Switching Opioid Painkillers Raises Risk of Overdose, Study Finds

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by Eric Pearson

According to the Centers for Disease Control (“CDC”), in 2009, drug deaths in America outnumbered traffic fatalities. That year, there were more than 36,000 drug poisoning deaths, a 90% increase from 10 years earlier. This incredible surge in drug deaths was led by a huge increase in the number of deaths caused by prescription painkillers, from 4000 in 1999 to nearly 15,000 in 2009.

A new study in the April 2012 issue of Pain Medicine, the journal of the American Academy of Pain Medicine, illustrates one of the major causes of opioid overdoses: switching from one painkilling opioid to another. The study, entitled “Review and Critique of Opioid Rotation Practices and Associated Risks of Toxicity”, was written by Lynn R. Webster, M.D. and Perry Fine, M.D.

According to the study, changing from one opioid to another, even at recommended dosages, greatly increases the risk of an accidental opioid overdose. Some of the most commonly prescribed opioid painkillers include hydrocodone (Vicodin), oxycodone (OxyContin), methadone, and the fentanyl pain patch (Duragesic).

Patients may be rotated from one opioid to another for a variety of reasons, including inadequate pain relief, side effects or lack of coverage by insurance companies. When prescribing a different opioid, doctors rely on dose conversion ratios and other guidelines, often provided by pharmaceutical companies, to select appropriate dosages. Webster and Fine studied reports of fatal or near-fatal outcomes that occurred during opioid rotation and concluded that most of the fatal outcomes were preventable, and that the conversion guidelines were inconsistent and had “important flaws that must be corrected.”

Webster and Fine recommend three steps for doctors to wean their patients from their original opioid without the use of a conversion table:

  1. Reduce the original opioid dose by 10% to 30% while starting the new opioid at the lowest available dose.
  2. Reduce the original opioid dose by 10% to 25% per week while increasing the dose of the new daily opioid dose by 10% to 20% based upon clinical need and safety.
  3. Provide sufficient immediate-release opioid throughout the rotation to prevent withdrawal and keep pain levels down so the patient is not tempted to take too much medication.

“It is time for professional societies, government agencies and industry to work together and correct the important flaws in current opioid rotation practices,” Webster concluded. “All patients who have indications for opioid therapy must be assured that routine clinical practices are safe and have an evidentiary basis.”

If a loved one died from an accidental prescription drug overdose from a drug, you may be entitled to compensation from the prescribing doctor. The lawyers at Heygood, Orr & Pearson have handled dozens of lawsuits involving medical malpractice related to painkiller prescriptions, and are available for a free legal consultation about your case. To find out if you are eligible, call us toll-free at 1-877-446-9001, or fill out our free online case evaluation form, and one of our representatives will contact you for more information.