Wednesday, February 20, 2013

In the News: Prescription Drugs Leading Cause of Fatal Overdoses

The company that makes the painkiller OxyContin, Purdue Pharma, has agreed to pay $600 million in fines and other payments to resolve the criminal charge of “misbranding” its product, one of the largest amounts ever paid by a drug company in such a case. The company and three of its current and former executives pleaded guilty in federal court to criminal charges that the firm had misled doctors and patients when it claimed that the drug was less likely to be abused than traditional narcotics. The three executives, including the company’s president and its top lawyer, also pleaded guilty to misdemeanor charges of misbranding the drug. Together, they agreed to pay $34.5 million in fines.
by Kristina Fiore, Staff Writer, MedPage TodayPublished: February 19, 2013

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

When patients overdose on prescription opioid painkillers, other drugs given for mental health disorders are often involved, researchers found.

In an analysis of CDC vital statistics data, among overdose deaths involving opioid analgesics, benzodiazepines were also found in 30.1% of the cases, reported Leonard Paulozzi, MD, of the CDC in Atlanta, and colleagues.

Antidepressants were involved in 13.4% of prescription opioid-related deaths, followed by anti-epileptic and anti-parkinsonism drugs at 6.8%, and antipsychotics and neuroleptics at 4.7%, they wrote in a research letter in the Journal of the American Medical Association.

"This analysis confirms the predominant role opioid analgesics play in pharmaceutical overdose deaths, either alone or in combination with other drugs," Paulozzi and colleagues wrote. "It also, however, highlights the frequent involvement of drugs typically prescribed for mental health conditions, such as benzodiazepines, antidepressants, and antipsychotics in overdose deaths."

According to the National Center for Health Statistics, drug overdose deaths continued to rise in 2010, with prescription opioid analgesics driving that increase.

Other pharmaceuticals are usually involved in opioid overdose deaths, the researchers explained, but their involvement is less well characterized.

Paulozzi and colleagues looked at data from the National Vital Statistics System multiple cause-of-death file and found 38,329 drug overdose deaths in the U.S. in 2010, about 58% of which involved pharmaceuticals.

The most common drugs involved in those deaths -- whether alone or in combination -- were opioids (75.2%), benzodiazepines (29.4%), antidepressants in (17.6%), and anti-epileptic and anti-parkinsonism drugs (7.8%).

When looking at deaths involving those other pharmaceuticals, opioids were often also present in:

77.2% of benzodiazepine deaths
65.5% of anti-epileptic and anti-parkinsonism drugs
58% of antipsychotic and neuroleptic drugs
57.6% of antidepressants
56.5% other analgesics, anti-pyretics, and anti-rheumatics
54.2% of other psychotropic drugs

Paulozzi warned that patients with mental health disorders are at increased risk for heavy therapeutic use, nonmedical use, and overdose of opioids.

They wrote that screening, identification, and appropriate management of these disorders "is an important part of both behavioral health and chronic pain management."

They called for greater use of tools such as prescription drug monitoring programs (PDMPs) and electronic health records (EHRs) in order to "identify risky medication use and inform treatment decisions, especially for opioids and benzodiazepines."

They acknowledged that the death certificate data they used have limitations, but said these records are the sole source for detailed death information at the national level. In particular, they were limited by the 25% of death certificates in which the type of drugs involved were not specified.

The study was supported by the CDC. The researchers reported no conflicts of interest. Primary source: Journal of the American Medical Association Source reference: Paulozzi LB, et al "Pharmaceutical overdose deaths, United States, 2010" JAMA 2013; 309: 657-659.

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