CNN CNN Health

Opioid Dose Linked to Overdose Risk

By Robert Shmerling, M.D.
Content provided by the Faculty of the Harvard Medical School

People who take higher doses of narcotics are more likely to overdose, a study finds. The study focused on people who took narcotics for pain. These drugs are also called opioids. They include Oxycontin, Vicodin and others. Researchers looked at 750 accidental deaths from opioid overdose. These were compared with data on nearly 155,000 other people who took opioids for pain. The overdose rate was less than one-half of 1%. It occurred more often among people who were prescribed doses of 100 milligrams a day or more. People who usually took lower doses were less likely to take too much. The Journal of the American Medical Association published the study. HealthDay News wrote about it April 5.

What is the doctor's reaction?

During the last decade, doctors have been urged to improve their treatment of pain. This plea has come from professional groups, accrediting agencies and quality improvement programs. All of them have stressed that it's important to take pain complaints seriously and treat them aggressively.

This makes sense. After all, a major goal of medical care is to reduce or eliminate suffering.

Yet it's also important to recognize that pain treatment can be risky. In fact, deaths caused by accidental overdose of pain medicines have increased dramatically in recent years.

Opioids (often called narcotics) are the strongest pain medicines available. They are often given for a short time for severe pain. For example, after surgery or a broken bone, a few days of pills containing codeine can make the recovery easier to bear. But longer lasting (chronic) pain is also commonly treated with opioids.

Long-term treatment with opioids is more likely to cause problems than short-term use. Longer treatment increases the risk of:

  • Side effects, such as constipation or nausea

  • The need for higher doses over time

  • Addiction

  • Accidental overdose

A new study looks at factors that may contribute to accidental overdoses of opioid drugs. The study is timely since a recent report found that drug overdose is the second leading cause of accidental death in the United States. Opioid medicines make up a big part of the problem. They contribute to more deaths than heroin and cocaine combined.

In the new study, researchers reviewed prescriptions for opioids among 750 people who died of accidental overdose. These were compared with prescriptions for more than 150,000 people who also received opioid treatment.

The study found that deaths due to unintentional opioid overdose were:

  • Relatively rare, occurring in about 1 out of 2,500 people treated with opioids

  • More common among white, middle aged adults

  • More likely to occur with higher prescribed doses

  • More common among those with substance abuse problems and psychiatric disease

  • Less likely among those with cancer

Perhaps it should not be surprising that a deadly overdose of an opioid medicine is more likely to occur with higher prescribed doses. A well-known opiate side effect is suppression of breathing. And opioids can interact with other drugs or alcohol. This increases the risk of dangerous side effects.

It's reassuring that the overall rate of death was low. Still, these medicines are meant to relieve suffering, not cause harm. Every effort should be made to prevent deaths caused by medicine overdose. This study points out the importance of keeping opioid doses as low as possible.

What changes can I make now?

If you have pain, talk to your doctor about all of your treatment options. Remember that some pain can be relieved without medicines. These other options include:

  • Physical therapy

  • Acupuncture

  • Massage

  • Relaxation

  • Psychotherapy

  • Transcutaneous electrical nerve stimulation (TENS), which uses electrical impulses to stimulate the nerve endings at or near the site of pain

Some of these treatments may stimulate the body's own painkillers, called endorphins. In other cases, non-drug treatments work directly on nerves to interfere with pain messages. Sometimes it isn't clear why pain improves with these treatments.

Several medicines besides opioids can work well for pain. These are often tried before opioids. For example, your doctor may recommend:

  • Analgesics, such as acetaminophen or tramadol

  • Drugs that reduce inflammation, such as ibuprofen or naproxen

  • Drugs applied to the skin, such as lidocaine or diclofenac gel

  • Antidepressants

  • Antiseizure medicines

If your doctor does recommend an opioid medicine, keep these safety measures in mind:

  • Take the lowest dose that controls your pain.

  • Don't double up on doses or take someone else's medicine.

  • Ask your doctor or pharmacist whether the pain medicine may interact with any other medicines you take. This should include over-the-counter drugs.

  • Ask your doctor about possible side effects. He or she can suggest ways to avoid them.

  • Don't be surprised (or offended) if your doctor asks you to sign a "contract" regarding your pain medicines. Such contracts are common. They are intended to promote the safe use of these powerful drugs.

Whatever you take for pain, review your progress over time with your doctor. If you're having side effects, let your doctor know. From time to time, try to reduce the dose. You may find you need less medicine as you recover from whatever is causing your pain.

What can I expect looking to the future?

Balancing pain relief with the risks of treatment will continue to challenge pain sufferers. You can expect drug makers to develop new medicines that reduce pain more safely than what is available now. Given the risks of pain medicines, interest in non-medicine approaches is likely to increase.

Last Annual Review Date: 2011-04-07T00:00:00-06:00 Copyright: Harvard Health Publications
This content is selected and managed by the Healthgrades editorial staff.