By Maria Szalavitz for MSN Health and Fitness
Celebrity magazines all too often feature stories about overdose deaths and rehab admissions, and the Office of National Drug Control Policy is running an advertising campaign about the dangers of prescription drug abuse.
But when taken as prescribed, just how risky are drugs like OxyContin and Vicodin?
The truth might surprise you. Myths and misinformation about opioid painkillers are widespread. Here are the facts.
Myth No. 1: Toughing it out is always better than relying on painkillers.
Although Americans pride themselves on their toughness, those who refuse medications despite severe pain may be putting their health— and their jobs and relationships— at risk.
“Uncontrolled pain is associated with adverse consequences in terms of daily functioning, mood, sleep, overall quality of life, energy level, the ability to work and marital relationships,” says Russell Portenoy, chair of Pain Medicine and Palliative Care at Beth Israel Medical Center in New York City.
Adds Dr. Richard Payne, professor of medicine and divinity at Duke University: “Newer studies actually show that persistent pain causes changes in the brain and spinal cord that begets more pain.” Some animal studies suggest that controlling pain could help prevent these problems.
“It’s clearly obvious that people whose pain is controlled effectively following surgery go home earlier, have fewer complications, get out of the hospital faster and recover better,” says Dr. Gavril Pasternak, a neurologist at Memorial Sloan-Kettering Cancer Center in New York City. “On the other hand, do I think every time a child scrapes his knee he needs an opioid? No.”
Studies of drivers on steady doses of opioids do not find impairment. In fact, says Portenoy, “At least one study by Finnish researchers showed that impairment on standard driving measures was more correlated with poorly controlled pain than with taking medication for it.”
“What people are concerned most about is judgment and somnolence,” says Pasternak.
“Would I recommend that someone just starting opioids drive? Of course not. But I would give the same advice to someone starting a sleeping pill. Once someone has been on the same dose for a while, they can.”
Adds Payne: “For people on a stable dose, they acclimate or develop tolerance to sedative and mental clouding effects.”
Myth No. 3: When taken as directed, opioids are more likely to kill you than aspirin, ibuprofen or naproxen.
“False. When takenas directed, opioids are safe drugs,” says Pasternak.
The vast majority of opioid-related deaths occur amongst recreational users or deliberate suicides. Deaths amongst pain patients are rare— in fact, recent research finds that even for people with advanced illnesses, use of high-dose opioids does not significantly increase risk of death.
Nearly three times as many people die from complications of correctly taking painkillers like aspirin and ibuprofen— known as non-steroidal anti-inflammatory drugs—than die from opioid overdose.
“More people die from gastro-intestinal bleeding from NSAIDs taken in correct doses than from inadvertent opioid overdose,” says Payne.
“It is true that the death rate has increased from accidental overdose related to opioids, but still the number of deaths related to accidental OD is dwarfed by the gastro-intestinal and [stroke and heart-related] complications of other analgesics,” Payne adds.
Myth No. 4: Accidental overdose is common amongst pain patients.
Most opioid overdoses do not result from medical use.
“As patients take opioids over weeks and months, they develop a tolerance to the respiratory depressive effect, which is the thing that can cause death,” says Payne.
This means that even if people forget they’ve taken their medication already and accidentally double their dose— unless they have dementia and do this rapidly and repeatedly— the risk of death is low.
Instead, the vast majority of opioid overdoses involve combinations of drugs that cause sedation— typically alcohol and sleeping pills or anti-anxiety medications like Valium or Xanax (benzodiazepines).
At least 80 percent of opioid overdoses are actually caused by such drug mixing—and while some severe pain patients need both benzodiazepines and opioids, they are prescribed together with great caution.
In many overdose deaths, use is obviously non-medical because the victims injected or snorted drugs meant to be taken orally.
Myth No. 5: Most people who get addicted to painkillers are “accidental” addicts who sought pain treatment and had no prior history of drug problems.
When a Florida newspaper covered the “OxyContin epidemic” in 2003, it later had to retract its series, in part because a man portrayed as an innocent victim of a pill-pushing doctor actually had a prior federal cocaine conviction.
Inadvertently, the paper had illustrated the real story of painkiller addiction: The vast majority of people who become addicted to prescription opioids have significant prior histories of drug problems.
Nearly 80 percent of OxyContin addicts have taken cocaine, for example, according to large national survey research. This means either that pain patients prescribed OxyContin suddenly start using cocaine—or, more plausibly, that most people who misuse opioids have a past or current drug problem.
“We published data on this; we looked at people who had Oxycontin addiction who presented for treatment—essentially, nobody had gotten addicted to Oxycontin who hadn’t previously been using opioids recreationally,” says Thomas McLellan, professor of psychiatry at the University of Pennsylvania.
More than three-fourths of the patients who had misused OxyContin in this national sample of addicts in treatment had never received a prescription for it.
Even having chronic medical problems—which includes chronic pain—did not increase risk for OxyContin addiction.
If you do not have a personal or family history of addiction—especially if you have never suffered psychiatric problems like depression, schizophrenia or bipolar disorder, and especially if you are middle-aged or older—your risk for developing addiction during pain treatment is “vanishingly low,” says Portenoy.