Dr. Mercola: Drug Overdoses Are the 9th Leading Cause of Death in the US

Between 2000 and 2009, and Americans now use 80 percent of all the opioids sold worldwide    Drug overdoses (63 percent of which are opioids) replaced kidney disease as the 9th leading cause of death in the U.S. as of 2015
    Addiction affects about 26 percent of those using opioids for chronic non-cancer pain; 1 in 550 patients on opioid therapy dies from opioid-related causes within 2.5 years of their first prescription

By Dr. Mercola

According to the U.S. surgeon general, more Americans now use prescription opioids than smoke cigarettes.1 This makes sense when you consider prescriptions for opioid painkillers rose by 300 percent between 2000 and 2009,2,3 and Americans now use 80 percent of all the opioids sold worldwide.4

In Alabama, which has the highest opioid prescription rate in the U.S., 143 prescriptions are written for every 100 people.5 A result of this over-prescription trend is skyrocketing deaths from overdoses.6,7

The most common drugs involved in prescription opioid overdose deaths, specifically, include8 methadone, oxycodone (such as OxyContin®) and hydrocodone (such as Vicodin®).

As noted by Dr. Tom Frieden, director of the U.S. Centers for Disease Control and Prevention (CDC): "We know of no other medication routinely used for a nonfatal condition that kills patients so frequently."9

There are safe options to treat pain, but education — both among doctors and patients — is sorely lacking. This is why I frequently write about this issue, and hope you'll do your part in spreading the word.

Far too many people in the prime of their life are losing it to painkiller addiction, and often they simply had no idea a prescription painkiller for a temporary injury or pain would send them into the throes of drug addiction.
Drug Overdoses Now 9th Leading Cause of Death in the US

In 2014, prescription drug overdoses, a majority of which involved some type of opioid, killed more Americans than car crashes (49,714 compared to 32,675).10 This held true for 2015 as well, despite 2015 being hailed as the deadliest driving year since 2008.

In all, 38,300 Americans died in car crashes in 201511 — a sharp rise thought to be related to a combination of cheaper gas prices and hence increased travel, and using smartphones while driving.12 A rise in overdoses also suddenly placed drug overdoses in the top 10 leading causes of death in the U.S.

In 2015, 52,404 Americans died from drug overdoses; 33,091 of them involved an opioid and nearly one-third of them, 15,281, were by prescription.13,14,15 Meanwhile, kidney disease, listed as the 9th leading cause of death on the CDC's top 10 list, killed 48,146.16

The CDC does not include drug overdoses on this list, but if you did, drug overdoses (63 percent of which are opioids), would replace kidney disease as the 9th leading cause of death as of 2015, inching its way toward the 8th slot, currently occupied by respiratory complications such as pneumonia, which took 55,227 lives in 2015.
Why Are Pregnant Women Prescribed Narcotics?

A statistic that shows just how overprescribed and misused opioid drugs are is the prescription rate for pregnant women and women of childbearing age.

Despite carrying risks of pregnancy-related problems and birth defects, shockingly, nearly one-third of American women of childbearing age are prescribed opioid painkillers17 and more than 14 percent of pregnant women were prescribed opioids during their pregnancy.18

Reasons for prescribing these extremely dangerous drugs include back and/or abdominal pain, migraine, joint pains and fibromyalgia. Clearly, if you are planning a pregnancy or are pregnant, you should go to great lengths to avoid narcotic drugs. If you wouldn't consider taking heroin, you shouldn't take a narcotic pain reliever.

Yet, in 2015, 27 million Americans either used illegal drugs and/or misused prescription drugs, and addiction to opioids and heroin now costs the U.S. more than $193 billion each year.

Please, take care to avoid becoming part of this devastating trend. Studies show addiction affects about 26 percent of those using opioids for chronic non-cancer pain. Worse, 1 in 550 patients on opioid therapy dies from opioid-related causes within 2.5 years of their first prescription.19

According to the latest data from the National Center for Health Statistics, life expectancy for both men and women dropped between 2014 and 2015, for the first time in two decades, and overdose deaths appear to be a significant contributor.20,21,22
Drug Industry Is Responsible for Mass Addiction

Many believe the drug companies that create and sell these drugs need to be held accountable for America's rapidly escalating drug problem, especially since several have been caught lying about the benefits and risks of their drugs.

As noted by the Organic Consumers Association,23 the drug industry has "fostered the opioid addiction epidemic" by:

• Introducing long-acting opioid painkillers like OxyContin, which prior to reformulation in 2010 could be snorted or shot. Many addicts claimed the high from OxyContin was better than heroin.

From a chemical standpoint, OxyContin is nearly identical to heroin, and has been identified as a major gateway drug to heroin.

• Changing pain prescription guidelines to make opioids the first choice for lower back pain and other pain conditions that previously did not qualify for these types of drugs.

• Promoting long-term use of opioids, even though there's no evidence that using these drugs long-term is safe and effective.

• Downplaying and misinforming doctors and patients about the addictive nature of opioid drugs. OxyContin, for example, became a blockbuster drug mainly through misleading claims that Purdue Pharma knew were false from the start.

The basic promise was that it provided pain relief for a full 12 hours, twice as long as generic drugs, giving patients "smooth and sustained pain control all day and all night."

However, for many the effects don't last anywhere near 12 hours, and once the drug wears off, painful withdrawal symptoms set in, including body aches, nausea and anxiety. These symptoms, in addition to the return of the original pain, quickly begin to feed the cycle of addiction.24
Drug Enforcement Administration Struggles to Hold Drug Makers Accountable for Black Market Sales

Evidence has repeatedly shown opioid makers have acted with callous disregard for human life, yet they keep getting off the hook with little more than a slap on the wrist. The Washington Post recently published an article detailing the Drug Enforcement Administration's (DEA's) failure to bring an opioid maker to justice.25

In 2011, the DEA began investigating Mallinckrodt Pharmaceuticals, one of the largest manufacturers of oxycodone in the U.S. This was the first time the DEA targeted a drug manufacturer for violating laws designed to prevent black market sales of legal narcotics.

To date, it's also the largest prescription drug case the DEA has ever pursued. Federal prosecutors accused Mallinckrodt Pharmaceuticals of ignoring "its responsibility to report suspicious orders as 500 million of its pills ended up in Florida between 2008 and 2012."

In all, 66 percent of all oxycodone sold in Florida between those years was shipped to suspected "pill mills" selling prescription drugs to addicts.

In 2010 alone, one distributor, Cincinnati-based KeySource Medical, shipped 41 million oxycodone tablets made by Mallinckrodt to Florida. That's enough pills to give every man, woman and child in the state 2.5 pills each. Cardinal Health, one of the largest drug distributors in the U.S., was also sending extremely large amounts of Mallinckrodt-made oxycodone pills to Florida.

One Delray Beach doctor named Barry Schultz received 92,400 oxycodone pills from Sunrise Wholesale in just 11 months. He once prescribed 1,000 pills to a single patient, all in one day — a clearly suspect prescription by any reasonable standard.

At the time these enormous shipments were made, the street value of one "oxy" pill was $30. Schultz was sentenced to 25 years in prison in 2016 after being charged with drug trafficking and one case of manslaughter, following the overdose death of one of his patients. As noted in the featured article:26

    "'Mallinckrodt knew through law enforcement reports that Barry Schultz was diverting controlled substances, and that the diverted oxycodone was supplied by Mallinckrodt through Sunrise,' prosecutors later wrote in an internal document sent to the company. 'When Mallinckrodt continued to distribute oxycodone to Sunrise for such purposes, and continued to pay incentives in the form of chargebacks for the product sales to Barry Schultz, Mallinckrodt was diverting oxycodone.'"

A pharmacy in Sanford, Florida, also stood in receipt of suspicious amounts of pills. Over the course of four years, it received 5.8 million oxycodone pills — nearly 20 times more than the state average for pharmacies.

By law, drug manufacturers must notify the DEA when suspicious orders such as these occur. Mallinckrodt stood accused of 44,000 federal violations, totaling $2.3 billion in fines. In all, federal prosecutors claimed 222,107 Florida orders were "excessive" and should have been reported to the DEA as suspicious.
Oxycodone Maker Gets Off Scot-Free — Again

Yet, despite a massive five-state investigation spanning several years, the U.S. government has taken no legal action against Mallinckrodt, and likely never will. "Instead, the company has reached a tentative settlement with federal prosecutors," The Washington Post writes, adding:

    "Under the proposal, which remains confidential, Mallinckrodt would agree to pay a $35 million fine and admit no wrongdoing … The case shows how difficult it is for the government to hold a drug manufacturer responsible for the damage done by its product. DEA investigators appalled by rising overdose deaths said they worked for years to build the biggest case of their careers only to watch it falter on uncertain legal territory and in the face of stiff resistance from the company.

    'They just weren't taking this seriously, and people were dying,' said a former law enforcement official who spoke on the condition of anonymity because the case is pending … 'It wasn't their kids, their wives, their husbands, their brothers. It was some hillbilly in Central Florida, so who cares?'"

A $35 million fine is a drop in the bucket for a company that boasts $3.4 billion in annual revenue, with a net profit of $489 million,27,28 and will do absolutely nothing to deter it or other drug companies from continuing business as usual. As noted by The Washington Post:

    "Drug manufacturers have paid much larger fines for other misdeeds. Glaxo­SmithKline was fined $3 billion, and Pfizer was fined $2.3 billion for illegally promoting off-label drug use and paying kickbacks to doctors. Purdue Pharma paid a $600 million fine, and three of its executives pleaded guilty to charges that they misled regulators, doctors and patients about the risks of the painkiller that is widely blamed for setting off the nation's opioid crisis: OxyContin.

    All of those cases were initiated by the Food and Drug Administration [FDA]. The largest fine the DEA has levied against a drug distributor was the $150 million that McKesson, the nation's largest drug wholesaler, recently agreed to pay following allegations that it failed to report suspicious orders of painkillers. For a company the size of Mallinckrodt, a $35 million fine is 'chump change,' one government official said."

Drug Industry Ensures Leniency by Hiring DEA and DOJ Agents

Last year, seven U.S. senators demanded to find out why there has been such a sharp decline in enforcement actions by the DEA against wholesalers suspected of distributing prescription narcotics to the black market.29

According to The Washington Post, DEA lawyers began delaying and blocking enforcement efforts by DEA agents against opioid distributors in 2013, suddenly insisting on increasingly higher standards of proof before moving cases forward. This included proof of intent — a factor that is very difficult to prove and typically only required in criminal cases.

In 2011, the DEA took 131 actions against distributors. By 2014, that number had dropped to 40. In that same time frame, the number of "immediate suspension orders" dropped from 65 to nine. (The suspension order allows the agency to freeze shipments of narcotics, effective immediately.) The question is why. I've written about the dangers of the revolving door policy that allows regulators to be hired by industry and vice versa on numerous occasions.

In this case, former DEA and Department of Justice (DOJ) officials hired by the drug industry fought for lenience and a "soft approach" to the burgeoning drug addiction problem.30 They succeeded, thereby allowing the problem to grow more or less unrestrained, despite official promises to the contrary. Many DEA officials did in fact suspect Clifford Lee Reeves II, the lawyer in charge of approving their cases, of secretly working for the drug industry.
New FDA Chief Unlikely to Take Hard Line Against Opioids

Unfortunately, President Trump's nominee for head of the FDA, Dr. Scott Gottlieb, is also in the opioid industry's pocket, having received nearly $45,000 in speaker's fees from opioid manufacturers and distributors.31 During his confirmation hearing, Gottlieb stated he believes the U.S. opioid crisis is a "public health emergency on the order of Ebola and Zika" that requires dramatic action, and promised that developing a strategy to curb the opioid epidemic would be his "highest and most immediate priority."32

The question is whether or not he'll actually follow through. Gottlieb's drug industry ties are so significant, he's agreed to recuse himself for one year from decisions involving more than 20 different drug companies with whom he has decades' long financial connections.

As noted by Dr. Andrew Kolodny, co-director of Opioid Policy Research at Brandeis University:33 "Our country is in desperate need of an FDA commissioner who will take on the opioid lobby, not one who has a track record of working for it." Senator Edward Markey (D-Mass) also criticized Trump's choice for the FDA saying,34 "Gottlieb's record indicates that he would not take the epidemic and the FDA's authority to rein in prescription painkillers and other drugs seriously."
Prescription Painkillers Are Gateway Drugs to Heroin and Other Deadly Highs

Oxycontin and other opioid pain killers have been identified as the primary gateway drugs to heroin.35 Chemically, these drugs are very similar and provide a similar kind of high. According to a 2013 U.S. Substance Abuse and Mental Health Services Administration report, nearly 80 percent of people who use heroin have previously used prescription painkillers.36 Opioids work by attaching to opioid receptors in your brain, thereby blocking pain signals.

This also has the effect of creating a sensation of pleasure or euphoria — and addiction. Over time they can also result in increased pain perception, setting into motion a cycle where you need increasingly larger doses, making a lethal overdose more likely.

Oxycontin's high rate of addiction is the result of a short half-life (the amount of time the drug stays in your system before you are left wanting more). Opioids are also very potent immune suppressors. As such they can wreck your health in serious ways, leaving you far worse off than where you started.

Many users are also turning to much stronger types of opioids, such as fentanyl, which is seeing the fastest rate of growth in use. Deadly overdoses involving fentanyl rose by 50 percent between 2013 and 2014, and another 72 percent between 2014 and 2015. Fentanyl is a synthetic opioid that can be anywhere from 500 to 1,000 percent more potent than morphine.

Besides a more potent high, price is another factor driving its popularity. Since it can be created in a lab, it's far cheaper than heroin, which in turn is cheaper than prescription opioids.

A recent NPR story37 reveals the tremendous impact fentanyl is having on many people's lives. Allyson, a 37-year old client at the AAC Needle Exchange and Overdose Prevention Program in Cambridge, Massachusetts, says she's lost 30 friends to these deadly painkillers. "Basically, my entire generation is gone in one year," she said.
Are You or Someone You Love Addicted to Painkillers?

Some of the marketing material for opioids claims the drug will not cause addiction "except in very rare cases," describing the adverse effects patients experience when quitting the drug as a "benign state" and not a sign of addiction. This simply isn't true. Panic is one psychological side effect commonly experienced when quitting these drugs, and this can easily fuel a psychological as well as physical dependence on the drug.

It's important to recognize the signs of addiction, and to seek help. If you've been on an opioid for more than two months, or if you find yourself taking higher dosages, or taking the drug more often, you're likely already addicted and are advised to seek help from someone other than your prescribing doctor. Resources where you can find help include:

    Your workplace Employee Assistance Program
    The Substance Abuse Mental Health Service Administration38 (SAMHSA) can be contacted 24 hours a day at 1-800-622-HELP

With all the health risks associated with opioid painkillers, I strongly urge you to exhaust other options before resorting to these drugs. For a long list of alternative pain treatments, please see my previous articles, "Treating Pain Without Drugs," and "New Treatment Guidelines for Back Pain Stress Non-Drug Interventions."
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