Car accidents are no longer the leading cause of accidental deaths in the United States. According to a recent report published by the CDC's National Center for Health Statistics, this dubious distinction now belongs to drug poisoning. What's at the root of this trend? A river of prescription painkillers.


Top image via WBUR.

Indeed, the report suggests that the United States is in the midst of a painkiller epidemic. Every year, more people now die from analgesic pain relievers, such as OxyContin and Vicodin, than cocaine and heroin combined. Abuse is so bad these days that doctors are having difficulty keeping up with the demand.


Celebrity watchers don't have to be reminded that there's a problem going on. Recent deaths in which painkillers were implicated (in whole or in part) include Michael Jackson, Heath Ledger, Jay Bennett (ex-Wilco), Dana Plato, Ol' Dirty Bastard, and Anna Nicole Smith.

And if the latest statistics are to be believed, it's a problem that's likely to get worse before it's fully acknowledged as a widespread problem.

Sea change

The change atop the accidental death leaderboard officially happened back in 2008 when over 41,000 Americans died as a result of poisoning, compared to 38,000 vehicle traffic deaths. Of those, 90% were caused by drugs. It marked the first time since 1980 that car accidents were not at the top of the list.


There's little doubt that deaths by vehicle accidents are on the decline, but it does not compare to the sharp rise of poisonings. During the past three decades, the poisoning rate has tripled from where it was in 1980, while motor vehicle deaths decreased by almost one-half over the same time. And from 1999 to 2008, the poisoning death rate increased 90%, while the motor vehicle traffic death rate decreased 15%.


Looking at the period 1980 to 2008, the percentage of poisoning deaths caused by drugs increased from 56% to 89%. Of the poisoning deaths that happened in 2008, about 77% were unintentional, 13% were suicides, and 9% were of undetermined intent.

Hard to quit

Because of the epidemic, a number of pharmacies are refusing to stock painkillers on account of a dramatic rise in armed robberies. Addicts, who suffer from awful withdrawal symptoms, are desperate to get their hands on these drugs, causing them to take rash action. Since 2006, there has been an 82% rise in pharmacy robberies – from 385 in 2006 to 701 in 2011 – and over 3,500 pharmacies have been hit.


Withdrawal symptoms from painkillers are not fun; users typically experience them even after relatively short use. Specific symptoms include depression, anxiety, shakiness, and lack of energy. And worse, people in withdrawal have exaggerated feelings of pain (like muscle aches) and flu-like symptoms.

The trouble with being addicted to painkillers is that once a user goes cold-turkey, all minor aches and pains are accentuated way out of proportion. Every little bit of tightness or soreness feels far more intense than usual, causing the person great misery – hence the often maniacal desire to get back on pain relief.


Dealing with it

Compounding the issue is a lack of consensus on what's to account for the epidemic and what to do about it. According to Daniel Bennett, a Denver pain physician and CMO of the American News Report:

Healthcare providers have inadequate education or misconceptions regarding when and how to use these medications effectively, as well as how to manage people effectively once on the medication. Legislators are torn between public safety and the outcry from people who have been harmed from misuse of these valuable medications, often confusing addiction with pain as a disease. Compounding this is the pharmaceutical industry, including some who have introduced questionable practices in the marketing of these medications.


This story, says Bennett, should certainly give people pause in the debate about the use of narcotic medications and the treatment of unrelenting pain.

To address the problem, some insurers are demanding that doctors justify prescriptions for pain pills that exceed a 30-day supply. And more than 40 states have implemented systems to monitor prescription drugs. That said, the programs are voluntary, and many clinicians remain completely unaware of them.


Another reason why Americans are top of the heap in terms of painkiller use is on account of the high use of prescription drugs in the United States. Statistics show that one third of all Americans take two or more prescription drugs, which seems astoundingly high. Moreover, the most frequently prescribed drugs are narcotics. This would seem to be a crucial place to start in addressing the problem.

In fact, many countries in Eastern Europe have adopted policies in which opioid drugs are restricted, mostly to prevent black market involvement. The side-effect of these strict policies is that addiction to such drugs has dropped appreciably. Their rules, restrictions, and formulary shortages have created an environment where drug abuse is less inclined to happen. By contrast, the black market for opioids thrives in the United States due to its unrestricted environment.


Given the widespread and pervasive use of painkillers in the United States, it's generally believed that a simplistic approach would likely be met with failure. Instead, a more effective effort would probably have to involve all stakeholders, including governments, the private sector, and concerned citizens – and there's nothing accidental about that.

Sources: CDC | NPR | ANR | LA Times | Psychology Today