Which Misused Prescription Meds Send Americans to the ER?
Most folks treated in a U.S. emergency room for misuse of prescription medications get into trouble because they mix different substances, a new study reports.
Benzodiazepines like Xanax (alprazolam) and Ativan (lorazepam) are most commonly implicated in health crises that lead to an ER visit, followed by prescription opioids, researchers found.
But in most cases, the patients fell ill because these drugs were taken with other substances and created a dangerous interaction, said lead researcher Dr. Andrew Geller. He's a medical officer with the U.S. Centers for Disease Control and Prevention's medication safety team.
"Most of the time there may have been only one pharmaceutical involved, but there were other non-pharmaceutical substances or psychoactive drugs or alcohol involved as well," Geller said. "When people get into trouble with misusing medicines, they're usually taking more than one substance."
And even though America struggles with an epidemic of opioid and other prescription drug addiction, only a minority of cases clearly involved outright abuse.
About 40 percent of the cases reviewed were specifically tied to drug abuse, Geller's team found, while about 44 percent of cases were overdoses with no clear indication whether drug abuse, misuse or attempted suicide was involved. People taking drugs that either hadn't been prescribed to them or weren't intended for that particular purpose accounted for the remaining 16 percent.
For the study, Geller and his colleagues reviewed federal surveillance data tracking ER visits involving prescription-drug misuse in 2016.
Misuse could involve taking someone else's medication, taking a larger dose than prescribed, or trying to use prescription drugs to get high, Geller explained.
The researchers identified nearly 360,000 ER visits related to misuse of pharmaceuticals, the findings show.
Benzodiazepines were the primary prescription drug in 47 percent of cases, and prescription opioids like OxyContin (oxycodone) were cited in 36 percent of cases.
Benzodiazepines are sedatives normally prescribed for anxiety or insomnia, according to the U.S. National Institute on Drug Abuse, while opioids are typically used as painkillers.
However, other substances were involved in 85 percent of the benzodiazepine cases and 69 percent of prescription opioid cases that hit the ER in 2016, Geller said. These substances included alcohol, heroin, cocaine and other illicit or prescription drugs.
"These results are consistent with other studies showing the potentially severe effects of misusing multiple pharmaceutical medications, especially opioids in combination with benzodiazepines," said Linda Richter, director of policy research and analysis with the Center on Addiction. "Since both drugs cause respiratory depression, or slowed breathing, each compounds the dangerous effects of the other."
Prior studies have also shown that most people who misuse or depend on an addictive substance do not use that substance in isolation, she added.
"Polysubstance misuse, or the misuse of multiple pharmaceutical drugs or pharmaceutical drugs along with alcohol or illicit drugs, is the most common pattern of substance misuse, especially among young people," said Richter, who wasn't involved with the study.
Much of the time, the drug users became dangerously ill, researchers found.
Two-fifths of cases resulted in hospitalization, and about a quarter involved people who either were unconscious or whose heart or breathing had stopped.
Half of the ER visits involved patients younger than 35. Despite concerns over opioid abuse among older adults, only 1 in 20 cases involved someone 65 or older.
The researchers also found that naloxone, the medication that can reverse an opioid overdose, is not routinely made available to OD patients when they leave the hospital.
"Patients who have been brought to the emergency room for an OD, these might be the most appropriate people to offer naloxone," Geller said. "We know that people who survive opioid overdose are at high risk for experiencing a subsequent and sometimes fatal overdose."
These findings also show that doctors should talk a bit with patients before handing out prescription drugs rife for misuse, Geller said.
"Before deciding to prescribe a commonly misused medication like a prescription opioid or benzodiazepine, physicians should ask a few questions to help determine if the patient currently is misusing substances," Geller said. "With some simple screening questions, we can identify which patients are using substances and we can help them start on the road to recovery."
Doctors also can use the information to decide which prescriptions to avoid while the patient is still taking other substances, Geller added.
The study appears in the March 6 American Journal of Preventive Medicine.
The U.S. National Institute on Drug Abuse has more about mixing benzodiazepines and opioids.
SOURCES: Andrew Geller, M.D., medical officer, U.S. Centers for Disease Control and Prevention, Medication Safety Team; Linda Richter, Ph.D., director, policy research and analysis, Center on Addiction; American Journal of Preventive Medicine, March 6, 2019