Are Clinicians Aware?
Medscape: I know that these are relatively new data, but how aware do you think community doctors are of this issue? The primary care providers? Also, the community neurologists and psychiatrists?
Dr. Weisler: I can just tell you that until I was pulling together data for a grand rounds on suicidality and suicide at Duke last January, I had only known there had been an increase in the death rate from methadone, for example, over the last decade and, to some degree, from the opiates. However, I was blown away when I got the data from the North Carolina state health department (Figure 6).
When I saw the charts I was, again, totally surprised by the magnitude of the increase in unintentional drug overdose deaths. Len has lived with this epidemic and sees it every day. He's tried to advocate, educate, written a lot of wonderful papers in MMWR and other journals, and so have a lot of other people. However, the magnitude of the problem is growing much faster than our ability to educate providers and, for that matter, the public about how big a public health problem unintentional drug poisonings are.
Figure 6. Poisoning deaths in North Carolina, 1999-2008.
From Centers for Disease Control and Prevention.[18]
Medscape: Has that been your sense, too, Dr. Paulozzi?
Dr. Paulozzi: I have been frustrated by how slowly this message gets through to providers, particularly primary care providers. I think that providers hear about boxed warnings, the so-called "black box" warnings, that the FDA has placed on drugs, like oxycodone and, most recently, methadone. However, I think there is a sense that these overdoses are relatively uncommon adverse drug effects when, in fact, they are quite common. The boxed warnings are not the only thing that is required. In my opinion, all the federal agencies probably need to do more to try to address this issue, because at least in the data that we have through 2008, it doesn't look like we are reducing the rate of rise.
Dr. Weisler: Yes, and one issue that makes it really challenging as well, is that a lot of individuals who are using these drugs may not have built up a tolerance to them. A lot of these compounds, for example, are designed to be used by people who have chronically been on opiates and been on a stable dose for a while, and then switched to something longer acting. However, some of these patients or individuals who are using or abusing just all of a sudden throw on a patch, for example, of fentanyl or take methadone without having built up a tolerance for it, or they episodically take too much oxycodone and often something else without having a tolerance built up to it.
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Cite this: Unintentional Drug Poisoning Deaths: A National Epidemic - Medscape - Jun 28, 2010.
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