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Prescription drug deaths drop, but still cause for concern

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After a decade of rapidly rising deaths from prescription drug overdoses from painkillers in Washington, a new trend has been spotted -- a downturn over four straight years.
The drop was significant, a decline of 23 percent from 2008 to 2011. Yet there is still cause for concern.
Snohomish County had a higher death rate from painkillers that the state average, with 201 deaths recorded from 2009 to 2011.
In recent years, statistics show that people in Snohomish County are more likely to die from an accidental drug overdose than in a car accident. The majority of unintentional poisoning deaths were caused by opioids, such as Vicodin. The drugs often were acquired illegally. That's one reason police and health officials have worked to get drug take-back programs operating here and across the state.
Even with the state's overall decline, the state still recorded 407 deaths from overdoses of prescription drug painkillers in 2011, the most recent data available.
The drugs involved with these deaths are known as opioids and can be addictive. They include drugs such as morphine, OxyContin, Percocet, and Vicodin.
"These aren't miracle drugs that make pain go away entirely," said Michael VonKorff an investigator at the Group Health Research Institute in Seattle. "For long-term use, they're modestly effective. The risks have been understated."
That's not an easy message to deliver to patients suffering from chronic pain, some of whom are on high doses of pain-killing medications.
Dr. Hannah Burdge, a Group Health doctor, decided to take on the challenge with her patients in 2008.
"There were some patients very, very afraid of having it taken away from them," she said.
Studies show that the powerful prescription pain relievers can be effective when used for relatively short periods of time, VonKorff said.
"The word painkiller is a little bit of a misnomer," said VonKorff, the Group Health investigator. "These aren't a simple solution for the problem of pain."
When these medications are used long-term for chronic pain, patients expect the same amount of relief. In reality, that's not what happens. The medications only reduce pain by up to 30 percent, Burdge said. Seventy percent of the pain is still there.
The longer patients are on high doses of these medications, the higher the risk for problems such as falling, car accidents, disrupted sleep and reduced testosterone levels, VonKorff said. And some pain medications reduce the body's ability to fight disease.
Potent pain medications were first introduced in the 1990s as a way to combat pain in patients dying from cancer.
Next, people began asking if they might also help with chronic, non-cancer pain, said Dr. Gary M. Franklin, medical director of the state's department of Labor and Industries. "The thought was, there's no problem with that," he said.
With marketing from pharmaceutical companies, demand for what had been a niche drug mushroomed into more widespread use.
In more than 20 states, including Washington, laws were changed so that physicians wouldn't be sanctioned for prescribing opiates for chronic pain, regardless of dose, Franklin said.
In 2005, Washington began to see a growing number of deaths due to overdoses of prescription pain pills, he said. In 2006, more than 16,000 people on state programs such as workman's compensation were using high levels, 120 milligrams, of opiates a day, he said.
In 2007, Washington became the first state in the nation to set guidelines for prescribing these medications, Franklin said. When the daily dose hit 120 milligrams and a patient's pain level hadn't improved, it advised prescribers to ask for advice before increasing the dosage.
Studies have shown that there is a dramatic increase in the risk of overdose when daily dosesehit 100 to 120 milligrams, he said.
"A lot of people are on more than one, a long- and short-acting opioide," he said. "You need to add it all up."
A statewide prescription monitoring database allows prescribers to see all the pain pills that their patients are receiving. The goal is to prevent patients from jumping from one doctor or emergency room to another to try to get multiple pain prescriptions.
Patients may not be taken off daily opiate medications, but they can be put on safer, lower doses, Burdge said.
When she first began her work with a group of more than 100 chronic pain patients, about one third were on high doses of prescription painkillers.
Some of the patients on high-dose prescriptions couldn't be convinced to try making a change and she recommended that they find another doctor. Of those who chose to keep her as their doctor, 20 get monthly refills, most of which are low-dose prescriptions, four are on moderate doses. None currently are on high doses, she said.
"What I tried to repeat over and over to them is I want you to live the best possible life you can," Burdge said. "And I'm not sure the current combination of medications are allowing you to do that."

By the numbers
Prescription pain medications in Washington 2009-2011:
45 to 54: The age group that has the highest deaths from prescription drugs.
6 per 100,000: The number of deaths statewide from prescription drugs
9 per 100,000: The average deaths from prescription drugs in Snohomish County.
230: The number of deaths in 2011 statewide caused by the type of methadone used for chronic pain relief. The drug caused a little more than half of all prescription drug deaths in that year.
Source: Washington State Department of Health
Story tags » HealthMedicines

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