Health Risks of Drug Cocktails

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“Don’t you ever get tired of being right?” an erstwhile friend once asked.

 

“No,” I should have said.  “But I do get tired of other people being wrong.”

 

The latest issue of Psychiatric News brought that memory to mind, with an article entitled “Study on Opioid Deaths Shows Need to Offer Treatment for Chronic Pain Patients.”  While the focus of the article is predictably to offer medication-assisted treatment, the statistics contained therein confirm for the first time what I’ve suspected all along.

 

The article notes that a full one third of patients who died from opioids filled prescriptions for benzodiazepines and opioids within one month of death.  Benzodiazepines constitute a class of medications known as muscle relaxants, anti-anxiety agents, and sleep aids.  They include such common medications as Xanax (alprazolam), Ativan (lorazepam), Valium (diazepam), and Klonopin (clonazepam), among others.  The benzodiazepines are commonly taken along with opioids for the same problems, such as chronic pain, and like opioids, they are dangerously addictive and also depress the respiratory center.  The cumulative effects can be deadly.

 

The article goes on to say that fully two thirds of people with fatalities filled prescriptions for both opioids and benzodiazepines within the previous twelve months.  It mentions alcohol as a possible factor in the fatalities, but the study didn’t specifically look into that.

 

What’s wrong with this picture?  The psychiatric establishment has been hot on the trail of the “opioid crisis” for some time now, but the literature has focused primarily on obtaining funding, pushing for “medication-assisted treatment,” conflating prescription opioids and heroin, and generally alarming while under-informing the public.  Moreover, it has skewed the information to promote a narrow and self-serving agenda for dealing with the problems.  The FDA has approved a specific protocol for treating “opioid use disorder,” and now requires special training for those who administer the approved medications, two of which are opioids themselves.  This means that access to treatment has become increasingly cumbersome and expensive, and there is no real evidence the treatment works long-term.  In fact, most studies on substance abuse treatment only follow patients for a year or less.

 

Additionally, the risk of fatal overdoses doesn’t stop with benzodiazepines mixed with opioids.  The US is generally an over-medicated society, and every additional medication increases the risk of drug interactions four-fold.  Not all depress the respiratory center, but common substances like alcohol do.  Other medications, such as antacids, anti-hypertensives, statins, and psychiatric medications, to name a few, are cleared through the liver and kidney and affect the efficiency of these organs.  While chronic pain patients may confine themselves to prescription drugs, the heroin addicts can be assigned to a different category of user, those who use intravenous routes of administration, for instance, and may mix their heroin with a variety of other illegal or dangerous drugs. 

 

Neither the psychiatric nor the medical establishment has addressed the risk factors that may lead even the non-addict to fatal overdoses.  When it comes to prescription drugs, a major risk is lack of information or a belief that the doctor wouldn’t prescribe something fatally dangerous.  Fact is, many people over-take meds.  If one pill doesn’t give the expected relief, another may.  The euphoric or pain-relieving effects of an opioid may decrease over time, but the respiratory depressing effects don’t.  And when someone is under the influence of mind-altering substances, they may forget what they have taken.  Benzodiazepines are notorious for causing memory loss.

 

The most reliable and best known treatment for substance abuse remains the simplest and least expensive, as well as the most easily accessed, and it relies on peer support and counseling.  This is Alcoholics Anonymous and its spin-off groups, such as Narcotics Anonymous and Cocaine Anonymous.  AA was founded in the 1930s by two recovering alcoholics, and its emphasis on abstinence and progression through its “Twelve Step Program,” remains the gold standard of substance abuse treatment. That the programs are free and easily accessible make them attractive to the down-and-outers who have hit bottom and have few resources.

 

If someone is in chronic pain and is not dependent on addictive opioids or benzodiazepines, there are many options other than drugs.  The medical community tends to frown on chiropractic, massage, physical therapy, or acupuncture, yet many people find relief from one or several of these approaches. 

 

The sad truth is that the medical establishment is stymied by its limited, medication-focused approach to a situation that is more comprehensive than anyone understands.  The pattern of turning to doctors and drugs to alleviate physical and emotional pain has become a national addiction in itself. The “opioid crisis” is just the tip of the iceberg.

 

 

 

 

 

Comments

Skip Stein Added Jan 24, 2018 - 12:51pm
Couldn't agree more.  The entire medical industry has been corrupted and co-opted by the drug industry.  People and doctors have been lied to and led to believe that chemicals and drugs are somehow 'good for you' as they continue to prescribe copious amounts to, well anyone visiting the doctor's office.
 
The medical system is totally broken, misdirected and riddled with malfeasance and greed.
 
You Cannot Poison a Sick Person Well!
 
Yet the medical industry does it's best despite the damning evidence that these 'treatments' DO NOT WORK. 
 
Americans are being treated to DEATH!
Dino Manalis Added Jan 24, 2018 - 1:43pm
Opioids have to be used temporarily and it's up to doctors and pharmacists to guide patients to use safer medicine to relieve continued pain.  Prevent addiction and death!
opher goodwin Added Jan 24, 2018 - 1:47pm
Katharine - I think this is a product of the privatisation of health. too many people are in it to make money. The health of the patient is secondary and recovery is a loss of income.
A very clear article - thanks.
Alcohol is probably the worst drug to mix with anything.
Ari Silverstein Added Jan 24, 2018 - 4:12pm
I’m not sure what you’re saying you’re right about? It’s pretty much common knowledge, as you point out, that over-taking meds or not using them per instructions (such as no alcohol) can be fatal. Nobody disagrees that medication should be a last resort, however a doctor only has one means to cure you and that’s via medication. It’s up to each of us to pursue those other alternatives and not the fault of any doctor if we don’t.
Leroy Added Jan 24, 2018 - 5:14pm
Excellent article, Katharine.  My father used to get together with other old men to brag about how many medications they were taking.  My father was taking thirteen.  The cocktail caused a rare skin disorder.  You could literally watch blisters develop under his skin.  He was prescribed another which didn't cure him but made the condition tolerable.  After a year, the doctor took his off of it.  The doctor told him to take all the Benadryl that he wanted.  It killed him.  Doctors don't care.  They just bury their mistakes.
 
Ari, I have had doctors insist that I take pain medication.  The same with my wife.  They don't give you much of a choice.  They don't make you take it long-term and you might have a point there.
George N Romey Added Jan 24, 2018 - 8:20pm
Great article Katharine. When my mother went on a litany of drugs it was all downhill from there.
 
Personally I stay as far away from the medical complex as I can.
 
Katharine Otto Added Jan 24, 2018 - 8:39pm
Skip,
Co-opted also by the insurance industry, which is in cahoots with the pharmaceutical industry.  Most insurance doesn't pay for alternative treatments.  I didn't mention homeopathy or naturopathy, because I know little to nothing about them, but I'm sure there are treatments for chronic pain there, too.
 
Katharine Otto Added Jan 24, 2018 - 8:43pm
Dino,
Thanks for your comment.  Ideally, it would be best to find the cause of the pain and treat that.  Opioids only offer symptom relief, and don't help much over the long term, but by the time people realize that, they are addicted.
Katharine Otto Added Jan 24, 2018 - 8:49pm
Opher,
I suspect the pharmaceutical companies are making lots of money in socialized medicine countries, too.  Doctors are not the ones making the most money with prescriptions.  
 
Alcohol is indeed one of the most dangerous drugs around.  Bad as withdrawal is from opioids, it's not life threatening.  Withdrawal from alcohol and benzodiazepines can be fatal.  There's a 35% mortality rate if an alcoholic progresses to delerium tremens (DT's).  
Katharine Otto Added Jan 24, 2018 - 8:53pm
Ari,
What am I right about?  That the medical establishment has a very narrow view and limited treatment options when it comes to addiction. 
 
And, it could do more than simply offer medications.  It could make a stronger effort to educate the public, rather than relying on individual doctors to do it one patient at a time.  In fact, I believe the public should make much more of an effort to familiarize itself with all the drugs being tossed our way.  Don't depend on the advertizers to inform you.
Katharine Otto Added Jan 24, 2018 - 8:57pm
Leroy,
Thanks for the anecdote, and I'm sorry about your father.  My father liked Benadryl and took 25 mg every night to help him sleep.  It's used a lot in psychiatry, but it has bad side effects, like urinary retention, delerium, constipation, and dizziness, especially when mixed with other psychiatric medications that also have anti-cholinergic side effects.
 
Unfortunately, with so many drugs on the market, many doctors don't know much about side effects or drug interactions, and I can't blame them.  That's why it's important for patients to educate themselves about what they are taking and t be alert to side effects.
Katharine Otto Added Jan 24, 2018 - 9:00pm
George,
Thanks for your comment.  I wonder how many people have been "treated to death," as Skip notes above.  One of my Continuing Medical Education courses claimed medical error is now one of the leading causes of death.
 
Stay healthy.
Dave Volek Added Jan 25, 2018 - 6:27am
I had an elderly friend who was taking a big cocktail. Eventually he was hospitalized. The new doctor stopped all drugs and he got better. Then he was perscribed two or three to address the real problems.
 
I don't think doctors have the abilities to understand how any more than three drugs at a time.
Johnny Fever Added Jan 25, 2018 - 9:26am
The insurance industry is mandated by the government via Obamacare on what they must cover in their plans.  So the finger of blame for what you believe should be covered and isn’t, belongs to the Democrats for passing such a ridiculous piece of legislation. 
Katharine Otto Added Jan 25, 2018 - 10:38am
Dave,
There's also the problem of people getting different drugs from different doctors, like specialists.  Patients often don't know what they are taking, and doctors don't know what other doctors are prescribing.  Electronic medical records are not the answer, because they are often outdated, since many doctors change drugs or dosages at every visit.
Katharine Otto Added Jan 25, 2018 - 10:42am
Johnny,
I believe problem is more comprehensive than that, since every insurance plan is different.  A primary focus of drug reps is to get their products on formularies, including insurance formularies, public health formularies, employer-sponsored health care formularies, and, of course, the Medicare and Medicaid formularies.  
 
Certain things may be mandated, but many are not, and that's where plans differ.
Donna Added Jan 25, 2018 - 2:11pm
Katharine,
I  pursue holistic treatments as much as possible. I am lucky, my Medical Dr. is a firm believer, in holistic medicine. Most are not. I always attempt this approach with him being my main consultant. 
Today is the day i lost my dad, 2 years ago, your article, makes me think of what he used to say,  " A Dr. in this Country is licensed to Practice medicine"   and that is just what they do.
 
Katharine Otto Added Jan 25, 2018 - 5:52pm
Donna,
It is all practice, and what works in one case may not work in another.  People expect way too much of doctors (and doctors of themselves), and the "health care industry" thrives on fostering the deception.  It's a set-up for a lot of disappointment and sense of betrayal.
 
I think more people are finding help in holistic medicine, but it's important to separate the true healers from the charlatans.  I'm not sure quite how to do that.
A. Jones Added Jan 25, 2018 - 9:40pm
Ideally, it would be best to find the cause of the pain and treat that.
 
And how do massage, physical therapy, and acupuncture do that? Are they any more successful at finding the cause of the pain than orthodox therapies and treatments?
 
I don't think so.
 
As for the supposed connection between prescription opioids and profit in a semi-private system like that of the US, we should take note that most chronic pain in the UK goes untreated by the NHS with anything other than a "You're fine, lady. Get some counseling and a good massage and learn to live with your pain" from most GPs who do not receive private profit from their practice.
 
The NHS will do anything to save money, especially if it's at the expense of patients, and especially if those patients are seniors (who are most likely to be the ones suffering from chronic pain).
A. Jones Added Jan 25, 2018 - 9:46pm
The article referenced at top is here.
B.E. Ladin Added Jan 26, 2018 - 12:03am
Alternative medicine, as you mentioned in your article, is the way to go. Acceptance is the key via the Medical profession.
Flying Junior Added Jan 26, 2018 - 3:43am
I tried muscle relaxants one time in my lonely early thirties living in Pacific Beach.  I was smoking at the time.
 
They made me drop my cigarets on the carpet even before I was ready to go to sleep.  Doesn't sound like a good thing to mix with opiates.
 
The sad fallout from all of this, of course, is this ridiculous idea that even hospital patients just out of surgery would be better off tolerating some pain in the interest of avoiding adequate medication by the milk of the poppy.  After all, the group the most at risk of addiction is the people who go to the hospital for minor surgery.  A prescription for twenty Vicodins might somehow destroy you.
 
h/t NPR
 
My take would be, the patient calls the doctor after seven days requesting a refill.  The doctor asks why they need additional pain relief.  The doctor refuses.
 
Nowadays, the lower staff, nurses and telephone operators are already trained to discourage patients from seeking pain relief from opiates.
 
Just how hard is it to get involved in this opiate crisis?  I, for one, would be willing to take my chances.
Katharine Otto Added Jan 26, 2018 - 2:56pm
A. Jones,
A lot of chronic pain is caused by chronically tense muscles, for one thing.  Many people store their stress in different body parts, like neck and shoulders, which makes them chronically tense.  Or they have bad posture.  Or they have old injuries that makes them favor one side over the other, leading to mis-alignment of the skeleton.  Chiropractic, physical therapy, massage, and acupuncture can all assist in making people aware of these mis-alignments, blockages, or postural mal-adjustments; and they can go a long way toward correcting them.  
 
A valuable take-home message is that "when muscle fights bone, muscle wins."  That can lead to osteoarthritis, nerve compression, and spinal fractures, to name a few.
Katharine Otto Added Jan 26, 2018 - 3:03pm
A Jones,
I'm an extremist who doesn't believe in drug laws, patents, or prescriptions.  If I were in charge, anyone could get whatever they wanted over the counter and take whatever risks they want, without the NHS or private medicine.  I believe in adult's taking responsibility for their own health care (and risks).  If they feel free to make their own decisions, they might be more careful.  I believe a major motivator with addiction is power struggles with arbitrary authority.
 
What right does the government have, after all, to dictate what people ingest?
Katharine Otto Added Jan 26, 2018 - 3:06pm
B. E. Ladin,
I would opt for a blend of allopathic and alternative (holistic) medicine, borrowing the best from each.  Unfortunately, few practitioners have comprehensive knowledge of all the available modes, and access is a problem, especially in non-urban areas.  
 
I think more and more establishment doctors are coming to accept alternative practices.  They are learning from their patients, for one thing.
Katharine Otto Added Jan 26, 2018 - 3:16pm
Flying Junior,
The issue of pain relief is a highly charged one, and it doesn't help that the DEA is looking over doctors' shoulders, eager to nab anyone who over-prescribes. 
 
Also, since pain is highly subjective, it's hard to know how much pain people are in.  Some people have higher pain thresholds than others.  Opioids supposedly work best with acute pain, so seven days should be enough.  If someone takes them for longer periods, there's the risk of physical dependency.
 
Jeff Jackson Added Jan 26, 2018 - 4:39pm
Can't wake up? Take a wake-up pill. Can't get to sleep? Take a sleeping pill. We are an over-drugged society. Of course, all of the overuse has meant that physicians are reluctant to prescribe drugs for pain, leaving people in pain. I even hear of terminal patients denied pain medication because of the possibility of addiction. Addiction to someone dying? What addiction? We hear of the people in pain seeking drugs on the street because their physician won't prescribe them any. I think most doctors should be allowed to use their discretion. The last pain prescription I had for a broken bone (quite painful) I didn't use many of them, because they clouded my thinking ability, but good to have a few extras just in case.
Jeff Michka Added Jan 26, 2018 - 4:45pm
JJ sez: Addiction to someone dying?-That is part of the fundementalist Xtain approach to pain.  Just pray for a quick death, addiction prevents a quick ride to heaven.  And yeah, a terminal patient should bear he social responsibility of ending addiction issues in the US.  I believe Katherine Otto was a practicing doctor or other health professional.  Treating pain has been a shortfall for medicos.  It's subjective unless it's you hurting, afterall.
Katharine Otto Added Jan 26, 2018 - 5:51pm
Jeff and Jeff,
As noted above, I don't believe in prescriptions, or in policing someone's possible addiction habit.  Pain is indeed subjective, and many people would rather live in pain than take even an aspirin.
 
There are no guaranteed treatments for pain.  Even opioids provide only marginal relief, and the longer you use them, the less effective they become, while side effects mount.
 
Fact is, doctors should not have to be in the position of having to make that decision for adults, but society demands it the way laws are set up now.  Even most doctors would probably disagree with me.  They like the power of writing prescriptions and can rationalize the paternalistic system that treats adults like children.
wsucram15 Added Jan 26, 2018 - 7:18pm
In fracturing my wrist on the 19th,I went to local ER up this way.  Even though I told them I didnt want strong pain pills they gave me oxys. I actually asked for large dose Ibuprofen. Now I was in a lot of pain and took 4 of them over a 2 day pd to sleep, they didnt really do much for pain. Now I have 800 mg Ibuprofen and dont get sick when I wake up.
They dont help much either..cold and heat help.
I thought drs werent giving opiods out like candy anymore..but they are.
 
Bill Caciene Added Jan 27, 2018 - 4:51am
What about the health risks of not taking your cocktail of doctor prescribed medication?  After all, there is scientific evidence these drugs work and no scientific evidence acupuncture does anything. 
Ed Dolan Added Jan 27, 2018 - 10:02am
A little way up this thread, A Jones advocated a free market for drugs of any kind, so that people could buy opioids or whatever legally. Personally, I think such a policy ought to be on the table. It would create some problems, but it would solve some, too.
One of the problems it would help solve (maybe not totally, but at least partly) is a different "drug cocktail" problem, namely, the problem that someone who buy what they think is Oxycontin or heroin on the black market is often getting something else, a mix of God knows what that might or might not produce a high and might or might not kill you.
I live in a rural county, which, like most rural county, has is share of opioid abuse. In last week's paper, there was an item about an "overdose" death of a heroin user. Forensic analysis later showed that the heroin was mixed with a high percentage of fentanyl. So who is to blame here? The user? Or the supplier of the fraudulent "cocktail," which, according to the article, is cheaper to produce? If you could buy brand name heroin from Eli Lilly at the pharmacy, at least you'd know what you're getting.
Bill H. Added Jan 27, 2018 - 11:17am
Again, we have the usual attempt to politicize this problem and blame it on Obama and the Democrats. The problem is that the pharmaceutical industry has been allowed to get out of control in ways such as being allowed to advertise direct to the consumer via television and print (no other country other than New Zealand allows this). They also offer incentives to Doctors such as golfing passes, vacations, and of course cash (see if your Doctor is being paid off). Opioids and Chemo drugs are their top sellers and profit producers, which is exactly why we will probably not see a cure for cancer in the near future.
Take a look at how much money goes into lobbying each year.
Oh, and Johnny, you may be surprised which party gets the most.
I wasn't.
Katharine Otto Added Jan 27, 2018 - 8:01pm
Jeanne,
I'm surprised they gave you oxys, considering all the hype about the opioid crisis.  Ibuprofen does work wonders.  Thanks for the tip.
Katharine Otto Added Jan 27, 2018 - 8:11pm
Bill,
I could give you multiple answers to your comment.  First, many people get their prescriptions from different doctors, many of whom don't know what others are prescribing.  Second, the "science" behind drug effectiveness is based on whether they work better than placebo in large samples.  They might be minimally effective, with lots of side effects, especially when mixed with other substances. 
 
Third, there is "scientific evidence" that acupuncture works, especially for pain and substance abuse, but it is not well studied.  Since pharmaceutical companies pay for most "scientific" studies on their medications, these are well funded, whereas acupuncture studies are not.  Also, it's impossible to do a double-blind acupuncture study, since the acupuncturist knows the supposedly effective treatment points.  Because Oriental medicine is pattern-based, rather than cause-and-effect-based, it's hard to do a "scientific" study by Western methods.
 
When I was practicing medicine, I was horrified by how many prescription drugs people were on, especially veterans, through the VA.  There was lots of overlap, and few vets even knew what they were taking or why.  They saw a different doctor every time they came, and there was little incentive to streamline the medication list.
Katharine Otto Added Jan 27, 2018 - 8:14pm
Ed,
I fully support over-the-counter medications of all kinds, with doctors acting in an advisory and educational capacity.  As you say, it reduces the risk of contaminants, eliminates the need for secrecy and black-market dealing, and respects individuals' adulthood and right of self-determination.
 
Katharine Otto Added Jan 27, 2018 - 8:23pm
Bill H.,
Congress, in its unbounded paternalism, is practicing medicine.  DTC advertising makes doctors irrelevant and raises the cost of the drugs.  And, the pharamaceutical industry is enormously profitable, what with patents and controlled access (via prescriptions).  I believe limited access makes drugs (and everything else) appear more valuable than they are.  
 
Yes, there are incentives to doctors, and there are lobbyists in Washington, and all are geared to increasing profits.  
 
I understand hospitals and the like get kickbacks for administering flu vaccines.  The promotional campaign for the flu vaccine boggles my mind.
Johnny Fever Added Jan 28, 2018 - 10:32pm
A drug company should be expected to promote their products.  They’re under no obligation to inform patients or doctors of the alternatives to what they’re selling.  And an insurance company should be expected to sell the type of plan people demand.  So I don’t understand your criticism of drug companies or insurance companies, they’re only providing what the market demands.  In the case of insurance companies, I’m sure the general public would love ultra-cheap catastrophic only coverage, however Obama made those plans illegal. 
Bill H. Added Jan 28, 2018 - 11:16pm
 
I have no issue with drug companies promoting their products to the medical industry, who is supposed to make the best decisions on what to prescribe and use for certain conditions. It is really not the place for a patient to "Ask your Doctor about Erectava" or for a death row inmate to "Ask your executioner about Deathovia", Just as I am not going to ask my contractor if he uses Acme nails. I do have issues with a drug company charging US citizens $337 for a single pill that sells for less than $60 elsewhere (Gleevec, a leukemia medication)
Being that the pharmaceutical companies, along with the medical insurance companies were part of making the final decisions on the latest health care plan, I am sure we are all in for a royal screwing when reality hits us with the pricing for both coverage and drugs in the future, as anyone who wants reasonable full coverage as many have these days will end up footing the savings that those who only get the ultra-cheap stuff and then end up not being able to afford their cancer surgery.
 
Jeff Michka Added Jan 29, 2018 - 4:03pm
KO notes: I understand hospitals and the like get kickbacks for administering flu vaccines.  The promotional campaign for the flu vaccine [this year] boggles my mind.-According to all the hype pieces, this year's flu outbreak surpasses the Black Death.  "If you don't get a 10% effective vaccine right now, YOU'll be dead in a day..." Fear, fear, fear...those immigrants will spread THE FLU!!!
Katharine Otto Added Jan 29, 2018 - 6:33pm
Johnny Fever,
The pharmaceutical and insurance industries have created artificial markets for themselves through advertising, lobbying, and legislative flim-flam.  They have raised the price of health care enormously, to little benefit.  I know "most people" will disagree with me on this, but fact is, Congress is practicing medicine, and that's why we are all so sick.
Katharine Otto Added Jan 29, 2018 - 6:37pm
Bill H.,
That the "health care industry" is so profitable should tell you something.  Patients (which includes just about everyone, eventually) are expected to foot the bill for shareholder dividends, and pay insurance forever, with no hope of cure.
Katharine Otto Added Jan 29, 2018 - 6:43pm
Jeff,
It's amazing, isn't it?  I believe the rate of effectiveness is 60%, but no one tells you how many un-vaccinated people escape the flu.  Or how many people have only mild symptoms.  Also, since flu is spread by a respiratory route, the best way to avoid it is to stay away from people, as in hospitals, schools, offices, churches, and other crowded places.  Especially hospitals, where sick people congregate.
A. Jones Added Jan 29, 2018 - 6:44pm
They made me drop my cigarets on the carpet even before I was ready to go to sleep.
 
Ever hear of an ashtray?
Jeff Michka Added Feb 3, 2018 - 7:37pm
ARI s SEZ: however a doctor only has one means to cure you and that’s via medication. It’s up to each of us to-That is just treatment, not a "cure." And you seem to ignore the giant media budgets selling medicines to cure "bowel problems, Just ask your doctor for Shitola."  Now mind you suckers that go ask their doctors meds based on ads they see on TV might be better served by a eating a portion of leafy greens their colons hasn't seen in a decade of consuming nothing but deep fried fast food. Who picks up the tab for those media budget$?  Tooth faireies?
Katharine Otto Added Feb 3, 2018 - 9:13pm
Jeff,
We have a two-pronged problem here, as I see it.  The decline in healthy habits, like good nutrition and regular exercise, and an increase in unhealthy habits, like eating fast/processed food and watching TV.  
 
No wonder everyone is so sickly.  When there are so many starving people in the world, Americans are whining about health care for lifestyle problems like stress and obesity, as well as the cancer we're creating with environmental toxins from industrial overkill and waste.  This is "progress"?

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