Painkillers kill

December 7, 2009 9:22 AM

Prescription painkillers kill more people than heroin, AIDS or H1N1.
posted by binturong (64 comments total)

Fixed for accuracy: Prescription painkillers kill more people than heroin, AIDS or H1N1... in Ontario.
posted by Pollomacho at 9:26 AM on December 7, 2009 [7 favorites]

...using more prescription opioids per capita than any country but any country but the United States and Belgium.

I do not think "than any country but any country but" means what you think it means.
posted by weapons-grade pandemonium at 9:29 AM on December 7, 2009 [5 favorites]

god damn it. now which one do I abuse in order to get high? I'm sick and tired of switching!
posted by shmegegge at 9:34 AM on December 7, 2009 [2 favorites]

If you could get a prescription for heroin from corrupt doctors...
posted by smackfu at 9:35 AM on December 7, 2009

Meanwhile non prescription pain killers kill even more people! (I bet)

And

The Canadian Medical Association study, released Monday, found that between 1991 and 2007, opioid-related deaths doubled in Ontario – from 13.7 per million people to 27.2.

That's not very many. With 13 million people, it works out to about 221 per year.
posted by delmoi at 9:35 AM on December 7, 2009

As someone who had two root canals (well, two halves of one) in two weeks, I'm boggled as to where these people find their painkillers to abuse.

I called for a refill and was treated like a goddamn junkie and I nearly yelled "STOP DRILLING MY TEETH TO SHARDS and I'll never call for another refill, until then I'll have to risk becoming addicted to your tiny 15 vicodin that you give me." Jesus Christ.
posted by unixrat at 9:38 AM on December 7, 2009 [5 favorites]

The O.C. (don't call it that)
posted by porn in the woods at 9:39 AM on December 7, 2009

And cars kill more than nuclear weapons!
posted by litleozy at 9:41 AM on December 7, 2009 [3 favorites]

OxyContin is an insane drug, extremely powerful and addictive. However, I think it's clear from the article that the problem may not even be the drug itself as much as it is the overuse of it coupled with the average person not having enough respect for the drug. From the article:

"The typical patient had seen a doctor 15 times in the year before they died. Those overdosing on oxycodone are predominantly people with family doctors or, at the very least, easy access to a walk-in clinic."

"One person in the data the provincial panel examined “walked out of the pharmacy with more than 2,000 pills” – all obtained through an apparently legitimate prescription."

"During that same period, oxycodone prescriptions – added in 2000 to the list of drugs Ontario's drug plan covers – shot up 850 per cent"

What did they expect? These results should be expected when you flood the market with very powerful downers. If someone can walk out with over 2000 pills it shows that abuse is built in to the system.

Finally, the article doesn't talk address the numbers from a 'per user' view point, only a total number of deaths. If as many people were using heroin as OC would the death rate be as high? I'm not suggesting prescription drug abuse isn't an issue, obviously it is. Sometimes these numbers are stated in a way that doesn't seem to make much sense to me.
posted by UserNumber42 at 9:41 AM on December 7, 2009

Hmm, according to this ther are about 7,600 deaths in the U.S each year due to non-prescription pain killers, or about 25 per million (assuming 300 million).

But Canada, with just 33 million people only suffers about 365 deaths due to non-perscription pain killers, and that's just 11 per million.

Perhaps with a national healtcare system, people are able to go to the doctor when they are in pain, rather then trying to self-treat with off the shelf aspirins/ibuprofens/etc and accidentally killing themselves.
posted by delmoi at 9:42 AM on December 7, 2009 [1 favorite]

delmoi: That's not very many. With 13 million people, it works out to about 221 per year.

We humans have awfully subjective standards for these things. If some questionable baby toy was killing "not very many" (i.e., 200+) Ontario infants every year, I believe that would cause some commotion.
posted by Western Infidels at 9:44 AM on December 7, 2009 [1 favorite]

After I got my wisdom teeth out, the first pharmacy my mom drove me to told us that we would have to wait until the next day for my percocet prescription... because they were out of percocet. That was kind of weird. I was a bloody, swollen mess, so we went to a different pharmacy, and then the percocet made me puke anyway.

Overall rating C-.
posted by oinopaponton at 9:47 AM on December 7, 2009

Well, if you restrict access to pain killers, it means that lots of people are going to suffer in debilitating pain because they don't have access.

So the question is "what's the appropriate ratio between people suffering in excruciating pain, to people dying from overdose from taking to many?"

Would you let 100 people suffer in extreme pain to prevent one of them from O.Ding? 1000?

Another important question is: just how many people are stupid enough to O.D? At some point, increasing availability won't increase overdoses, since most people probably won't overdose.

It's important to remember that there is a tradeoff here, and the tradeoff thousands or millions of people living with excruciating pain 24/7.
posted by delmoi at 9:48 AM on December 7, 2009 [21 favorites]

And yet alcohol is available over the counter.
posted by hermitosis at 9:49 AM on December 7, 2009 [6 favorites]

Drug overdose deaths have climbed dramatically in the U.S. as well, with nearly all the increase resulting from prescription opiate overdoses; this isn't limited to Ontario. Overdose is now the second leading cause of accidental death in the U.S., and the leading cause of accidental death in some states and in some age groups, like middle-aged men.

It's interesting that this article blames oxycodone, as in the US it is increasingly methadone prescribed for pain that is the problem. Doctors have switched prescribing practices from Oxy to methadone believing it less likely to be diverted, but methadone is easier to unintentionally overdose on.

There is an amazing program in North Carolina called Project Lazarus that encourages physicians to train their patients on how to avoid overdosing and gives patients naloxone, a very safe medication that can reverse an opiate overdose. If we spent more time distributing naloxone to patients and their family members, and less time treating people in pain like criminals, we might have a better chance of reducing the number of overdose deaths.
posted by gingerbeer at 9:51 AM on December 7, 2009 [16 favorites]

We humans have awfully subjective standards for these things. If some questionable baby toy was killing "not very many" (i.e., 200+) Ontario infants every year, I believe that would cause some commotion.

So what? We're not talking about infants, we're talking about, presumably mostly adults, accidentally killing themselves.

Now, granted it might be possible to reduce those numbers by making sure people understand the dangers, but ultimately adults are responsible for their own well-being. I'm sure lots of people die in motorcycle accidents in Canada, I doubt it gets that much play beyond reminding people to wear helmets.
posted by delmoi at 9:51 AM on December 7, 2009 [1 favorite]

See also.
posted by jeffamaphone at 9:53 AM on December 7, 2009

delmoi: "We're not talking about infants, we're talking about, presumably mostly adults, accidentally killing themselves."

ha. I know you're aware there's more to it than that. not all overdoses are accidental, and not all accidental overdoses are the result of a simple mistake in proper medication, even with a prescription. sometimes we see a problem only when a number is brought to our attention, so the context makes it more important to us, such as why so many people are getting so much medication. 211 a year could simply be mistakenly taking more than prescribed, or 211 people a year could be evidence of systemic abuse we can address.
posted by shmegegge at 9:57 AM on December 7, 2009

We humans have awfully subjective standards for these things. If some questionable baby toy was killing "not very many" (i.e., 200+) Ontario infants every year, I believe that would cause some commotion.

In 1996, NSAIDs (aspirin, ibuprofen, naproxen, diclofenac, ketoprofen, and tiaprofenic acid) accounted for 7600 deaths in the US.
posted by krinklyfig at 10:01 AM on December 7, 2009

If we spent more time distributing naloxone to patients and their family members, and less time treating people in pain like criminals, we might have a better chance of reducing the number of overdose deaths.

my brother used to say, 'what comes first? the trucker or the belt buckle? i mean, do people get into long-haul trucking because they like the belt buckles, or is the belt buckle something they acquire after they get the job?

i would postulate that the same applies here: what comes first? the pain or the painkiller?
posted by msconduct at 10:03 AM on December 7, 2009

15 doctor visits over a year sounds like a lot, the kind of number of visits someone with a terminal condition might have... could it be that these drugs are the preferred method of doctor assisted suicide?
posted by acro at 10:04 AM on December 7, 2009

"One person in the data the provincial panel examined “walked out of the pharmacy with more than 2,000 pills” – all obtained through an apparently legitimate prescription."

I'm curious as to why the pharmacist allowed that to happen. AFAIK, the pharmacist bears some responsibility for ensuring the prescription makes sense. 2000 highly addictive painkillers in one swell foop is not sensible.
posted by five fresh fish at 10:04 AM on December 7, 2009

It's interesting that this article blames oxycodone, as in the US it is increasingly methadone prescribed for pain that is the problem. Doctors have switched prescribing practices from Oxy to methadone believing it less likely to be diverted, but methadone is easier to unintentionally overdose on.

Methadone is also highly addictive. It doesn't have the same debilitating side effects as most opiods, but many addicts started out addicted to methadone, which is many times what they end up doing trying to kick from heroin.
posted by krinklyfig at 10:04 AM on December 7, 2009

I note, for discussion's sake, that the linked article seems to assume all the overdose deaths were unintentional. As small a number (per-capita) of deaths as we are discussing, I'm surprised that the idea that a good number of these may well be suicides isn't even on the table.
posted by Thorzdad at 10:06 AM on December 7, 2009

shmegeggeha : not all overdoses are accidental

Bingo.

I would very much like to see a breakdown of these numbers that includes how many of them come from terminally ill people.

We may have a culture that officially opposes euthanasia, but we tend to give (for example) hospice patients access to enough opiates to kill a herd of horses. Granted, late-stage cancer combined with a serious tolerance means they need some scarily high doses just to get relief from the pain, but I know I'd rather shuffle off this mortal coil than rot in bed for two months of agony with no chance of recovery.
posted by pla at 10:09 AM on December 7, 2009 [3 favorites]

Infographic
posted by the cuban at 10:11 AM on December 7, 2009 [1 favorite]

Prescription painkillers are useful. AIDS, the flu, and heroin (now that we have opiates and opioid analogues manufactured to clinical standards) are not.
posted by Inspector.Gadget at 10:12 AM on December 7, 2009

It is hard to know how many deaths are accidental, but there's a different code for suicide, and the coroner should use that code when reporting the cause of death. That's not to say that there aren't family pressures to record something as an accident, etc., but at least for the CDC reporting in the U.S., they make some effort to keep non-accidental deaths out of the accidental death figures. I can't say for Ontario's process though.

Methadone is also highly addictive. It doesn't have the same debilitating side effects as most opiods, but many addicts started out addicted to methadone, which is many times what they end up doing trying to kick from heroin.

I'm not saying that people don't develop a dependence on methadone, although I would disagree that "many" addicts start out with methadone. Far more likely to be either street heroin or other prescription opiates. At least that's true in my area. The irony is that physicians have been trying to do some harm reduction and switching from prescribing the drug most likely to be diverted and abused, and ended up prescribing one that has a worse safety profile, and is easier to accidentally overdose on.
posted by gingerbeer at 10:15 AM on December 7, 2009

Meanwhile, alcohol kills more people than everything else combined, excepting organized religion.

(couldn't find any info in the article about alcohol-painkiller interactions, which was probably a big chunk)
posted by Eideteker at 10:24 AM on December 7, 2009

FTA: If you were seeing your doctor 15 times in the year before you died, that means there are 15 visits where the fact that a person was on multiple drugs … could be addressed. Alternative strategies for dealing with chronic pain could be considered.

If you saw your doctor 15 times in the last year of your life, it tends to suggest that perhaps you have more going on than a case of the sniffles. As for "other strategies", with the exception of purely neurogenic pain, no other effective strategies really exist as an option. A lot of "fringe" alternatives seem to work for a small number of people (hypnosis, VR, accupuncture, etc), but to put it bluntly, modern medical science has exactly one truly effective weapon against moderate to severe pain - Opiates.

Not to say that "doctor shopping" doesn't happen - Of course some people go around collecting scripts either to get high or to sell, and it might even fall into the majority (most casual drug users don't OD, so we only hear about the unlucky or the worst-of-the-worst); But progressively more severe crackdowns only hurt those who really do need some degree of pain relief.


krinklyfig : Methadone is also highly addictive. It doesn't have the same debilitating side effects as most opiods

Not sure what you mean by that, methadone has pretty much the same side effect profile as any other opiate. It does, however, have one feature that makes it a factor in a good number of deaths (as well as a useful drug in treating long-term pain, ironically enough) - It has a long biological half-life. And an interesting feature of the opiate "buzz", it largely wears off before the drug does. So random-junkie gets a fix of methadone, later that day the high wears off and he scores some OC80s, crushes one up, and snorts it. Normally he has enough of a tolerance to handle 80mg of oxycodone, but he still has a hefty level of methadone in his body. Next morning, a friend finds him dead in a pool of his own vomit.
posted by pla at 10:25 AM on December 7, 2009

If the U.S. data here is too much of a derail, I'll back off. I work on this stuff, so have a lot of info around. Here's the report from the CDC from earlier this year. This report includes intentional ODs in the numbers.

Some excerpts:

From 1999 through 2006, the number of fatal poisonings involving opioid analgesics more than tripled from 4,000 to 13,800 deaths.

In 2006, the rate of poisoning deaths involving opioid analgesics was higher for males, persons aged 35-54 years, and non-Hispanic white persons than for females and those in other age and racial/ethnic groups.

The number of poisoning deaths involving methadone increased nearly sevenfold from almost 790 in 1999 to almost 5,420 in 2006, which is the most rapid increase among opioid analgesics and other narcotics involved in poisoning deaths.

For what it's worth, those over 65 have the lowest rate of overdose deaths, which may argue against the euthanasia perspective.

A couple of other resources:

Closing Death's Door (pdf)
Preventing Overdose, Saving Lives (pdf)
posted by gingerbeer at 10:26 AM on December 7, 2009 [2 favorites]

How many people died from smoking marijuana, again?

Oh yeah. None.
posted by fourcheesemac at 10:30 AM on December 7, 2009

Prescription painkillers kill more people than heroin, AIDS or H1N1.

This doesn't strike me as being of particular note. The more interesting statistics would be on a per-affected basis.

That is, I am guessing that far more people take prescription painkillers than take heroin. Without taking that information into account, a flat "kills more people" isn't particularly meaningful. I bet that more people are killed while walking or jogging than are killed by heroin, too.

To be clear, I'm not saying that it's not important, or even that heroin is obviously worse. I'm just saying the information given to us doesn't really allow us to justifiably reach a conclusion.

delmoi: That's not very many. With 13 million people, it works out to about 221 per year.

We humans have awfully subjective standards for these things. If some questionable baby toy was killing "not very many" (i.e., 200+) Ontario infants every year, I believe that would cause some commotion.

This suffers from a similar problem. "Two hundred infant deaths" per year is a vastly different thing than "two hundred deaths per year"; there are a whole lot less infants than there are people.
posted by Flunkie at 10:30 AM on December 7, 2009

And an interesting feature of the opiate "buzz", it largely wears off before the drug does. So random-junkie gets a fix of methadone, later that day the high wears off and he scores some OC80s, crushes one up, and snorts it. Normally he has enough of a tolerance to handle 80mg of oxycodone, but he still has a hefty level of methadone in his body. Next morning, a friend finds him dead in a pool of his own vomit.

Yes, but it is used as a way to kick opiods, and a lot of people end up really struggling with kicking methadone when they're ready to get clean for good. It's much more addictive than a lot of people realize when they start taking it.
posted by krinklyfig at 10:35 AM on December 7, 2009

fourcheesemac : For what it's worth, those over 65 have the lowest rate of overdose deaths, which may argue against the euthanasia perspective.

Ah, good call! Thank you for that, not often we see such a conclusive answer to speculation. :)

Interesting, though, that your data also fits in with my second post (regarding polydrug abuse including methadone); I wonder why we'd see such an increase only recently, though - None of these really count as "new" drugs (within the timeframe mentioned), so what has changed?
posted by pla at 10:37 AM on December 7, 2009

I'm sure if doctors wrote everyone an equal prescription for oxycontin, AIDS, Heroin and H1N1, and we took them all, the oxycontin wouldn't seem quite as sinister.
posted by Theta States at 10:38 AM on December 7, 2009

During that same period, oxycodone prescriptions – added in 2000 to the list of drugs Ontario's drug plan covers – shot up 850 per cent

Well of course it did... The only people who are on Ontario's 'drug plan' are those on disability and social assistance. They'd been waiting for years, with inadequate Rx's to Tylenol 3, before these stronger opiod drugs were added to the list. These days, my mother still can't get proper medication for her migraines, but would be allowed this crap, if she'd be willing to take it. Thankfully she knows better.
posted by sunshinesky at 10:41 AM on December 7, 2009

pla : fourcheesemac : For what it's worth [...]

Hmm, I did it again, not sure how that keeps happening. Sorry, that quote came from gingerbeer, not fourcheesemac.
posted by pla at 10:43 AM on December 7, 2009

there are a whole lot less infants than there are people

Well thank God for that. Those bastards would kill us all if they ever got the upper hand.
posted by Horace Rumpole at 10:45 AM on December 7, 2009

How many people died from smoking marijuana, again?


It didnt do Linda McCartney any favours.
posted by the cuban at 10:45 AM on December 7, 2009

They are saying oxycodone as a roundabout way to say that these are OxyContin related deaths. Purdue Pharma, the company that makes OxyContin, has continually protested claims about OxyContin related deaths because the active ingredient in OxyContin, oxycodone, is also found in Percocet and Endocet, though the milligram doses in those medications are far lower than in OxyContin so honestly it's a lot less likely that anyone other than a neophyte user is going to accidentally overdose on those medications. A toxicology report will be able to determine a difference between oxycodone and methadone (and any other opiate, for that matter), so if they're saying the deaths are oxycodone related, they are oxycodone related.

I have honestly never met an addict who started out using methadone, though I guess that's conceivable. It's not a very good drug to get high on, and an abuser who is trying to get high will choose pretty much any other shorter acting, faster onset opiate over methadone.

I wonder if heroin channels are starting to develop into these parts of Canada. I was at a drug court conference a couple weeks ago and the Central Pennsylvania case managers were talking about how heroin is starting to come down from Binghamton, NY now that there's a demand for it among Oxy users. Reading and Lancaster PA also have smallish heroin markets started up by Latino transplants from Philly's Badlands barrio. But I think the heroin in these more remote markets becomes so expensive that OxyContin is actually a financially viable option, and considering Oxy is also safe in that it's manufacture is controlled it might actually be more appealing to users in these far out locations. A friend of mine ditched out of Caron rehab to go cop in Lancaster, said the dope was $40 a bag and shitty at that. For $40 you can get an OC80 that is comparable in strength and consistent in quality.

In Philly working class white kids tend to start off on Percs and Oxys and then transition to heroin when $40 per pill is no longer affordable. In any market where heroin is cheap and prevalent hardcore users will eventually transition on to it from OxyContin because it's cheaper, more available, more potent, more easily injected, etc., etc.
posted by The Straightener at 10:50 AM on December 7, 2009 [4 favorites]

I wonder why we'd see such an increase only recently, though - None of these really count as "new" drugs (within the timeframe mentioned), so what has changed?

I don't have a conclusive answer to that question, but here are a few contributing factors:

- increased prescription of methadone as a pain medication, without appropriate attention to patient education, naloxone distribution, and FDA safety advisories
- increased diversion of prescription opiates into the black market, including increased use by teenagers
- lack of awareness of the dangers of overdose, including who is most likely to be at risk, how to recognize one, and how to stop one
- the mistaken perception that only street heroin injectors are at risk of overdose
- a counter-productive drug war approach to overdose which focuses on criminal justice intervention instead of patient and doctor education and naloxone distribution
- continued lack of improved pain management options.
posted by gingerbeer at 10:53 AM on December 7, 2009

This sort of thing is bound to continue to get worse, as long as the most important question related to painkillers is not "how do we best manage pain", or even "how do we ensure that painkillers don't kill anyone accidentally", but "how do we keep people from using these for fun".

As delmoi points out, "safe" over-the-counter painkillers kill nearly as many patients per year as prescription opiates do, even when you take into account the recreational use of the latter... and as gingerbeer noted, we already have drugs which can mitigate the effects of an opiate overdose. The obvious solution would seem to be harm reduction and overdose education... but here we are on the hysteria rollercoaster again, because omg omg opiates.

Meanwhile, doctors are allowed to pass out TNF blockers (which are wildly expensive and have comparatively mild side-effects such as... um, well, more-or-less AIDS-like symptoms, but what's a bit of lymphoma, tuberculosis, or histoplasmosis between friends?) And yet the International Anesthesia Research Society must write articles like this one and this one, pointing out that the legal consequences of prescribing opiates to patients -- even within reason -- can include prison time in the United States.

None of these really count as "new" drugs (within the timeframe mentioned), so what has changed?

My first guess would be poverty and joblessness -- the latter has increased more than five-fold since 1999. But of course, that would suggest that addiction can be triggered by social factors, and is not always an inevitable result of drug use or a moral failure on the part of "criminals"...
posted by vorfeed at 10:59 AM on December 7, 2009 [3 favorites]

My sister is listed as a "seeker" and that's debatable. It's certainly fucked up her attempts to get on the disability she needs (and boy does she need it).

Anyways, for the longest time she has been having to suffer with muscle relaxants as a substitute...

Recently, however, some doctor decided to give her methadone.

I have seen my sister use Percocet and a few other opiates from her prescriptions. She never did it to get high. But because she used it a lot, they called her a seeker.

My point being: She never had a problem with the other opiates. But methadone did a fuckin number on her. Badly. She fell asleep while pushing the shopping cart in a store. She backed into a concrete block and fucked up her van. She would fall asleep while eating food. And her attitude was rotten. (she has other issues with borderline personality, but this was something completely different -- or perhaps disinhibited, I dunno).

Long story short, she got off the methadone between sometime in the beginning of October (which is when I saw her all fucked up) and Thanksgiving, and she was clear and capable (overlooking all the other issues). She was back to "normal"

But yes: Methadone is nasty shit.
posted by symbioid at 11:31 AM on December 7, 2009

Generic opiates are a dirt cheap and effective way to treat pain. As someone who suffers from occasional but severe back pain I can tell you from experience it is not easy to get a script for a flare up. I don't even try unless it goes on for several days. Doctors who prescribe a lot of opiates get harassed by the DEA and the cynic in me thinks it is precisely because the drugs are cheap and effective that access to them is so restricted.
posted by Tashtego at 11:43 AM on December 7, 2009 [1 favorite]

Anybody who uses methadone recreationally is the definition of "doing it wrong." It's fine for getting off dope, but even still, I think it's harder to kick than just using pain pills or heroin. I think it's great for what it is, but the way some physicians use it as a end-all, be-all, cure-all given how hard it can be on your system and hard it is to get off of is the perfect example of how f'ed up drug policy can be.
posted by MCMikeNamara at 11:46 AM on December 7, 2009

Emacs kills more people than even the Gypsies.
posted by everichon at 12:08 PM on December 7, 2009 [1 favorite]

Ewoks kill more people than even the Wookies.
posted by Pollomacho at 12:09 PM on December 7, 2009 [1 favorite]

Meanwhile, alcohol kills more people than everything else combined, excepting organized religion.

Obviously, a speculative assertion. One of the local papers recently reported that countywide, prescription drugs caused more deaths than alcohol, mostly methadone followed by oxycodone. Plumas County is pretty rural, which I suppose makes this a bit surprising: you've got a pretty small pool of pharmacists to game. I think the worst part of that article was:

[Undersheriff] Hagwood and [Investigations Sargent] Peay said the problem was particularly disturbing because it wasn’t as simple as the traditionally accepted DARE narrative of drug use where stupid people and out-of-control maniacs seek out completely destructive substances and uncaringly consume them.

which made it sound like the sheriff's department had drank the D.A.R.E. kool-aid which would be both provincial and sad. Hagwood redeemed himself by later saying:

...most people didn’t think taking these medications was as significant as drinking alcohol, because of the place prescription drugs occupy in our society.

“The American public is just being bombarded by the pharmaceutical industry to take a pill for any and everything that could conceivably be wrong with you and some stuff that you haven’t even thought of.”

posted by Ogre Lawless at 12:11 PM on December 7, 2009

I note, for discussion's sake, that the linked article seems to assume all the overdose deaths were unintentional. As small a number (per-capita) of deaths as we are discussing, I'm surprised that the idea that a good number of these may well be suicides isn't even on the table.

It looks like the idea is on the table, just not in the Globe article. I spotted this item in the Eurekalert feed about the same study, and it says:

Between 1991 and 2004, 7099 deaths with complete records were attributed to alcohol and/or drugs. In 3406 of these deaths — 61.9% — opioids were implicated as cause of death. The median age of death was 40 years and 67% were men. Suicide was a factor in 23.6% of deaths.

"The rise in opioid-related deaths was due in large part to inadvertent toxicity," write Dr. Irfan Dhalla, of the University of Toronto and coauthors. "There was no significant increase in the number of deaths from suicide involving opioids over the study period."

posted by benign at 12:37 PM on December 7, 2009

Prescription painkillers kill more people than heroin, AIDS or H1N1.

Maybe in Hollywood--Michael Jackson, Heath Ledger, Anna Nicole Smith.

Odd comparisions to have. Alcoholism, cancer, diabetes, obesity would be more relevant.
posted by stormpooper at 1:45 PM on December 7, 2009

Damn, I wish I had some sweet delicious vicodin right now.
posted by Ratio at 1:55 PM on December 7, 2009

Missed one though, eh?
posted by Smedleyman at 2:24 PM on December 7, 2009

i would postulate that the same applies here: what comes first? the pain or the painkiller?

What I really wanted to write in response to this question would probably get me moderated hard, so instead I'll just answer:

The pain.

You see, the anger-headache that your question just gave me began before I reached for the ibuprofen.
posted by Kutsuwamushi at 4:59 PM on December 7, 2009 [2 favorites]

...between 1991 and 2007... oxycodone prescriptions... shot up 850 per cent, and the number of oxycodone-related deaths quintupled.

So prescribing oxycodone in 2007 is less likely to result in a death than doing so in 1991?

This doesn't mean that there isn't a problem here. A large number of absolute deaths from one source (even if it is caused by increased exposure as opposed to increased risk) is a sign that, if there is something that can be done to further lessen the risk, focusing on this problem can potentially save many lives. (Granted, this is only one factor among many, but it can be important.) But nobody ever seems to use these kinds of statistics for this kind of argument. Instead, they get used to claim that something is inherently more dangerous. In this case, maybe oxycodone is unreasonably dangerous for the benefit it provides. If so, then the argument should be playing the benefits off of the risks, not pointing out the rather obvious fact that increased use of something often increases the total number of people negatively impacted by it. It might be that there is an easy way to lessen the risk. But if that were the case, the article should be spelling out what that way is.

It strikes me that this is probably an issue where some good can be done (and if so, then it's worth drawing attention to) but this article does a very poor job of making that argument.
posted by ErWenn at 5:32 PM on December 7, 2009

“The American public is just being bombarded by the pharmaceutical industry to take a pill for any and everything that could conceivably be wrong with you and some stuff that you haven’t even thought of.”

Weirds me out that medicine which requires a decade of training to understand, is allowed to be marketed to people who can't point to their own state on a map. Is there not some sort of law about how informed your market must be before you are allowed to market to them? You can't market cigarettes to children, can you? Why can you market mind-altering medications to people who have only a child's understanding of its use and the probabilities of potential risks and benefits? Same-same. Unethical and destructive to the social good.
posted by five fresh fish at 8:47 PM on December 7, 2009

Up until I was about twenty-five, magazines in Canada were not allowed to have prescription advertising.

I always found it shocking to flip through an American magazine.

I think we shot ourselves in the foot by getting rid of that law. Probably a victim of NAFTA. It's just ever so much more important that drug companies have direct access to the minds of its victims, than it is to protect our society from greedheads.

We should start treating marketing like the potential social threat it really is. Time and again we can show how marketers have been able to dupe the ignorant or gullible public into doing the worst possible things to themselves. Why do we let them keep getting away with it?
posted by five fresh fish at 8:55 PM on December 7, 2009

I recently went to a funeral for a 29 year old who accidentally overdosed on prescription medication (for migraine, non-narcotics) taken after drinking alcohol. Truly, truly tragic.

As a culture, we're so nonchalant about prescription drugs that we ignore that they really are powerful. If a doctor prescribes it, it can't hurt you! And that's so, so not true.
posted by grapefruitmoon at 5:52 AM on December 8, 2009

If these were still patented and making money for a drug company, no one would care.
posted by kathrineg at 7:28 AM on December 8, 2009 [1 favorite]

I know this article is about Ontario, but for your reference here are some statistics from US poison control centers for 2007. "Exposures" are calls to the poison center from/about people who have been exposed to a substance.

There were 584 fatalities associated with single-substance exposures (Table 21). The 407 pharmacueticals included 198 analgesics (61 acetaminophen, 27 methadone, 24 acetaminophen/hydrocodone, 18 aspirin, 15 acetaminophen/diphenhydramine, 7 acetaminophen/propoxyphene, 6 oxycodone, and 5 fentanyl patch), 49 stimulants/street drugs (20 cocaine, 9 heroine, 7 methamphetamine, and 5 MDMA), 36 cardiovascular drugs (10 cardiac glycoside, 9 diltiazem, and 7 verapamil), 32 antidepressants (9 amitriptyline, 7 lithium, and 7 bupropion), and 24 sedative hyphotics/antipsychotic (8 quetiapine).

I have to show ID when I get Adderall, but I can buy Tylenol and asprin by the bucketful. Good job, FDA.
posted by kathrineg at 9:04 AM on December 8, 2009

According to this page (I can't vouch for accuracy, but it's the best data I could find), Americans consume approximately 44 million aspirin tablets a day. Suppose we overestimate and say that the average dose is 4 tablets. That gives us 11 million aspirin doses per day in the U.S., or approximately 4015 million doses per year. If 18 of those resulted in fatalities, then the chance of dying from an aspirin dose is somewhere around 0.00000045%. I'd bet that most of them are intentional overdoses.

Aspirin is not particularly addictive (as far as drugs go) and doesn't have nearly as much of a history of abuse as many other drugs.

Amphetamines (like Adderall), on the other hand, are extremely addictive, abused constantly, and are really bad idea for people with heart conditions (and there are lots of them).

While there are plenty of things that the FDA does stupidly, I think that they've got their priorities straight as far as this particular comparison goes.
posted by ErWenn at 10:04 PM on December 8, 2009

Adderall is extremely addictive, at a theraputic dosage? Cite, please.
posted by kathrineg at 2:07 PM on December 9, 2009

And in today's news, a man shot and killed a doctor in Eastern Kentucky over the doctor's refusal to prescribe pain medications without getting a drug test first.
posted by dilettante at 4:41 PM on December 9, 2009

I didn't say that it was addictive at theraputic dosages. I'm not sure whether it is or not. I know I would have a hard time quitting entirely if I needed to, but that's just me. When I referred to it being "extremely addictive", I meant as commonly abused. Perhaps the "extremely" was overreaching.
posted by ErWenn at 5:14 PM on December 9, 2009