The word “overdose” calls to mind crack and heroin, not pills your doctor gives you. But legal prescription drugs now cause more deaths in North America than either cocaine or heroin.
Irfan Dhalla and David Juurlink, both at the University of Toronto’s department of medicine, and their colleagues, wanted to know what effect the introduction of long-acting oxycodone had on death by overdose in Ontario. Health Canada first approved the drug in 1996 and provincial drug plans agreed to cover it in 2000.
Oxycodone is a prescription opioid painkiller, and in its slow-release form, sold as “OxyContin,” it can combat pain for about 12 hours. It was originally thought that the slow-release version would lower the risk of abuse. But once users realized it could be chewed or crushed to release the full dose all at once – up to 16 times what’s contained in other prescription oxycodone painkillers – its dangers became obvious.
The researchers reviewed all opioid-related deaths in the province between 1991 and 2004 and also examined prescribing trends. They found that the addition of long-acting oxycodone to the provincial drug plans was associated with a five-fold rise in oxycodone-related deaths, as well as an increase in overall opioid-related mortality. Over half the deaths were unintentional, often caused when they were mixed with alcohol, antidepressants or benzodiazepines.
“Many doctors have been surprised to hear just how many deaths are related to the use of OxyContin and other similar painkillers,” says Dr. Dhalla. Doctors could do more to reduce the risk, he says, including not prescribing these drugs to people with a history of psychiatric illness or substance abuse, and, except when being used for cancer pain, getting patients to sign contracts and to submit to urine tests.