with overdoses. In general, some longer-acting medications can build up to dangerous levels in the body if taken too closely together. Sometimes the pain relief from a pill wears off before blood levels actually decrease. Patients in desperation for more relief may keep taking pills (such as methadone pills) to maintain the analgesic effect without realizing that their blood levels are climbing to dangerous levels. In other words, sometimes the subjective effect that you feel from a medication doesn’t fully represent the circulating blood levels of that medication.
What Dramatically Raises OD RiskThe riskiest behavior involves combining opioid pain pills with benzodiazepines such as Xanax, Klonopin, Ativan and others, and/or with alcohol. All three of these classes of substances suppress the body’s ability to keep breathing. When taken in combination they have synergistic effects that exponentially increase the risk of fatal overdose. Even individuals with a high tolerance to opioids remain at heightened risk of overdose when taking even small amounts of benzodiazepines or alcohol.
Finally, all of the above risk factors are multiplied among people with a pre-existing health problem such as lung disease (COPD), heart disease (congestive heart failure, aortic insufficiency) or a neurologic condition like dementia, a prior stroke or any brain injury.
Opioid painkillers certainly have important roles to play in clinical and surgical medicine, but at high doses and in combination with other medications they warrant close scrutiny to prevent a life-threatening overdose. Part of the physician’s responsibility, both clinically and legally, is to assess their patients for the risks and benefits of every treatment the doctor prescribes. If you feel your physician is not adequately addressing your questions, consider getting a second opinion. Just as a second opinion can be helpful in making a diagnosis or determining a treatment plan, it’s worth considering getting input from another doctor if you have concerns about your pain regimen and ways to reduce your risk of overdose.
Arthur Robinson Williams, MD, MBE
Arthur Robinson Williams, MD, MBE, graduated from the Woodrow Wilson School at Princeton University and the Perelman School of Medicine at the University of Pennsylvania where he also earned a Master in Bioethics from the Center for Bioethics. He completed his residency at NYU-Bellevue and is a board-certified psychiatrist. He currently works in a clinical and research position at Columbia University in the Division of Substance Abuse, Department of Psychiatry. His research addressing addiction and mental illness, policy and the law has been published widely. Dr. Williams also maintains a limited private practice in New York City and can be reached at [email protected].
Read more from this expert's blog: A Sober Look at the Science of Addiction and Mental Illness
by Arthur Robinson Williams, MD, MBE on August 31, 2015 in Drug Addiction Expert Blogs 2Unintentional overdose deaths in the U.S. have been skyrocketing in the past decade, largely due to the widespread increase in long-term use of opioid pain pills like OxyContin, Vicodin, Percocet and others used to treat chronic pain. More recently, there has also been an upswing in heroin-related overdose deaths as people move from expensive pharmaceuticals to cheaper heroin. Because heroin is traded in the black market, its potency is unknown and it’s often contaminated with adulterants. People who progress to using heroin are also more likely to start injecting drugs, which carries additional risks such as disease transmission (hepatitis C, HIV), skin infections and abscesses, and, again, overdose. An overdose from opiates (which includes narcotic painkillers and heroin) is when someone stops breathing and loses oxygen to the brain, potentially causing death.
Who is most likely to die from an overdose specifically related to pain pills? There are a few indicators that are now known to portend bad outcomes, namely:
- Being on a high dose of opioids
- Taking a long-acting version of a prescription painkiller
- Taking a benzodiazepine and/or alcohol along with a prescription painkiller
- Having a medical condition, such as a lung, heart, or neurologic disease
Aside from the total dose (number of milligrams) taken over the course of each day, the duration of action can also increase risk for overdose. Namely, extended release (“XR”), controlled release (“CR”) and long-acting (“LA”) formulations tend to be associated disproportionately with overdoses. In general, some longer-acting medications can build up to dangerous levels in the body if taken too closely together. Sometimes the pain relief from a pill wears off before blood levels actually decrease. Patients in desperation for more relief may keep taking pills (such as methadone pills) to maintain the analgesic effect without realizing that their blood levels are climbing to dangerous levels. In other words, sometimes the subjective effect that you feel from a medication doesn’t fully represent the circulating blood levels of that medication.
What Dramatically Raises OD RiskThe riskiest behavior involves combining opioid pain pills with benzodiazepines such as Xanax, Klonopin, Ativan and others, and/or with alcohol. All three of these classes of substances suppress the body’s ability to keep breathing. When taken in combination they have synergistic effects that exponentially increase the risk of fatal overdose. Even individuals with a high tolerance to opioids remain at heightened risk of overdose when taking even small amounts of benzodiazepines or alcohol.
Finally, all of the above risk factors are multiplied among people with a pre-existing health problem such as lung disease (COPD), heart disease (congestive heart failure, aortic insufficiency) or a neurologic condition like dementia, a prior stroke or any brain injury.
Opioid painkillers certainly have important roles to play in clinical and surgical medicine, but at high doses and in combination with other medications they warrant close scrutiny to prevent a life-threatening overdose. Part of the physician’s responsibility, both clinically and legally, is to assess their patients for the risks and benefits of every treatment the doctor prescribes. If you feel your physician is not adequately addressing your questions, consider getting a second opinion. Just as a second opinion can be helpful in making a diagnosis or determining a treatment plan, it’s worth considering getting input from another doctor if you have concerns about your pain regimen and ways to reduce your risk of overdose.
Arthur Robinson Williams, MD, MBE
Arthur Robinson Williams, MD, MBE, graduated from the Woodrow Wilson School at Princeton University and the Perelman School of Medicine at the University of Pennsylvania where he also earned a Master in Bioethics from the Center for Bioethics. He completed his residency at NYU-Bellevue and is a board-certified psychiatrist. He currently works in a clinical and research position at Columbia University in the Division of Substance Abuse, Department of Psychiatry. His research addressing addiction and mental illness, policy and the law has been published widely. Dr. Williams also maintains a limited private practice in New York City and can be reached at [email protected].
Read more from this expert's blog: A Sober Look at the Science of Addiction and Mental Illness