Are Prescription PainKillers America’s Most Toxic Drugs?
“The biggest and fastest-growing part of America’s drug problem is prescription drug abuse,” says Robert DuPont, a former White House drug czar and a former director of the National Institute on Drug Abuse. “The statistics are unmistakable.”
According to the Centers for Disease Control and Prevention the misuse and abuse of prescription medication has caused a drastic increase in substance fatal substance overdose. This epidemic has gone generally unrecognized and continues to claims thousands of lives each year around the world. 38,371 people died in 2007 as a result of drug overdose this makes overdose the 10th leading cause of death.
“The death toll is equivalent to a hundred 757s crashing and killing everybody on board every year, but this doesn’t make the news,” said Dan Bigg of the Chicago Recovery Alliance
“The number of overdose deaths from opioid painkillers — opium-like drugs that include morphine and codeine — more than tripled from 1999 to 2006, to 13,800 deaths that year” according to CDC statistics released Wednesday.
“About 120,000 Americans a year go to the emergency room after overdosing on opioid painkillers” says Laxmaiah Manchikanti, chief executive officer and board chairman for the American Society of Interventional Pain Physicians.
“In the past, most overdoses were due to illegal narcotics, such as heroin, with most deaths in big cities. Prescription painkillers have now surpassed heroin and cocaine, however, as the leading cause of fatal overdoses” Paulozzi says. “And the rate of fatal overdoses is now about as high in rural areas — 7.8 deaths per 100,000 people — as in cities, where the rate is 7.9 deaths per 100,000 people” according to a paper he published last year in Pharmacoepidemiology and Drug Safety.
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Experts have found that prescription drug abuse is an unidentified epidemic. Over 38,371 fatal overdoses occur each year. Of these, well over half are caused by prescription medications. Opiod pain relievers (OPR) alone account for almost 13,800 fatal overdoses in 2006. Two years later, 15,000 individuals fatally overdosed on OPRs. In the last 10 years, these numbers have nearly quadrupled. Likewise, the sales for OPRs have also quadrupled. In 1990, 10,000 people died as a result of drug overdose; just 15 years later the yearly numbers had tripled.
It’s time to face the facts; the more opiod based medications are produced and distributed, the more abuse occurs. Increasing cases of misuse and abuse equals more fatal overdoses. In just ten years, if this trend continues OPRs will cause 45,000 deaths in America alone.
Prescription drug over-dose death numbers are significantly higher than all illicit drugs combined. Heroin, methamphetamine, crack, cocaine, and other problematic illicit drugs equal only one-third of deaths by over-dose.
Prescription Drug Abuse Facts from the Office of National Drug Control Policy (ONDCP)
Reach Beyond Generational Boundaries:
Prescription drug abuse is an epidemic that reaches the vast majority of generations. Old or young every individual is susceptible to addiction and overdose.
Out of the top ten abused substances, amongst high-school seniors only four are not prescription medications. Even more daunting is the fact that when comparing the numbers from 1998 and the most recent studies more than four times as many individuals above 12 years old are receiving treatment for prescription drug abuse.
Studies suggest that last year nearly two million adults ages 50 and over used prescription medication for non-medical purposes. Also, the number of people in this age group who receive substance abuse treatment has doubled in the last 10 years.
The New Gateway Drug:
- Almost one-third of individuals who misuse or abuse substances for the first time start with some form of prescription drug.
- Prescription medication is the second most abused substance, second only to marijuana.
- In 2010 one of every twenty individuals, totaling 12 million adults, used prescription medications without having a prescription
Fentora, a popular narcotic painkiller manufactured by Cephalon, was implicated in the deaths of four people in September 2007. The drug, which was approved by the Food and Drug Administration (FDA) in 2006, is only approved for use in cancer patients with severe pain. Fentora contains fentanyl, a highly addictive opiate 80 times more powerful than morphine. Fentanyl is considered a Class II substance by the Drug Enforcement Administration, putting it in the same class as cocaine or heroin.
Fentora is a faster acting version of Cephalon’s Actiq, another narcotic painkiller. Sold as a berry-flavored lozenge on a stick, Actiq has been linked to more than 120 deaths, including those of two children who thought the drug was candy. Actiq will soon be available in a generic version, and Cephalon says that it will eventually seek approval for Fentora to be used to treat all acute pain that does not respond to other opiate painkillers.
Unlike Actiq, Fentora is sold in a pill form. For now, Fentora is approved only for use in cancer patients already taking morphine or other narcotic painkillers. Fentora was meant to relieve brief periods of break through pain that occurred following the administration of these other narcotic painkillers. According to the warning letter Cephalon sent to physicians following the four deaths related to Fentora, none of the fatalities occurred in cancer patients. Two deaths occurred in patients who were prescribed Fentora for headaches, a third death was the result of improper dosing, and a fourth used the drug to commit suicide.
Fentora off Label Use
Off label use occurs when a drug is used to treat a condition for which it was not approved. It is known that physicians prescribe Fentora to treat headaches and back pain, even though it is only indicated for use in cancer patients. Such off label use is not illegal. However, a drug company is barred from marketing a medication based on its off label uses.
Cephalon has been in trouble before for marketing the off label uses of Actiq. In 2006, an investigation conducted by the Wall Street Journal found that 80-percent of those being treated with Actiq were not cancer patients. That same investigation found that Cephalon often marketed Actiq to sports medicine and family practice physicians, not just cancer specialists. A 2006 investigation by the Connecticut Attorney General found evidence that Cephalon had been marketing Actiq for off-label use, including setting high sales quotas for the drug that could only be reached if Actiq was prescribed off-label.
Now, Cephalon is being investigated by Connecticut, as well as the US Attorney in Philadelphia and the US Congress, for the off label marketing of Fentora. Since it was approved, more than 80,000 prescriptions have been written for Fentora, a high number considering the limited uses for which it was approved. Considering Cephalon’s history of off-label marketing with Actiq, suspicions have been raised that the company is employing the same type of marketing with Fentora.
Darvon and Darvocet
Public Citizen’s Health Research Group asked the FDA on February 28, 2006 to issue a Darvon and Darvocet recall of the two popular painkillers. Among side effects of Darvocet and Darvon, the painkillers are alleged to have caused the deaths of at least 2,110 people between 1981 and 1999.
In January 2009, an FDA advisory panel narrowly voted 14-12 to recommend that the FDA remove Darvon and similar products from the market. Rather than heed the advice of its advisory panel, the FDA decided to permit continued marketing of Darvocet (despite reported Darvocet side effects) and other propoxyphene products, but required that a new boxed warning be added to the drug label alerting patients and health care professionals to the risk of a fatal overdose.
According to the AHRQ statistics, doctors, nurses and hospitals are to be blamed for the injuries and side effects resulting from various prescription drugs. It has been discovered that patients who received wrong prescription medications from doctors were the worst sufferers. More than 838,000 patients in outpatient and emergency services developed side effects from unspecified medicines, pain killers, antibiotics, tranquilizers and antidepressants, and corticosteroids. The AHRQ statistics state that of the 838,000 patients, more than 100,000 suffered from side effects of painkillers.
At the end of January, the FDA held a public hearing to reconsider the safety of Darvon, a painkiller that has been on the market since 1957. Following in the footsteps of the United Kingdom which banned the drug in 2005 after concluding the benefits of Darvon did not outweigh the serious risks. The panel voted 14 to 12 in favor of withdrawing the drug from the market. Safety panels are concerned that the weakness of the drug might induce drug dependence and overdose. In fact, the FDA safety panel found more than 3,000 cases connecting serious issues such as addiction, overdose, and suicide to Darvon. In recent years, more than 20 percent of deaths linked to Darvon have been suicides.
The Cochrane Review stated that when Tramadol is taken for up to 3 months, there may be decreased pain, improvements in function, stiffness, and overall well-being. However, Tramadol can cause side effects that are significant enough to require that the patient stop taking the medication. Risks outweigh benefits for many people who have tried Tramadol.
Washington State Methadone Problem
Assign a dot to each person who has died in Washington by accidentally overdosing on methadone, a commonly prescribed drug used to treat chronic pain. Since 2003, there are 2,173 of these dots. That alone is striking evidence, a graphic illustration of an ongoing epidemic.
But it’s the clusters that pop out — the concentration of dots in places with lower incomes.
Everett, whose residents earn less than the state average, has 99 dots. Bellevue, with more people and more money, has eight. Working-class Port Angeles has 40 dots. Mercer Island, upscale and more populous, has none.
For the past eight years, Washington has steered people with state-subsidized health care — Medicaid patients, injured workers and state employees — to methadone, a narcotic with two notable characteristics. The drug is cheap. The drug is unpredictable.