Fatal overdoses due to painkillers have reached epidemic levels, greatly exceeding those from heroin and cocaine combined and becoming the worst drug epidemic in US history. Prescriptions for painkillers in the United States have nearly tripled in the past two decades, and the results are dreadful. In 2012, enough painkillers were prescribed to keep every single citizen medicated around the clock for a month – or once every 12 days for an entire year. Even after a patient overdoses, but survives, he’s still put on prescriptions: 91% of the time, according to a paper published in the Annals of Internal Medicine.

Image: Ed in the Ed

According to a report released on Jan 1st by the Centers for Disease Control and Prevention (CDC), in 2014 “a total of 47,055 drug overdose deaths occurred in the United States, representing a 1-year increase of 6.5%, from 13.8 per 100,000 persons in 2013 to 14.7 per 100,000 persons in 2014.” In the same year, 150% more people died from drug overdoses than from car crashes. Fatal overdoses due to heroin, an illegal drug, increased by 26% from 2013 to 2014 and have more than tripled since 2010, from 1.0 per 100,000 in 2010 to 3.4 per 100,000 in 2014. Yet, most drug overdoses are due to prescribed opioid pain relievers, like oxycodone and hydrocodone. With these stark findings in mind, the CDC recommends safer prescribing of prescription opioids. Reality is a tad different, though. Opioid prescriptions have quadrupled since 1999, and it seems like even those who overdose on the meds, but survive, are given the same prescriptions.

In 2013, 16,235 people died of overdoses of opioid prescription painkillers.

The researchers from Boston, Massachusetts picked 2,834 patients from a huge database numbering 50 million people who filed insurance claims between 1999 and 2010. These patients were prescribed an opioid for chronic pain, then at some point in the 12 year-long survey had  a nonfatal overdose. In the next 299 days following the overdose, more opioids were dispensed to 91% of patients. Two years later,  17% of those who were prescribed a high dose had a repeated overdose; 15% for those receiving a moderate those and 9% for those receiving a low dose. Moreover, 70% of the patients of the overdose survivors were prescribed opioids by the same doctor.

Opioid drugs work by binding to opioid receptors in the brain, spinal cord, and other areas of the body. They reduce the sending of pain messages to the brain and reduce feelings of pain, hence they’re prescribed for alleviate the suffering of people with advanced cancer, but also for many other afflictions that cause chronic pain. Considering this huge drug epidemic sweeping the United States, it may be that many doctors are too lenient with how and in what conditions they decide to prescribe opioids and their dosage.

Some have suggested that the endemic opioid painkiller usage is driven by  small groups of prolific prescribers and “corrupt pill mills”. A study published in the journal JAMA Internal Medicine suggests this isn’t the case. The study found  a huge number of those drugs are coming from run-of-the-mill family doctors and general practitioners. “You can’t just blame a handful of pain doctors,” said Dr. Jonathan Chen, an internist at the Stanford School of Medicine, and lead author of the study published in JAMA. “All of us are part of this problem whether we want to admit it or not.”

From the study’s data, it’s hard to make out if the same dosage was prescribed to the overdose survivors. After all, these drugs were prescribed in the first place because the patients experienced severe pain, so pulling out the medication altogether is unethical. No doctor wants to see patients in pain. What they hate most, I suspect, is seeing their patients die, though. As such, these findings should serve as a wakeup call. There are too many opioids being prescribed.  Maybe, pain is better than the alternative: the risk of overdose and addiction.