LifeSource , a nonprofit organization established to fund healthcare-related projects, is addressing the nations biggest healthcare problem. According to the Food and Drug Administration (FDA), 29 million Americans age 12 and older misused extended-release and long-acting opioids in 2002, climbing to more than 33 million in 2007. The Centers for Disease Control estimates that the number of emergency department visits for nonmedical use of opioid analgesics from the year 2004 to the year 2008 increased from 144,600 visits to 305,900 visits. That is an increase of 111 percent. The number continued to increase another 29 percent from the year 2007 to 2008.
Dr. Lynn R. Webster, co-founder and medical director at Lifetree Clinical Research and co-founder of LifeSource, announced today that new information is now available regarding deaths related to prescription opioid therapy. Study findings on these deaths and how to understand the causes behind avoidable mortality in legitimately treated patients were released this week in a special supplement of Pain Medicine, a journal published by Wiley-Blackwell on behalf of the American Academy of Pain Medicine (AAPM).
The supplement is titled Preventing Avoidable Opioid-Related Deaths Top Priority for Pain Medicine Field – Risky Behavior, Psychiatric Disorders, Substance Abuse Contribute to Opioid Overdose. It contains findings from studies conducted by pain medicine clinicians, patient advocates, and regulators who reported on statistics, causes, and adverse events involving opioid treatment.
One of the biggest health care problems in this country today is prescription drug addiction and overdose deaths. It is the goal of the LifeSource organization to address this problem honestly and to find solutions in the healthcare field to improve quality of life, says Dr. Webster. In summer 2009, LifeSource hosted a conference in Salt Lake City during which experts from all over the country examined overdose death data with the intent to publish their findings in an article. The resulting information became the content for this groundbreaking medical supplement of Pain Medicine.
Dr. Webster states that preventing unnecessary deaths from opioid therapy should be a central focus for everyone working in the field of pain medicine. The primary objective is to increase understanding of the major risk factors associated with opioid-related deaths and exploring methods that mitigate the adverse effects involved in treating patients with analgesics that are potentially lethal.
Studies in the Pain Medicine Supplement
One study in the Pain Medicine supplement on opioid mortality reports on the findings of epidemiologists at the Utah Department of Health (UDOH) who examined medication-related harm starting in 2004. The research team, led by Christina A. Porucznik, Ph.D., M.S.P.H., of the Division of Public Health at the University of Utah, analyzed several data sources including vital statistics, medical examiner records, emergency department diagnoses, and the state prescription registry. Our analysis showed that prescription drug-related harm, including death, in Utah primarily involved opioids, commented Dr. Porucznik. Additional studies are needed to identify risky prescribing patterns and individual-level risk factors which contribute to opioid-related injury or death.
In a related study, a panel of pain medicine experts, led by Dr. Webster, reviewed the medical literature and state and federal government sources to assess frequency, demographics, and risk factors associated with overdose deaths caused by opioids. Analysis revealed a pattern of increasing opioid-related overdose deaths beginning in the early 2000s. While methadone represented less than 5 percent of opioid prescriptions dispensed, one third of opioid-related deaths in the U.S. were attributed to this drug.
Researchers determined that root causes of deaths from methadone included physician error due to knowledge deficits, patient non-adherence to prescribed medication regimen, and unanticipated medical or mental health comorbidities. Furthermore, some insurance companies require that methadone be used as first-line therapy to control pain over other opioid therapy. Forcing the use of methadone by healthcare providers who may not be aware of how to safely prescribe this drug may lead to greater mortality risk.
Additional contributors to overall opioid-related deaths included the presence of sleep-disordered breathing and use of other drugs that depress the central nervous system such as alcohol, benzodiazepines, and antidepressants. Approximately two thirds of opioid-related deaths are caused by opioids other than methadone. Patients with depression, anxiety, or other mental illness who also have chronic pain need structured care that minimizes risks associated with opioid therapy, concluded Dr. Webster. It is very difficult to safely treat chronic pain in patients who have serious mental health issues. We must strike a balance between treating pain and preventing harm.