Rise in deaths of middle-aged white American women attributed to opioid, anti-anxiety drug overdoses

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MURRAY, Utah (KSTU) -- Melanie Apgood, of Holladay, has two kids. Her youngest, Thomas, is 10 years old.

A decade after giving birth, she is still dealing with the impacts of what was a difficult pregnancy that had her hospitalized for three months.

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"I was getting two Percocets every six hours as well as a shot of morphine every day," Apgood said.

Percocet and morphine are both opiate-based pain relievers, a class of drug that can be highly addictive.

Ten days after giving birth, her doctor took her off the medication. Though she didn't realize it at the time, she was addicted. Apgood contemplated suicide. She was depressed and questioned her own sanity.

Recognizing something was wrong, she went to her doctor.

"When I went to my primary care, he prescribed me Xanax," Apgood said.

Xanax is an anti-anxiety medication, part of the benzodiazepine class of drugs.

A report in The Washington Post, looked at death rates for middle-aged white women. It found women, like Apgood, are five times more likely to receive prescriptions for both anti-anxiety drugs and painkillers.

"When we mix those two medications a benzodiazepine and opioids, there's a huge risk for overdose," said Angela Stander, the prescription drug overdose prevention coordinator for the Utah Department of Health.

The impacts are both more widespread and more profound than many people realize and they appear to have the biggest impact on middle-aged white women.

The report found a 400-percent jump in opioid overdose deaths among middle-aged white women from 1999 to 2014. It is contributing so much to that specific demographic, it's actually changing the overall death rates.

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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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In Salt Lake County, the death rate over the same time period for the same demographic went up 9 percent. In Wayne County, the death rate jumped 65 percent for middle-aged white women.

"A lot of times these are, you know, prescribed with the best intentions and taken with the best intentions," Stander said.

The intention is to reduce pain, but the price is a higher rate of addiction and ultimately overdoses.

Last week the U.S. Surgeon General wrote a letter addressed to every doctor in America asking them to take a pledge to use greater care when prescribing opiate based medications. The care may need to focus specifically on a group, most would not stereotype as drug abusers, middle-aged white women.

"A Caucasian person like myself. A professional, somebody who has employment, we wouldn't expect them of being someone who is addicted to a drug," said Mary Jo McMiller, Director of Utah Support Advocates for Recovery Awareness.

The Utah Health Department says the statistics show after taking painkillers for just seven days a dependence can form. It happened to Melanie Apgood and it took two years before family intervened.

Clean for eight years and raising both of her sons as a single mom, Apgood still feels the impact of addiction.

"It really is an ongoing battle and I don't think it will ever, it won't every go away," she said.

Opioid Addiction has reached crisis level in the US:

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Apgood recently had surgery to repair a problem with her large intestine. Once again, painkillers were prescribed. Not taking any chances, she set up a safety plan.

A family member has the prescription bottle, giving her only a day's dose at a time. It is a small price to pay to avoid joining a larger statistic of women dying too soon.

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