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There's no question that Hollywood has been hit hard in the last several years by prescription drug overdoses: The deaths of Jeff Conway, Brittany Murphy, Heath Ledger and others have been linked to lethal combinations or quantities of drugs typically prescribed by a doctor to treat pain, anxiety and insomnia. But new research shows that ODing on these meds has actually become dramatically more common overall, and women are at special risk.
Between 1999 and 2006, hospitalizations for prescription-drug poisoning--specifically for opioids (pain meds), benzodiazepines (anti-anxiety and sleep aids) and tranquilizers--soared by 65 percent. Fifty-nine percent of those patients were middle-aged women. We asked study co-author Jeffrey Coben, M.D., director of the West Virginia University Injury Control Research Center, to fill us in on this growing problem.
A 65 percent increase in hospitalizations for these drug overdoses sounds pretty scary. How concerned do we need to be about this?
It's a pretty significant problem. People have heard in the news about some high-profile cases involving celebrities, and they think it's sad and tragic but doesn't really affect the majority of normal people out there. This actually points out that this is a significant problem that affects a lot of people and we're seeing it in a lot of hospitals around the country. This has definitely been escalating at a much higher rate in the last 10 years.
Why is that?
There are multiple factors. In the early 1990s there were several guidelines that suggested physicians weren't adequately treating pain and needed to be somewhat more liberal in their approach in providing pain medications. Since then, there's been a documented, large increase in prescriptions of opioid analgesics (pain medicines) by healthcare providers. Much of that has been appropriate, but it has basically increased the amount and availability of these drugs in the general population.
There also have been studies showing that attitudes toward use of these drugs are generally different than attitudes toward street drugs like heroin and cocaine. Young people in particular believe they are less dangerous, less addictive and easier to obtain.
Finally, an illegal market, including on the Internet, has been established. A lot of factors are bringing this all into play.
Why study hospitalizations? Are they a foreshadowing of death from overdose from these drugs?
That's a real concern of ours. We don't know whether people who are hospitalized with overdoses are at greater risk for dying from them, but that's certainly quite possible. You could look at these folks as having near misses. The only thing that may distinguish someone who survives an overdose with someone who does not is whether there's a bystander available who provides first aid.
The study notes that the biggest increase in hospitalizations was for benzodiazapines. What are benzodiazapines, and why are they being implicated more now than before?
Benzodiazepines are a class of medications that generally are prescribed for their sedation and effects for reducing anxiety. The most common one is Valium. These medicines are also used for other purposes like muscle spasms, back pain or neck pain.
Exactly why we saw the largest increase in that one class, I'm not sure. It may be related to their overall distribution in the population. We're probably seeing that they're being used in combination with opioids, but we couldn't tease that out without doing toxicology analyses. It's hard to say if they're more dangerous than previously thought.
These drugs have eclipsed painkillers as the No. 1 type of prescription drug implicated in these overdoses. Are they easier to get a prescription for now that so much attention is being paid to recreational use of and addiction to painkillers?
Something we alluded to in the study is that the majority of focus has been on opiates and less on benzodiazepines. There may be a need to look more closely at this.
You found that most of the people hospitalized for these overdoses were middle-aged women between 35-54. Why the gender disproportion, and what about this age group makes them most likely to be affected by this problem?
What accounts for the difference we're seeing in gender? We're not exactly sure. Men seem to be at highest risk for fatal -- but unintentional -- drug overdoses, including with prescription drugs. But we saw that women were hospitalized for intentional overdoses at a greater frequency than men were. We're seeing an increasing number of self-harm attempts by women using prescription drugs. This may reflect what's seen in general for suicide attempts or drug overdoses that are intentional in nature: nonfatal suicide attempts more frequently occur in women. When men attempt suicide, they are more often successful--they use a gun or jump off a bridge. Women use less fatal methods and may not be successful.
Women also tend to see healthcare providers more frequently than men do, and the more contact there is with the healthcare system, the greater likelihood prescriptions will be provided. That also may be part of it.
Just a few years ago, accidental overdose became the leading cause of death from injury in people 35-54, and second only to motor vehicle accidents for people younger than 35. That sounds pretty serious.
It's always been the motor vehicle injuries that were the leading cause of unintentional injury deaths for middle-aged people, and over the last two or three years, prescription drugs have assumed that dubious distinction. We’ve been studying motor vehicle injuries and how to approach those for almost 30 years now, or even longer, and a lot has been done and accomplished in that time when you consider seat belt laws, airbags, rollover improvements, safer highways and reduced alcohol-related injuries.
Now we've got this emerging problem that frankly we've got to get our act together on and figure out how to intervene. Use of prescription medicines is potentially dangerous. They are powerful drugs and it's important to use them only as they're prescribed by a healthcare provider. If people get in a situation where they feel as though they must have these medicines on a daily basis, I'd encourage them to seek treatment. Be an educated consumer... These are potentially dangerous drugs and you've got to be careful in their use.
Join us for a #endmedicineabuse Twitter chat on Monday September 24, 2012 at 8:00pm EST. Our hosts, @StevePasierb and @MedicineAbuse, will answer your questions and give you expert advice on how to protect your children from medicine abuse.