Taking Multiple Drugs Increases Risk Associated with Abuse of Prescription Pain Pills
By Hugh C. McBride
A little more than a month after the death of Billy Mays, autopsy reports indicated that the famous pitchman had ingested a number of drugs, including cocaine, three types of painkillers (hydrocodone, oxycodone and tramadol) and two anti-anxiety medications (alprazolam and diazepam), in the days before his death.
A report by the Hillsborough (Fla.) County medical office indicates that Mays' death was the result of heart disease, with the cocaine cited as a "contributory cause of death."
Though most headlines called attention to Mays' cocaine use, the presence of the other drugs raised questions about the impact multiple prescription painkillers can have on the health of even a relatively young man (Mays was about a month shy of his 51st birthday when he died).
Is it Ever Safe to Take Multiple Painkillers?
No one has implied that Billy Mays had procured his painkillers or anti-anxiety medications from anywhere other than legal sources. As Brian Palmer reported in an Aug. 10 article on the website Slate, taking more than one prescription pain pill at the same time does not necessarily indicate either illicit activity or improper medical care:
Is there a valid medical reason for taking three medications that do the same thing?
Yes. A doctor might prescribe one medication to treat chronic, baseline pain and another one for a more acute pain that the first drug couldn't prevent. In unusual circumstances, a third medication might be used to treat another "breakthrough" pain that differs in intensity, duration, or location from earlier symptoms. ...
Patients often take several medications that work in different ways to improve clinical impact without increasing the likelihood or intensity of side effects.
However, Palmer notes, even with competent medical supervision, taking such a cocktail of powerful medications over a long period is "dangerous and unusual." And adding cocaine into the mix would both exacerbate the risk and lessen the likelihood of keeping the abuse of this illicit substance a secret.
"Any responsible doctor who would offer these medications in combination would be testing Mays' urine regularly to ensure that he was taking the drugs as prescribed," Palmer wrote. "Through these tests, he would have found out that Mays was also taking cocaine. Federal law prohibits doctors from prescribing opioids to patients with uncontrolled substance-abuse problems."
What Are the Risks of Taking Multiple Painkillers?
Prescription painkiller abuse is one of the nation's most pressing drug-related problems. Among teenagers, for example, prescription pills are being abused at a rate that exceeds all other illicit substances except marijuana.
Even when taken under a doctor's care, prescription painkillers can be dangerous:
• Opioids can cause drowsiness and depress breathing.
• Central nervous system depressants (such as Valium, Xanax and the sleep medication Lunestra) can slow both breathing and heart rate.
• Stimulants such as Ritalin, Adderall and Dexedrine can increase blood pressure, raise the user's body temperature and cause irregular heartbeat.
These symptoms are more likely to occur when the drugs are being abused (taken recreationally in larger-than-recommended doses or for extended periods of time). Taking these pills together can also worsen the symptoms; for example, taking two different opioids, or an opioid with a CNS depressant can intensify the effects of each medication. If the effect being intensified included slowed heart rate or depressed breathing, death can result.
What Happens When the Doctor Says 'No'?
Again, no evidence has been presented to allege that Billy Mays had been illegally acquiring prescription painkillers or anti-anxiety medications. But tens of thousands of other Americans are doing just this on a daily basis.
According to the National Institute on Drug Abuse (NIDA), painkillers from the opioid family are among the most commonly abused prescription medications in the United States today. For purposes of misuse and abuse, the most sought-after opioids include:
• Hydrocodone (the primary active ingredient in Vicodin)
• Oxycodone (marketed as OxyContin)
• Codeine (legally used for more mild pain such as headaches)
• Morphine (prescribed for extreme pain)
• Fentanyl (a powerful painkiller prescribed to address "breakthrough" pain, such as that experienced by some cancer patients, that is not eased by morphine)
One of the more prevalent forms of acquiring these prescription medications is known as "doctor shopping." Doctor shoppers visit multiple physicians and present with pain-related symptoms in an effort to acquire several prescriptions for these powerful drugs.
A number of states have instituted online prescription registries to prevent this type of behavior. In these states, prescriptions are logged by doctors, and multiple prescriptions for the same medication by the same person would be flagged by the system.
However, as Zac Anderson and John Davis reported in a July 19 Herald-Tribune article, Florida's efforts to use technology to prevent doctor shopping have been hindered by a significant loophole in the process:
Billy Courtright got prescriptions for 250 addictive painkillers from doctors in Venice and North Port within a matter of days last month. His wife, Linda, got dozens more. ...
A new state law is supposed to prevent such "doctor shopping" for prescription pain pills, which have become the state's leading drug killer, but the law has a big loophole: Pharmacists have 15 days to enter prescriptions into a new electronic database.
"That 15-day window really troubled us," Dr. Rafael Miguel, a pain expert with the University of South Florida, told the Herald-Tribune. "No pain physicians wanted it. I'm already working with our lobbyists on an amendment to the law."
Getting Help for Pain & Addiction
Some people who end up abusing pain medications do so after first using them for legitimate, physician-approved purposes. But as their use devolves into abuse, they may find that they need to take increasingly large doses in order to fight what feels like greater and greater amounts of pain.
People who find themselves dependent upon pain pills need to get professional help to treat both their substance abuse and chronic pain. Depending upon the nature and severity of a person's problems with drugs and pain, treatment may range from outpatient therapy to long-term residential care.
For example, in Navarre, Florida, the Twelve Oaks Recovery Center has had considerable success helping patients who are dealing with both chronic pain and drug addiction. Licensed by the Florida Department of Children and Families and fully accredited by the Commission on Accreditation of Rehabilitation Facilities, Twelve Oaks is a private, 101-bed recovery center that provides comprehensive care for adults and adolescents who are struggling with drug addiction and chronic pain.
Regardless of how a person begins abusing prescription pills, the behavior can inflict lasting damage on one's health, social relationships, education and career. But help is available, and a future free of the chains of addiction and pain can be as close as a phone call or mouse-click away.
