Prescription painkiller abuse: A worst drug overdose epidemic in history

The Centers for Disease Control calls prescription painkiller abuse "one of the worst drug overdose epidemics in history."

New studies on prescription painkillers show that from 1999 to 2011, the consumption of hydrocodone more than doubled and oxycodone use increased by 500 percent. During that time, opioid pain reliever (OPR) overdose nearly quadrupled.

"The rise in opioid consumption has resulted in a doubling in visits to the emergency department for nonmedical OPR use but I also see patients who make errors with medications they are legitimately supposed to be taking," says Megan Rech, emergency medicine pharmacist, Loyola University Health System. Loyola, an academic medical center, has a dedicated pharmacist with expertise specific to the Emergency Department.

Addicts will frequent emergency rooms complaining of phantom conditions to try to get painkillers. "At Loyola, we limit painkiller prescriptions to last between 7 and 10 days with no refills, to avoid abuse and also to make sure people who genuinely are ill see their doctor for follow-up care," says Dr. Rech, who is a registered and licensed pharmacist with advanced residency training in critical care. "At Loyola, we utilize an Illinois database that tracks scheduled prescriptions to help identify OPR addicts."

Addiction is defined as continued use of a drug despite negative consequences.
"Red flags that a patient may be an addict include complaining of general pain or excess pain compared to the exam, refusing to see a specialist or to contact his/her primary care physician, asking for brand name painkillers, or displaying an overfamiliarity with opioids," says Dr. Rech.

Loyola emergency medicine physicians often will opt for non-opioid forms of pain relief. As an Emergency Department pharmacist, Dr. Rech screens appropriate patients for presence of any medication or substances and counsels staff and patients on prescriptions.

Dr. Rech is also careful to stress the importance of patient education. "Many patients are also unaware that they can build up a tolerance to medication. If they stop taking prescribed painkillers for a while, the tolerance decreases," says Dr. Rech. "A patient can then restart the medication at the previous dose, which is now too high, increasing the risk of an overdose."

"When physicians prescribe medication, they need to be very clear with the patient on what it is, when it should be taken, when it should be stopped and disposed of and if it is habit-forming," says Dr. Rech. "Some patients make honest mistakes with self-dosage that unfortunately result in overdose."

Loyola's Emergency Department receives some of the region's most critically ill and injured patients and the severity level of emergency admissions is among the highest in the country. Loyola emergency medicine physicians are board-certified and treat more than 50,000 seriously ill and injured patients every year, including major trauma, stroke, high-risk obstetrics, unstable cardiac conditions, poisonings and severe illnesses. The 31-bed emergency facility is one of the most advanced in the Midwest and contains specialty care sections for trauma, cardiac care and pediatrics. Specialty services at Loyola include a level 1 trauma center, aeromedical transport, chest pain emergency evaluation center, pediatric emergency care and stroke center.

As an academic medical center, Loyola offers professional education to emergency medical technicians and also conducts clinical research trials. As part of Loyola's leadership in preventing and diagnosing infectious disease, Loyola offers a free HIV test to all Emergency Department patients.