A US Epidemic: Unintentional Prescription Drug Overdose

Unintended deaths from prescription drug overdoses  are the latest  focus of a “CDC Grand Rounds” in Morbidity and Mortality Weekly Report – MMWR. Grand Rounds is a monthly webcast created to foster discussion on major public health issues. Each session focuses on key challenges related to a specific health topic, and explores cutting-edge scientific evidence and potential impact of different interventions. The Grand Rounds sessions also highlight how CDC and its partners are already addressing these challenges and discuss the recommendations for future research and practice.

Medical experts in the US say deadly abuse of painkillers and other prescription drugs has reached epidemic levels. More than thirty-six thousand people died from drug overdoses in two thousand eight, the latest year available. That was almost as many as from road crashes. More than half of the overdoses involved drugs that need a doctor’s approval. And three-fourths of those deaths involved what are called opioid pain relievers. These include drugs like methadone, morphine, hydrocodone, also known as Vicodin and oxycodone, or OxyContin.

Death rates from prescription drugs were highest among people forty-five to fifty-four years old. This latest CDC report said painkiller deaths more than tripled in the past decade. They now top the number of heroin and cocaine deaths combined. The Obama administration released a plan last year to try to deal with the problem.  In this latest report, the authors point to various prevention strategies, including mandatory education for physicians as a prerequisite for obtaining Drug Enforcement Administration registration. The state of Washington is singled out for its approach in improving medical practices by offering opioid-prescribing guidelines.

Prescription Drug Overdoses — a U.S. Epidemic

MMWR Report: In 2007, approximately 27,000 unintentional drug overdose deaths occurred in the United States, one death every 19 minutes. Prescription drug abuse is the fastest growing drug problem in the United States. The increase in unintentional drug overdose death rates in recent years  has been driven by increased use of a class of prescription drugs called opioid analgesics. Since 2003, more overdose deaths have involved opioid analgesics than heroin and cocaine combined . In addition, for every unintentional overdose death related to an opioid analgesic, nine persons are admitted for substance abuse treatment, 35 visit emergency departments , 161 report drug abuse or dependence, and 461 report nonmedical uses of opioid analgesics. Implementing strategies that target those persons at greatest risk will require strong coordination and collaboration at the federal, state, local, and tribal levels, as well as engagement of parents, youth influencers, health-care professionals, and policy-makers.

Overall, rates of opioid analgesic misuse and overdose death are highest among men, persons aged 20–64 years, non-Hispanic whites, and poor and rural populations. Persons who have mental illness are overrepresented among both those who are prescribed opioids and those who overdose on them. Further defining populations at greater risk is critical for development and implementation of effective interventions. The two main populations in the United States at risk for prescription drug overdose are the approximately 9 million persons who report long-term medical use of opioids, and the roughly 5 million persons who report nonmedical use (i.e., use without a prescription or medical need), in the past month. In an attempt to treat patient pain better, practitioners have greatly increased their rate of opioid prescribing over the past decade. Drug distribution through the pharmaceutical supply chain was the equivalent of 96 mg of morphine per person in 1997 and approximately 700 mg per person in 2007, an increase of >600%. That 700 mg of morphine per person is enough for everyone in the United States to take a typical 5 mg dose of Vicodin (hydrocodone and acetaminophen) every 4 hours for 3 weeks. Persons who abuse opioids have learned to exploit this new practitioner sensitivity to patient pain, and clinicians struggle to treat patients without overprescribing these drugs. Read the full report »»»» www.cdc.gov/mmwr/