Prescription opioids can lead to addiction and death

Prescription drugs

Oleg Reznik — Various forms of addictions and drug addictions in particular have been increasing in the US over the past thirty years and probably longer before that. Health Policy Review published in 2007 indicates unintentional drug poisoning mortality rates increased on average 5.3% per year from 1979 to 1990 and 18.1% per year from 1990 to 2002; the rapid increase during the 1990s was attributed mostly to narcotics.

I have been treating addictions, parallel to my family practice, for the past seven years, and experienced these figures directly. While generally more fear and public dismay are centered around heroin use, the prescription opioids have been mostly hidden from the public eye till the past several years.

While the use of heroin has been increasing, both rate of increase and the absolute number of people affected, are much higher for prescription opioids. Between 1999 and 2002, the number of opioid analgesic poisonings on death certificates increased 91.2%, while heroin and cocaine poisonings increased 12.4% and 22.8%, respectively.

The same Health Policy Review has even more striking figures: the US, which constitutes about 5% of the world population, consumes 80% of world’s supply of pharmaceutical opioids.

Under the guise of “chronic pain management”, we in effect have legalized opioid distribution and consumption to unprecedented levels. There has been a 542% increase of New Abuse of Prescription Opioids Among Teenagers from 1992 to 2003. Here methadone, oxycodone, fentanyl, hydromorphone, hydrocodone, and morphine top the list.

A 2010 Morbidity and Mortality Weekly Report indicates that in 2008, drug overdoses in the United States caused 36,450 deaths. Opioid pain relievers were involved in 14,800 deaths (73.8%) of the 20,044 prescription drug overdose deaths. Death rates varied fivefold by state and were related to the rates of prescribing of these medications. In 2009, 1.2 million emergency department (ED) visits (an increase of 98.4% since 2004) were related to misuse or abuse of pharmaceuticals, compared with 1.0 million ED visits related to use of illicit drugs such as heroin and cocaine. In 2007, nearly 100 persons per day died of drug overdoses in the United States. The death rate of 11.8 per 100,000 population in 2007 was roughly three times the rate in 1991. Prescription drugs have accounted for most of the increase in those death rates since 1999.

The problem of prescription opioid use is multifaceted. First, there is a false perception of safety, as it is a pharmaceutically manufactured medication subject to various regulations and oversight. Second, there is also a lack of social stigma attributed to the street “hard drugs.” Third, there is a general acceptance among professionals and general public of the philosophy of drug dependence. Drugs that were originally meant for the management of acute traumatic pain, surgical pain, or terminal pain, have earned a place for the various daily aches and pains for which only half a century ago (and today in most developing countries) they would never be considered.

The view of health has changed from the one that places value on autonomous function on multiple levels accessible to a human being, to the one in which comfort takes number one place. Physical comfort took precedence over the capacity to participate in emotional, mental, social, family and spiritual life. Physical longevity took precedence over living a full life, since fullness of life cannot be quantitatively measured, or broken down into categories that can easily be compared to others.

The view of health-as-taking-drugs (non-habit forming drugs included), and disease as a random affliction, unrelated to the everyday life, contributes to this problem.

Other forms of addictions, including addictions to food, sexually related addictions, legal drugs, gambling, have existed for millennia and their magnitude is difficult to evaluate. I do not believe there has ever been a historical precedent to a regulated and systematically implemented addiction (daily use for many years) of the present day prescription opioid pain relievers.

Help is available, but the most common problem with treading addictions is an underestimation of their power. Relapses and switching to different forms of addictions are much more common than true recoveries. Accepting help from others is important, as self-deception is the very nature of addiction. True healing takes nothing less than a profound self-transformative process, and entails addressing issues with family, friends, and social network.



About the Author

Oleg Reznik, MD is a board certified family physician and book author, practicing in Oregon for ten years. He is the author of the book The Secrets of Medical Decision Making. Dr Reznik has a holistic approach to health, using conventional as well as alternative healing modalities, and treating addictions. Visit him online at www.olegreznikmd.com.