PBS NewsHour recently aired a report on prescription drug abuse that led viewers to ask many questions. We asked the CDC to answer them, below.
One in 20 people in the United States say they’ve used prescription painkillers for non-medical reasons in the last year, according to the Centers for Disease Control and Prevention. Many ended up addicted.
In fact, overdoses tied to common opioid or narcotic pain relievers — like Vicodin (hydrocodone), OxyContin (oxycodone), Opana (oxymorphone), and methadone — killed more than 16,500 people in 2010. That’s roughly 45 deaths per day — quadruple the amount killed from those drugs in 1999.
Enough painkillers were prescribed in 2010 to medicate each American adult every four hours for a month, CDC officials say. The quantity sold to pharmacies, hospitals and doctors offices in 2010 was four times higher than a decade earlier. And when doctors prescribe more than a patient needs, the drugs often make their way into the wrong hands.
Recently on the PBS NewsHour, health correspondent Betty Ann Bowser traveled to Oklahoma to profile the personal consequences of this addiction for people like University of Oklahoma linebacker Austin Box, who died suddenly after an accidental overdose in 2011. The Box family was stunned. They saw Austin regularly and had no idea he had a problem, let alone one that would kill him at age 22.
After the NewsHour story aired, we received dozens of questions about this growing problem. Below, CDC officials answer many of them.
Need a review of the basics first? Read the “Top 10 Things the CDC Says You Should Know About Prescription Drug Abuse” and watch Bowser’s full NewsHour segment here:
Prescription Drug Abuse: CDC Answers Your Questions
Viewer Question 1: Many states have prescription limits. Are doctors simply ignoring these? Or do they prescribe more doses per patient than is required for relief?
CDC: Thirty-five states had some kind of prescription limit laws by August 2010. However, most such laws are restricted to certain schedules of drugs, to emergency prescriptions or to members of certain benefit plans (such as Medicaid). Very few states have laws requiring specific steps when exceeding daily dosage limits for all prescription painkillers (also called opioid pain relievers). The existing limits do not place major constraints on prescribing.
Viewer Question 2: Do physicians make any money when a patient fills his or her prescription for narcotics? Do they have other incentives or fears that may cause them to over-prescribe opiates?
CDC: No, physicians do not receive a fee when a patient fills an opioid prescription unless that physician is also authorized to dispense those drugs. They might charge an extra fee in that case, just as a pharmacy does. But only a small minority of prescribing physicians also dispense medications. It’s also important to examine other potential incentives for prescribing decisions, like insurance coverage of certain drugs or inadequate coverage for physical or behavioral therapy.
Viewer Question 3: My son is addicted to opiates and is desperately seeking inpatient treatment. He was initially prescribed them for treatment of Piriformis Syndrome. He has no insurance and very little money, but we will find a way to pay for this treatment. He is currently living in North Carolina, but he is willing to go anywhere for treatment. We are all fully aware that his life is in danger. Is there somewhere you can direct me to find help for him? A place that effectively treats addiction as soon as possible?
CDC: We do not recommend specific facilities. It would be best to contact a service that helps find treatment resources. The Substance Abuse and Mental Health Services Administration provides such a source. You can reach their treatment referral line by phone at: 800-662-HELP. You can also click on the “treatment locater” link at: http://www.samhsa.gov.
Viewer Question 4: Does CDC have data on the percentage of prescription overdose deaths that also had illegal drugs like marijuana in their system? Or alcohol? How do these substances interact with prescription drugs?
CDC: In 2010, marijuana was involved in less than 1 percent of prescription painkiller overdose deaths. Illegal drug involvement is much lower than other prescription drugs, like benzodiazepines (anti-anxiety medications like alprazolam [Xanax] or lorazepam [Ativan]). Benzodiazepines are recorded as contributing causes in 30 percent of prescription painkiller overdose deaths. Alcohol is recorded as a contributing cause in about 20 percent of prescription painkiller overdose deaths. Alcohol is also a depressant to the central nervous system. So the combined effect of alcohol and prescription painkillers can cause breathing to slow down so much that it stops.
Viewer Question 5: What is the correct way to dispose of prescription painkillers prescribed after surgery and no longer needed? I have heard some talk of putting them in coffee grounds and then putting them in the trash. Is that true? Is there a better method?
CDC: FDA has published guidelines on disposing of unused medicines — including steps for home disposal and information on drug take-back programs — which can be found here.
Viewer Question 6: How many people who end up addicted obtain these drugs legally through prescriptions? Or do people get them from people who obtain the pills illegally, i.e., drug dealers?
CDC: We know from national surveys, that most people (about 60 percent) who report using prescription painkillers non-medically (without a prescription or for the feeling they cause) obtain them from family or friends. More than one in six people (17 percent) who report using prescription painkillers non-medically said that they got the drugs they most recently used through a prescription from one doctor.
The more often people use such drugs non-medically, the more likely they are to turn to other sources such as drug dealers. We also know that a large number of people who die of prescription painkiller overdoses obtain their drugs without a prescription. It is difficult to estimate these numbers exactly because the source information is often not available or not accurate. We do know that women are more likely to start with a prescription and then move to nonmedical use than are men.
Viewer Question 7: My husband takes at least two Hydroco/Acetamin 10-325 (that is what it says on the label) every morning. He sometimes takes more during the day for pain. He had a car accident over 10 years ago and has pain from his injuries. When he takes a lot of the medication he acts goofy and slow. How do I know whether he is addicted or whether he really needs it for pain?
CDC: We can’t provide medical advice in individual cases. To ensure proper medical care, patients should discuss any and all drug use — including prescription and over-the-counter medications — with their doctors. You can find information about specific drugs, including their side effects, here.
Addiction can be defined using the ABCDE mnemonic as:
A) Inability to consistently Abstain;
B) Impairment in Behavioral control;
C) Craving; or increased “hunger” for drugs or rewarding experiences;
D) Diminished recognition of significant problems with one’s behaviors and interpersonal relationships; and
E) A dysfunctional Emotional response.
Viewer Question 8: What sort of income patterns do you see among abusers and which are more likely to end up dead? I know that hydrocodone is being talked about a lot by the FDA for possible C2 classification. Does C2 classification significantly reduce abuse and death or does the damage just shift to a new drug?
CDC: Prescription painkiller overdose deaths are more likely among people with lower education and income levels, people on Medicaid and the unemployed. It is difficult to predict what the effects of C2 classification of hydrocodone would be.
Viewer Question 10: I bet the real stats are much worse. They are only looking into a few pills, not all the new sleeping aids or ADHD meds, liver damage and suicide. They are looking at overdoses from a few of the big name downers … pills are a mess in this country. Are overdoses from other legal drugs — or in combination with some of the main opiates — being examined?
CDC: Yes, the CDC is looking at other types of pharmaceuticals. A recent CDC report published in the Feb 20, 2013, issue of the Journal of American Medical Association, for example, shows the number of overdose deaths involving 21 different types of pharmaceuticals. In particular, it shows the high involvement in overdose deaths of drugs prescribed for mental health conditions such as benzodiazepines, antidepressants and antipsychotics.
Viewer Question 11: Is there fear in the medical community that hesitancy over prescribing prescription drugs on the part of some doctors will lead to more pain for those who truly need these drugs?
CDC: The appropriate management of pain, including the use of prescription painkillers when necessary, remains a national goal. To date, there is no evidence that the legitimate use of prescription painkillers in the United States is declining as a result of attention to the overdose problem. Doctors should take precautions such as screening, urine drug tests and checking prescription drug monitoring programs before initiating prescriptions painkiller treatment in a patient and when deciding whether to continue their use. Prescription painkillers are powerful, addictive drugs, and should only be taken if necessary.
Top photo by flickr user ep_jhu.