Many Americans on Long-Term Painkillers Take Potentially Fatal Drug Combinations

Nearly 60 percent of patients on opioid pain treatments for long-term conditions were prescribed potentially dangerous mixtures of medications during the same time period, according to a report released today. Two-thirds of patients on these medication mixtures were prescribed the drugs by two or more physicians, and nearly 40 percent filled their prescriptions at more than one pharmacy.  

The new report, A Nation in Pain, provides a comprehensive analysis of the use of prescription opioid medications – such as codeine, morphine, oxycodone and hydrocodone – in the U.S. between 2009 and 2013.

Among  those taking dangerous drug mixtures last year, nearly  one in three patients were on both an opiate and an anti-anxiety benzodiazepine, a combination that is the most common cause of multiple drug overdose deaths. Approximately 28 percent of opioid users were taking a muscle relaxant. Eight percent were combining an opioid, muscle relaxant and a benzodiazepine – a popular combination among pill mills known as the "Houston Cocktail." Additionally, 27 percent were taking multiple opiate pain treatments simultaneously.

Women accounted for nearly two-thirds of those taking these potentially hazardous mixes of medications.

"There could be instances when prescribing these combinations of drugs is appropriate, but not at this scale. The fact that the majority of these patients are being treated by multiple physicians and pharmacies signals a communication breakdown that leads to dangerous use," said Lynne Nowak, M.D., medical director at Express Scripts and a former hospice care physician. "Government- and insurer-run drug monitoring programs can help prevent these possibly life-threatening scenarios, but unfortunately they are underused and vary by state. As more people gain access to health coverage, this problem will worsen if the country doesn't use every tool at its disposal to ensure the safe use of these medications."

Same Number of Patients, Increasing Number of Prescriptions

From 2009 to 2013, the number of Americans taking opioids on a long-term basis remained fairly constant, stabilizing the upward trend seen in recent decades. However, the amount of medication taken by people filling opioid prescriptions increased significantly. Both the number of opioid prescriptions filled and the number of days of medicine per prescription rose more than 8 percent over the past five years. 

Other Utilization and Demographic Trends

• Nearly half of patients who took opiate painkillers for more than 30 days in the first year continued to use them for three years or longer.
• Almost half of chronic opioid users took only short-acting medications – rather than longer-acting formulations – thus increasing their risk for addiction.
• Women were 30 percent more likely than men to use an opioid pain medication, but men tended to fill more frequent and potent opioid prescriptions.
• While the elderly had the highest prevalence rate of opioid use, younger adults tended to fill more frequent opioid prescriptions.