Death by prescription painkiller

Posted on Monday, June 23, 2014

pillsFirst major review provides evidence of sharp increase in deaths from painkillers in U.S. and Canada

By Cynthia Lee

The number of deaths involving commonly prescribed painkillers is higher than the number of deaths by overdose from heroin and cocaine combined, according to McGill researchers. In a first-of-its-kind review of existing research, the McGill team has put the spotlight on a major public health problem: the dramatic increase in deaths due to prescribed painkillers, which were involved in more than 16,000 deaths in 2010 in the U.S. alone. Currently, the U.S and Canada rank #1 and #2 in per capita opioid consumption.

“Prescription painkiller overdoses have received a lot of attention in editorials and the popular press, but we wanted to find out what solid evidence is out there,” says Nicholas King, of the Biomedical Ethics Unit in the Faculty of Medicine. In an effort to identify and summarize available evidence, King and his team conducted a systematic review of existing literature, comprehensively surveying the scientific literature and including only reports with quantitative evidence.

“We also wanted to find out why thousands of people in the U.S and Canada are dying from prescription painkillers every year, and why these rates have climbed steadily during the past two decades,” says King, “We found evidence for at least 17 different determinants of increasing opioid-related mortality, mainly, dramatically increased prescription and sales of opioids; increased use of strong, long-acting opioids like Oxycontin and methadone; combined use of opioids and other (licit and illicit) drugs and alcohol; and social and demographic factors.”

“We found little evidence that Internet sales of pharmaceuticals and errors by doctors and patients–factors commonly cited in the media — have played a significant role,” Prof. King adds.

The findings point to a complicated “epidemic” in which physicians, users, the health care system, and the social environment all play a role, according to the researchers.

“Our work provides a reliable summary of the possible causes of the epidemic of opioid overdoses, which should be useful for clinicians and policy makers in North America in figuring out what further research needs to be done, and what strategies might or might not be useful in reducing future mortality,” says King. “And as efforts are made to increase access to prescription opioids outside of North America, our findings might be useful in preventing other countries from following the same path as the U.S. and Canada.”

The results of this research are published in the American Journal of Public Health and can be read here.

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2 Responses to Death by prescription painkiller

  1. richard place says:

    “These determinants operate independently but interact in complex ways that vary according to geography and population, making generalization from single studies inadvisable. Researchers in this area face significant methodological difficulties; most of the studies in our review were ecological or observational and lacked control groups or adjustment for confounding factors; thus, causal inferences are difficult.”

    Wow, so pretty much a complete lack of science.

  2. Trish Morrison says:

    Mr. Place’s quotation above is but one (albeit an essential one) of the many misleading inferences that riddle this “Systematic Review.” Several others: 1) The title refers to “Increased Opioid-Related Mortality in the United States and Canada,” but read a little further, and we learn that, “National data [for this type of mortality] are UNavailable for Canada…” (And what exactly is the relevance of mortality statistics from one province out of Canada’s ten?) 2) The selection process described under “Methods” is fraught with holes although readers are presumably meant to be reassured because, on a regular basis, “…all disagreements [between the participants] were resolved through discussions with the first author, who had final say on data extraction.” 3) The authors point out that one of at least 3 significant limitations in their undertaking (see “Limitations”), “…necessitate[ed] substantial discretionary judgment” while another “did not entirely eradicate…[a]…potential bias.” 4) And when, precisely, does the substance of this “systematic review” commence? The title suggests 1990; the 1st sentence of the 1st pgh implies 1994; later in this pgh, 1999 is used to demonstrate a 4-fold increase; electronic databases were searched from 1946 through 2013; and the earliest date from “the Final Sample” of articles was the year 2005. 5) One of the several “methodological challenges” was the following: “Although we classified determinants into 3 categories for conceptual clarity, we should note that they may interact and mutually influence one another.” 6) The authors frankly admit that “a number of commentaries…have argued that phenomena not discussed in this review – including prescriber error and lack of training and patient error…have been significant determinants of increases in opioid-related mortality. We found no evidence to support these claims [in the 47 articles under review]. However, absence of evidence should not be taken to imply evidence of absence.” Indeed.
    The last pgh FINALLY brings to light a TRULY alarming statistic from a 2007 article entitled, “Addressing the global tragedy of needless pain: rethinking the United Nations single convention on narcotic drugs”, and that is, “Without access to adequate pain management, 600 million people alive today are likely to experience negative health effects caused by untreated pain.” This salient point is followed by a cluttered attempt to bring to light “global inequalities…[regarding] access to effective pain management, particularly opioid analgesics.” But by then, it is far too little, too late, and the damage has truly been done. Just look at the very media article which introduced this abstract at the outset, “Death by Prescription Painkiller.” Be assured that the press will latch onto this muddled Systematic Review as its foundation for sweeping generalizations such as the following: “The findings point to a complicated ‘epidemic’ in which physicians, users, the health care system, and the social environment all play a role, according to the researchers.” Reporters reassure readers that, “King and his team conducted a systematic review of existing literature, comprehensively surveying the scientific literature and including only reports with quantitative evidence.” Clearly, even the authors’ preface to their Review refutes such a statement, namely, “…most of the studies in our review were ecological or observational and lacked control groups or adjustment for confounding factors; thus, causal inferences are difficult.” No, the press will extract all the dramatic causal inferences necessary from this ill-founded “Systematic Review” – which will virtually assure that the 600 million people (and counting) who suffer from untreated pain will continue to do so.

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