Women are more likely to have fatal outcomes in the ongoing U.S. epidemic of prescription opioid addiction, according to the CDC.
Deaths related to prescription opioid painkillers among women increased fivefold from 1999 to 2010, accounting for almost 48,000 deaths. The increase was nearly double the rate observed in men during the same time period (415% vs. 265%), Karin Mack, PhD, of the CDC and colleagues reported in Morbidity & Mortality Weekly Report.
“These are really troubling numbers. This is a growing problem that is getting worse quickly,” CDC Director Tom Frieden, MD, MPH, said during a press conference. “Mothers, wives, sisters and daughters are dying from overdoses and at rates we have never seen before.”
From 2004 to 2010, ED visits related to prescription opioid misuse or abuse more than doubled. Rates were highest among women aged 25 to 34, who accounted for nearly 50,000 opioid-related ED visits in 2010 alone.
Frieden attributes the increases in opioid-related deaths and ED visits to an increase in opioid prescribing habits — prescriptions for painkillers such as vicodin, oxycontin and methodon increased 300% during the study period. He called the rise in opioid prescriptions unexpected and unprecedented, and added it “could not possibly have been clinically indicated.”
Using data from he National Vital Statistics System multiple cause of death files and the Substance Abuse and Mental Health Services Administration’s Drug Abuse Warning Network (DAWN), Mack and colleagues found that nearly 71% of the 15,323 deaths among women attributed to drug overdose in 2010 were opioid related.
Opioid painkiller-related overdose deaths increased substantially from 1,287 in 1999 to 6,631 in 2010. To put these figures in perspective, in 2010 there were more opioid overdose-related ED visits than from cocaine and heroin combined, and twice as many deaths among from opioid overdose than cervical cancer.
Several unique risks contribute to these trends including common forms of pain that are more prevalent, more intense and longer lasting in women than men, the researchers hypothesized. Because of this, they tend to receive more prescriptions overall at stronger doses than men, even though they are more likely to have adverse events.
“We don’t understand why women are getting higher doses, when on average they should be getting lower doses than men,” Frieden said, adding that clinicians need to recognize women as a risk population for death from opioid overdose. He also called for greater clinician adherence to guidelines for responsible opioid prescribing.
The inherent danger of opioids dictates that these medications only be prescribed for certain, severe cases, such as patients with chronic cancer pain, Frieden emphasized. For less painful conditions, “the risks far outweigh the benefits,” as a patient given “a single course may become addicted for life.”
“Painkillers have a place when used in the right patients in the right quantities,” CDC researchers Christopher M. Jones, PharmD, said during the press conference. He noted that conditions like fibromyalgia and migraines are often treated with opioids, even though such a course is not supported by research.
Other trends were seen within certain cohorts of women. Nonhispanic white women had the highest rate of opioid deaths (12.7 per 100,000 population), as did women aged 45 to 54 years (21.8 per 100,000). Nevada had the highest rate of opioid-related deaths than any other state (18.5 per 100,000).
The researchers suggested several ways to combat the rising death rates, such as screening patients for psychological disorders and consulting state prescription drug monitoring programs prior to writing prescriptions to combat doctor shopping.
“These are risky drugs, and often there are other therapies such as physical therapy, exercise and cognitive therapies that can be important in addressing chronic pain,” Frieden said.
by Walker Harrison, an undergraduate student at Columbia University and editorial intern with Clinical Advisor.