A healthy society is an educated one. With increased car manufacturing regulations and higher driving education standards, there has been a steady decline in motor vehicle deaths over the past decade.

By contrast opioid overdoses, many of which can be accidental, are increasing. In fact, they’re on their way to exceeding motor vehicle deaths, says Mike Lancaster, MD, medical director of behavioral health integration at Community Care of North Carolina.

“Overdose deaths are rising at a significant rate, and we know that the numbers of children being born addicted to opioids has increased by almost 300percentover the past eight years,” says Dr. Lancaster. “The public health issue is apparent.”

Fortunately, the public health and pain management communities are working to shrink these daunting statistics. One of the first and most important stepsof this process has been to identify those who are at highest risk.


Opioid Profiles; Raising Awareness

Most of us are familiar with high-profile celebrity overdoses, like that of late actor Heath Ledger, who died due to a lethal combination of opioids and other prescription drugs. But many mistakenly believe that such incidents are rare. In fact, nationally, there area round 17,000deaths a year due to opioid overdoses. And often, death occurs from accidental misuse rather than intentional abuse.

Dr. Lancaster remembers the case of a high school quarterback who died after taking just one of his grandmother’s methadone tablets. “He figured it was just a pain pill he could take for some aches and pains after a game,” remembers Dr. Lancaster. “What he didn’t realize was that his grandmother was taking a dosage that her body had acclimated to. And there he was, a 17-year-old kid with low body fat, taking this pill that was a small dose for his grandmother but a lethal dose for him.”

Tragic stories of overdose occur daily, whether they make the news or not. One person might take an extra dose of sleeping pills, hoping to get a good night’s rest, not knowing that high levels of benzodiazepines can fatally interact with opioids. Another person might take just a few opioids for temporarily severe pain, but leave the rest of the bottle in the medicine cabinet where it can be taken by someone else who may abuse it.

Who’s at risk for accidental overdose or misuse? Certain people who are at a higher risk than others may include:

Those whose Pain is uncontrolled or not managed well: Ineffective pain management is problematic because it means people on opioids may take or request increased dosages in an effort to better treat their pain. Opioids are only one component of a pain treatment regimen. If you feel your chronic pain could be managed better, talk to your pain physician about additional therapeutic options.

Friends or family of those who take opioids: “If you get your wisdom teeth taken out and your doctor prescribes 30 Percocet, you don’t need all 30of them; you only need a couple,”explains Dr. Lancaster. “Having that extra cache of drugs is dangerous. It gives you the opportunity to misuse them in the future. And anyone who comes into your house can find them and then abuse them or sell them.”

If you only require opioids for a short amount of time, it’s a good idea to get rid of the rest. Ask your doctor for his or her recommendation on proper disposal, as there are a variety of regulations and guidelines for disposing of prescription narcotics. Even if you do take opioids regularly, it’s a good idea to keep them in a secure location and also to keep track of how many you have in the bottle at any given time.

Those who are taking other central nervous system medications such as benzodiazepines (this includes certain anti-anxiety or sleep medications) in addition to opioids: People with chronic pain may also experience anxiety and sleep issues. A common class of drugs prescribed or such problems is benzodiazepines, which includes medications like Xanax and Valium. Benzodiazepines can be taken along with opioids, but both drugs must be used exactly as prescribed. Misuse can lead to respiratory distress and overdose.

Those with respiratory disease: Opioids can slow down breathing and cause the brain to react more slowly to oxygen loss. And as mentioned above, opioids are much more likely to lead to respiratory trouble when combined with drugs like benzodiazepines. Because of these factors, people with existing respiratory problems, such as COPD or sleep apnea, are at an increased risk of possible fatal accidental overdose.

opioids-3For Mark Baker,* a 52-year-old machinist, the combination of sleep apnea and poorly managed pain led to an accidental overdose that landed him in an emergency room.

“I take oxycodone for persistent lower back pain,” he says. “One night I was experiencing a flare-up so painful I couldn’t sleep, so I decided to take a few extra pills before bed. Because of my sleep apnea, and because I took too many pills that night, I stopped breathing. Luckily, my wife called for an ambulance, and I was rushed to the ER.”

While Baker had never in the past abused or felt addicted to his oxycodone, it only took one misuse to put his life in jeopardy. As with any medication, opioids should be taken exactly as prescribed. If you have a respiratory issue and are on opioids, talk to your doctor about non-benzodiazepine sleep aids and anxiety treatments.

Those who require high doses of opioids: Some people on high levels of opioids, such as cancer patients, may be at risk for unintentional opioid overdose.

Those who have abused prescription medications in the past: If you’ve overdosed before, you have a much higher risk of doing so a second time. Talk with your doctor about your health history.

opioids-4Opioids, Safely

Opioids are one of the most effective methods of man -aging chronic pain, and while misuse may occur, there is good news: overdoses and deaths can be prevented. Today’s anti-abuse programs are offering patients and physicians effective strategies for safe opioid use.

Dr. Lancaster works with Project Lazarus, an overdose prevention agency that has seen drops in opioid-related deaths throughout North Carolina, where it is located. Any physician or pain patient can adopt the successful tactics they’re using. And almost all of these strategies are being used across the country by various other state agencies and nonprofits.

Opioid Safety: Accidental overdose and misuse are two issues being addressed by physicians. In addition, federal legislation requires all states now have a substance reporting system. This system records every controlled substance dispensed, regardless of payer source. In the past, abusers would often try to pay cash for prescription narcotics to avoid having their purchase tracked through an insurance plan. This program, however, keeps a record of every opioid purchase. Doctors can then check the system before prescribing an opioid to ensure that patient hasn’t recently received them from other doctors. If the doctor sees that a patient is doctor shopping, he or she can avoid dispensing another prescription and also refer the patient to an overdose prevention agency.

Physician Education and Outreach: More physicians are becoming proactive in helping prevent prescription drug abuse or misuse. In addition to looking for the signs of abuse, they can reach out to patients who are at risk by helping them find other effective ways of dealing with chronic pain. Physicians are also encouraged to make any patient taking opioids aware of the dangers of misuse, including possible abuse by friends and family. Finally, it’s helpful for doctors to have literature or posters in their offices that make patients aware of the reporting system and prevention agencies.

Proper Storage and Disposal of Opioids: If you have opioids in your home, it’s important to keep them where others won’t have access to them. Baker says he keeps his locked in a small safe. “We have kids; I can’t be too careful,” he says.

Pain Contracts: This is an agreement between a physician and patient that clearly details the pain treatment plan. It should include helpful information such as drugs to avoid while on opioids and what to do for breakthrough pain on opioids. Patients should take this contract with them if they have to see an-other doctor or visit an emergency department.

Availability of Naloxone: Naloxone is an opioid antagonist, meaning it reverses the effects of opioids.“It blocks the opiate receptors,” explains Dr. Lancaster. “So if someone has accidentally or intentionally overdosed, they can receive this and it’s almost an immediate rescue. It’s kind of like receiving epinephrine for anaphylactic shock. Having naloxone more available to those at risk will save lives.”

Drug abuse prevention agencies like Project Lazarus are working to educate physicians and communities about this potential lifesaver. “We want those who are at risk to have naloxone available in their homes; we want all first responders to have this as well,” says Dr. Lancaster. “It doesn’t cause any negative effects if administered at the wrong time. It’s essentially an inert substance, except in the presence of opioids, and it won’t change or hurt anything if the person receiving it doesn’t have opioids in his or her system. There is concern that it will be seen as a ‘get-out-of-jail-free card,’ but the simple fact is that it saves lives.” The FDA is looking into ways to make naloxone more widely available and is also evaluating new naloxone products that may be easier to use than the currently available syringe systems. {PP}

*Not his real name.