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    Tuesday, August 21, 2007

    More Popular Than Statins: A rise in pain medication sales is sweeping the country:

    Retail sales of five leading painkillers nearly doubled over the last eight years, reflecting a surge in use by patients nationwide who are living in a world of pain [or a world of narcosis- ed.], according to a new Associated Press analysis of federal drug prescription data.

    ...The amount of five major painkillers sold at retail establishments rose 90 percent between 1997 and 2005, according to Drug Enforcement Administration figures.

    More than 200,000 pounds of codeine, morphine, oxycodone, hydrocodone and meperidine were purchased at retail stores during 2005, the most recent year represented in the data. That is enough to give more than 300 milligrams of painkillers to every person in the country.

    Well, maybe we can keep those Afghan poppy farmers in legitimate business.

    The increase has its price, however:

    Unintentional fatal drug overdoses in the United States nearly doubled from 1999 to 2004, overtaking falls to become the nation's second-leading cause of accidental death, behind automobile crashes, the government reported.

    The number of accidental drug overdose deaths rose from 11,155 in 1999 to 19,838 in 2004, according to the U.S. Centers for Disease Control and Prevention.

    The report was based on death certificates, which do not clearly detail which drugs played the greatest role. But CDC researchers said they believe sedatives and prescription painkillers like Vicodin and OxyContin were the chief cause of the increase.

    One of the large pain management groups in our area recently announced that they would no longer be using OxyContin for this very reason. Although I can't find a link to the reference to back this up, their letter announcing the change said this:

    The amount of oxycodone prescribed nationally has increased by over 400% for the period between 1997 and 2002. The number of deaths from accidental overdoses of oxycodone rose nearly 350% from the same period, according to the Centers for Disease Control and Prevention.

    Keep those figures in mind the next time you read pieces of journalism like this:

    Contrary to the old saw, pain kills. A body in pain produces high levels of hormones that cause stress to the heart and lungs. Pain can cause blood pressure to spike, leading to heart attacks and strokes. Pain can also consume so much of the body’s energy that the immune system degrades. Severe chronic pain sometimes leads to suicide.

    Acute pain can cause heart rates and blood pressure to go up, but chronic pain doesn't. The body reaches a new set-point, and things calm down. Now, chronic pain can cause depression, but high dose narcotics aren't necessarily the answer to that, either. There are better treatment alternatives than narcing a patient to unconsciousness:

    Shealy’s son, David, an auto mechanic, testified that the OxyContin pain relief also came at a price. He said he felt his father was overmedicated — often sleepy. Once, his father backed his truck into a tree.

    Shealy died in his sleep early on the morning of May 29, 2003. He had OxyContin pills in his stomach, and his bloodstream contained alprazolam — Xanax — as well. The pathologist at McIver’s trial testified that the levels of drugs were consistent with the prescriptions McIver had been writing — the high levels that so alarmed the insurance agent. Shealy was taking five 80-milligram tablets of OxyContin every 12 hours, plus up to six 30-milligram tablets of Roxicodone every 4 hours for breakthrough pain, plus as much as 2 milligrams of alprazolam every 8 hours. The prosecution’s toxicologist, Demi Garvin, concluded that the OxyContin and Roxicodone caused Shealy’s death by respiratory depression.

    ...There was something else that might have caused Shealy’s death: he suffered from advanced congestive heart failure. The pathologist testified that he had 90 percent blockage in one coronary artery and 50 percent in another, and a greatly enlarged heart and other organs. He had a scar on the back wall of his heart that indicated he at one time suffered a heart attack. Opioids do not worsen heart disease and would likely have helped, because pain causes stress to the heart.

    If he had died of a heart attack, the autopsy would have revealed acute damage to the heart, not an old scar. And his clinical history isn't all that suggestive of death by heart failure. The evidence is most supportive of death by drugs.

    Narcotics are great for relieving pain, but they have to be used with utmost care.

    posted by Sydney on 8/21/2007 08:04:00 PM 0 comments


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