Following a hospitalization for drug overdose, 1 in 5 fill opioid prescription

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Are Doctors to Blame for the Prescription Drug Addiction Epidemic?


A simple step to helping curb opioid abuse would seem to be stemming the supply of the highly addictive medications to people who become dependent on them. But a new study suggests that even after patients have been hospitalized for drug abuse or overdose, doctors continue to write them prescriptions for opioids.

More than 1 in 5 patients treated in hospitals for conditions related to reliance on opioids filled opioid prescriptions within 30 days of their release, according to findings published in the Psychiatric Services in Advance.

SEE ALSO: Prescription painkillers might actually cause chronic pain

The research comes after years of growth in the number of opioid prescriptions written and as the number of Americans addicted to prescription painkillers, heroin or both has skyrocketed. The increases have resulted in more emergency room visits and more deaths. Each day, 46 people die from an overdose of prescription painkillers in the U.S., according to the Centers for Disease Control and Prevention.

The situation has raised concern among doctors about prescribing patterns – mainly that physicians are too widely distributing the medications. In 2012, health providers wrote 259 million prescriptions for painkillers, nearly enough for everyone in America.

RELATED: What opioids do to your health

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Following a hospitalization for drug overdose, 1 in 5 fill opioid prescription

Opioid painkillers capitalize on our body's natural pain-relief system. We all have a series of naturally produced keys ("ligands") and keyholes ("receptors") that fit together to switch on our brain's natural reward system — it's the reason we feel good when we eat a good meal or have sex, for example. But opioids mimic the natural keys in our brain — yes, we all have natural opioids! When they click in, we can feel an overwhelming sense of euphoria.

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Opioid painkillers can have effects similar to heroin and morphine, especially when taken in ways other than prescribed by a doctor.

When prescription painkillers act on our brain's pleasure and reward centers, they can make us feel good. More importantly, though, they can work to reinforce behavior, which in some people can trigger a repeated desire to use.

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You may also feel sleepy.

Opioids act on multiple brain regions, but when they go to work in the locus ceruleus, a brain region involved in alertness, they can make us sleepy. Why? The drugs essentially put the brakes on the production of a chemical called norepinephrine, which plays a role in arousal.

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Your skin may feel flushed and warm.

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You'll begin to feel their effects 10 to 90 minutes after use, depending on whether they're taken as directed or used in more dangerous ways.

Some drugmakers design versions of their medications to deter abuse. Extended-release forms of oxycodone, for example, are designed to release slowly when taken as directed. But crushing, snorting, or injecting the drugs can hasten their effects.

It can also be deadly. Between 2000 and 2014, nearly half a million Americans died from overdoses involving opioid painkillers and heroin, a report from the US Centers for Disease Control and Prevention found. The most commonly prescribed painkillers were involved in more overdose deaths than any other type of the drug.

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Your breathing will slow as well.

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Depending on the method used, the effect can last anywhere from four to 12 hours.

For severe pain, doctors typically prescribe opioid painkillers like morphine for a period of four to 12 hours, according to the Mayo Clinic. Because of their risks, it's important to take prescription painkillers only according to your physician's specific instructions.

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Overdosing can stop breathing and cause brain damage, coma, or even death.

2014 report from the American Academy of Neurology estimates that more than 100,000 Americans have died from prescribed opioids since the late 1990s. Those at highest risk include people between 35 and 54, the report found, and deaths for this age group have exceeded deaths from firearms and car crashes.

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Combining them with alcohol or other drugs — even when taken according to the directions — can be especially deadly.

Since they slow breathing, combining opioid painkillers with other drugs with similar effects can drastically raise the chances of accidental overdose and death.

Yet they're often prescribed together anyway, according to the National Institute on Drug Abuse. "Unfortunately, too many patients are still co-prescribed opioid pain relievers and benzodiazepines [tranquilizers]," the institute said. In 2011, 31% of prescription opioid-related overdose deaths involved these drugs.

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Abusing opioid painkillers has been linked with abusing similar drugs, like heroin.

A CDC report found that people who'd abused opioid painkillers were 40 times as likely to abuse heroin compared with people who'd never abused them. The National Institute on Drug Abuse says that close to half of young people surveyed in three recent studies who'd injected heroin said they'd abused prescription painkillers before they started using heroin.

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You may also develop a tolerance for the drugs so that you need more to get the same effect over time.

Tolerance to opioid painkillers happens when the brain cells with opioid receptors — the keyholes where the opioids fit — become less responsive to the opioid stimulation over time. Scientists think that this may play a powerful role in addiction.

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Suddenly stopping the drugs can result in withdrawal symptoms like shakiness, vomiting, and diarrhea.

Taking prescription painkillers for an extended period increases the likelihood that your brain will adapt to them by making less of its own natural opioids. So when you stop taking the drugs, you can feel pretty miserable. For most people, this is uncomfortable but temporary.

But in people who are vulnerable to addiction, it can be dangerous because it can spurn repeated use.

"From a clinical standpoint, opioid withdrawal is one of the most powerful factors driving opioid dependence and addictive behaviors," Yale psychiatrists Thomas Kosten and Tony George write in a 2002 paper in the Journal of Addiction Science & Clinical Practice.

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The researchers behind the study pulled insurance claims data from the Truven Health MarketScan Commercial Claims and Encounters database. Using that data, they looked at patients with an opioid-related hospital admission, then followed their prescription claims to see what prescriptions the patient filled in the 30 days after release from care.

Of those patients, 22 percent filled an opioid prescription in the month after they left the hospital. In fact, more patients filled a prescription for opioids than filled medications that have been shown to help them stop abusing painkillers.

The researchers hypothesize that the doctors writing the prescriptions weren't informed about the hospitalization.

Currently, in many states, an addict can go from doctor to doctor in order to get new prescriptions, meaning that no doctor has a true picture of the patient's history with medication. If a patient were hospitalized, he or she could go to another doctor without needing to share information about overdoses or abuse. Indeed, creating databases to track the prescribing of painkillers has been a popular suggestion for curbing opioid abuse.

Many states have pushed through efforts to develop prescription-drug monitoring programs. But even with a database in place, forcing doctors to check it is another matter.

Prescription patterns among doctors in different states have also long varied. Southern states in particular have high rates of painkiller prescriptions, according to the CDC.


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