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Prescription Opioid Fatalities: Examining Why the Healer Could be the Culprit

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Abstract

Prescription opioid use has increased rapidly in developed countries, as have fatalities and other related adverse events. This review examines the intrinsic characteristics of opioids, including their mechanisms of action and pharmacokinetic and pharmacodynamic properties, to determine how the use of a regonised pharmacological remedy for a medically confirmed ailment could result in an accidental fatality. Opioids trigger biological processes that inhibit their own therapeutic effect. Prolonged use of opioids can result in activation of pronociceptive systems, leading to opioid-induced hyperalgesia and tolerance, while opioid metabolites can antagonise the antinociceptive action of the parent drug, also leading to opioid-induced hyperalgesia and tolerance. Pain stimulates respiration and counteracts the respiratory depression effect of opioids. Analgesia from opioids leads to loss of this protective mechanism, leading to increased risk of death due to respiratory failure. Increased patient counseling during opioid prescribing and dispensing, and limiting prescription to short-term use in non-malignant pain, may decrease the adverse effects of opioids. The vast majority of patients who unintentionally experience serious adverse events from pharmaceutical opioids do not start out as drug seekers. Even opioid use within prescribing guidelines can place some patients at risk of death and may prevent patients from seeking help for prescription opioid dependence.

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Acknowledgements

Special thanks to Mr. Glen Tapley, Director of Pharmacy, Maryborough Hospital, for approving the time needed to complete this project.

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Authors and Affiliations

  1. Institute for Social Science Research, The University of Queensland, Indooroopilly, QLD, 4068, Australia

    Adeleke D. Adewumi & Rosa Alati

  2. School of Clinical Medicine, Rural Clinical School, The University of Queensland, Hervey Bay, QLD, 4655, Australia

    Adeleke D. Adewumi

  3. Maryborough Hospital Pharmacy, Wide Bay Hospital and Health Service, 185 Walker Street, Maryborough, QLD, 4650, Australia

    Adeleke D. Adewumi

  4. School of Pharmacy, The University of Queensland, 20 Cornwall St, Woolloongabba, QLD, 4102, Australia

    Christine E. Staatz & Samantha A. Hollingworth

  5. Centre for Youth Substance Abuse Research, The University of Queensland, St Lucia, QLD, 4067, Australia

    Jason P. Connor

  6. Discipline of Psychiatry, The University of Queensland, Herston, QLD, 4029, Australia

    Jason P. Connor

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  1. Adeleke D. Adewumi
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  2. Christine E. Staatz
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  3. Samantha A. Hollingworth
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  4. Jason P. Connor
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  5. Rosa Alati
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Contributions

ADA had full access to all the data in the study and takes responsibility for the integrity of the data and accuracy of the information. Concept and design: ADA, JPC, RA. Acquisition and analysis of data: ADA. Interpretation of data: ADA, CES. Drafting of manuscript: ADA. Critical revision of the manuscript for intellectual content: CES, SH, JPC, RA. Technical and material support: SH, JPC, RA. Supervision: SH, JPC, RA. Final approval of the version to be published: CES, SH, JPC, RA.

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Correspondence to Adeleke D. Adewumi.

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Conflicts of interest

Adeleke D. Adewumi was supported by an Australian Government Research Training Program (RTP) scholarship. The funder had no role in the design or conduct of this study, including the acquisition, analysis, and interpretation of data, or in the preparation, review, or approval of the manuscript or the decision to submit it for publication. No other conflicts of interest were declared by authors Christine E. Staatz, Samantha A. Hollingworth, Jason P. Connor and Rosa Alati.

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Adewumi, A.D., Staatz, C.E., Hollingworth, S.A. et al. Prescription Opioid Fatalities: Examining Why the Healer Could be the Culprit. Drug Saf 41, 1023–1033 (2018). https://doi.org/10.1007/s40264-018-0687-6

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