Monday, August 20, 2007

Prescription painkiller overuse can be a killer

The amount of five major painkillers sold at retail establishments rose 90 percent between 1997 and 2005, according to an Associated Press analysis of statistics from the Drug Enforcement Administration.

An AP investigation found these reasons for the increase:
The population is getting older. As age increases, so does the need for pain medications.
Drugmakers have embarked on unprecedented marketing campaigns.
A major change in pain management philosophy is now in its third decade.

Consider (however):
More people are abusing prescription painkillers because the medications are more available. The vast majority of people with prescriptions use the drugs safely. But the number of emergency room visits from painkiller abuse has increased more than 160 percent since 1995, according to the government.

We have been seeing an increase in deaths related to prescription painkillers. Some of those individuals have died by suicide, but most are accidental deaths. These accidental deaths fall into several categories: partying/experimenting, self-medication gone awry, over-prescribing and misuse. The misuse can be on the part of the decedent or, miserable dictu, on the part of the prescribing physician.

I have no problem with prescribing pain meds when appropriate and in needed doses, I have in the past treated many individuals with severe acute and chronic pain, including those with severe AIDS-related neuropathy. It is critical, however, to know the meds you are prescribing: actions, interactions, side-effects, etc.

We have had a few cases lately that have revealed that some physicians prescribe this class of meds without knowing quite what they are doing. For example, fentanyl (not looked at in the AP article, but one we are seeing with increased frequency). Fentanyl delivered in a skin patch has a very long half-life causing it to build in the body, if not used properly, until toxic and potentially lethal levels occur. When we have discussed this with a few physicians we found that they were unaware of that possibility and of some other characteristics unique to this drug and delivery system.

We have seen over-prescribing by a very few physicians, cases we have reported to Professional Regulation and the DEA. We have seen individuals taking meds who apply the “rule” that if “one is good a few are even better” with disastrous results. We have seen folks not controlling the meds they bring into their homes, often not realizing just how deadly they can be if misused.

Control of painkiller misuse and abuse, as is true of several things I have brought up in this blog, will require “system” changes. Our office will continue to work to stop those few “bad apple” doctors abusing the system, harming or contributing to the deaths of individuals. Other doctors must be educated or educate themselves regarding the proper indications and use of these pain meds, as well as their possible interactions with other meds, their potential side-effects, actions, pharmacokinetics, etc. People need to be aware that these drugs have a potential for addiction and abuse just like that street drugs and should be treated with “respect”.

Pain meds are useful tools, but like any tool, when improperly used they can harm or kill.


Anonymous said...

Have you seen any counterfeit pain killers coming into the county from Asia and Mexico? I heard they look like and are packaged like the real thing? Just wondering.
By the way, awesome blog, I read about it in the Trib today.

Dr. Richard Keller said...

We have seen medications from outside the country (e.g. recently some from India). It seems that those we have seen have contained the medication they were supposed to, although we do not test for impurities or adulterants. said...

What do you see can be done for over prescription of these drugs? what limits can be plced on pharmacies or prescribers?

Dr. Richard Keller said...

Pharmacies should serve as a “check” on physicians with regard to over-prescribing and some pharmacies do. Unfortunately individuals don’t necessarily stick with a single pharmacy so that that pharmacy can compare prescriptions or track filling practices of individuals. Pharmacies ought to feel that it is there role to report practices that seem beyond the norm, likely even mandated to report them. There are databases out there that ought to be available for “practice checks” if you will. They are currently used by pharmaceutical companies to know which docs are prescribing their meds and in what quantities. There are ways to monitor these practices; we just need to have the “will” to use them. By the same token, there needs to be more oversight of pharmacy dispensing practices to ensure they aren’t dispensing based on prescriptions that are obviously beyond usual and customary practice.

Anonymous said...

If you know of an individual that is abusing these meds who should you contact?

Dr. Richard Keller said...

That is an incredibly difficult position. Unfortunately, there really isn’t anyone to report it too. You can try to get them to seek help for themselves or if there is someone else in their life that might persuade them, you could enlist their help. The police might get involved if there is criminal activity involved. The state Department of Professional Regulation might listen if a doctor is inappropriately prescribing and involved in the individual’s abuse.