Legal drugs, deadly outcomes: LA Times investigation on prescription drug deaths

An excellent long read on the growing phenomenon of prescription drug overdoses in Southern California, which a Los Angeles Times investigative team reports "now claim more lives than heroin and cocaine combined, fueling a doubling of drug-related deaths in the United States over the last decade."

Health and law enforcement officials seeking to curb the epidemic have focused on how OxyContin, Vicodin, Xanax and other potent pain and anxiety medications are obtained illegally, such as through pharmacy robberies or when teenagers raid their parents' medicine cabinets. Authorities have failed to recognize how often people overdose on medications prescribed for them by their doctors.

A Los Angeles Times investigation has found that in nearly half of the accidental deaths from prescription drugs in four Southern California counties, the deceased had a doctor's prescription for at least one drug that caused or contributed to the death. Reporters identified a total of 3,733 deaths from prescription drugs from 2006 through 2011 in Los Angeles, Orange, Ventura and San Diego counties.

Not one of them was from marijuana, which remains a schedule 1 narcotic and is responsible for zero overdose deaths because one cannot die from a marijuana overdose.

Read the rest. Reporting by Scott Glover, Lisa Girion, with photos and video by Liz Baylen.


    1. From WikiAnswers:

      The L50 lethal dose to effective dose ratio is over 1000 times, that means THC would kill 50 of the test subjects when administrated over 1000 times the dose needed to get the desired effect.

      BTW, the L50 lethal dose for LSD seems to be ∞ (infinity).  Same for DMT.  Seems that the stronger the trip, the safer it is!
      Ain’t that something?

      1. And isn’t DMT neurologically associated with the experience of death?

        When I think of cultures that have lost their ability and/or freedom to live in harmony with themselves, each other, and the idea of existence, I think of their attitudes toward the psychedelic experience as a primary cause. And by that I don’t mean “let’s party and drop some acid”. But something more akin to rolling up one’s spiritual sleeves and examining and experiencing life/existence/non without the confines of preconceptions and prejudice.

        Perhaps I’m a bit cynical regarding this, but why would for-profit pharmas ever want to cure anything? Wouldn’t it be better to maintain treatment indefinitely? Why not actually create, perpetuate, or worsen conditions that would compel us to seek treatments?

        It’s likely because psychedelics could be more effective than most pharmaceuticals that they’ll continue to be illegal in most of the world. That they’re non-addictive seems enough to already eliminate their viability in for-profit enterprises. That they’re safer seems moot.

        1. me thinks the cynicism here is being applied a bit too widely and liberally.

          pharma markets all sorts of cures and preventions for lots of stuff. 

          with regards to psychedelics… i can see the plausibility in your point

      2. Where did they get this ‘1000 times’ value?? I really don’t trust WikiAnswers.

        7. Drugs used in medicine are routinely given what is called an LD-50. The LD-50 rating indicates at what dosage fifty percent of test animals receiving a drug will die as a result of drug induced toxicity. A number of researchers have attempted to determine marijuana’s LD-50 rating in test animals, without success. Simply stated, researchers have been unable to give animals enough marijuana to induce death.

        Source: US Department of Justice, Drug Enforcement Administration, “In the Matter of Marijuana Rescheduling Petition” (Docket #86-22), September 6, 1988,
        p. 56-57.

        That description from a DEA judge would seem more like a non-value to describe no toxicity; not 1000 times to become lethal. Also, DMT is produced by our bodies, just like adrenaline, and therefore hard to regulate production.

      1. Indeed, it’s almost as many as six times more deaths than alcohol, alone.  Five times as many deaths if you include motor-vehicle deaths attributed to alcohol, too.

  1. What’s interesting to me is that there was an explosion of these news stories just as Purdue’s patent on Oxycontin was about to run out, which would enable a generic version to be made. Coincidentally, Purdue has come up with a new version that is tougher to crush up for snorting or injecting. Of course, they’re the only ones allowed to make it since the new version gets a new patent. So now we get a bunch of news stories talking about what a problem it is (I’m not saying it isn’t. Just that it has been for quite a while). My cynical suspicion is that Purdue wants to get doctors to not prescribe the old version since patients could get a generic version of that and they’d prefer it be banned altogether.

    1. Wait, what?  Is the active ingredient different, or is it just the same drug but using a different binder to make it into pills?

      1. Over time, individuals have learned effective ways to tamper with OxyContin’s controlled-release technology. Tampering with the tablet, via cutting, chewing, breaking, or dissolving, can be very dangerous because it releases high levels of oxycodone all at once.

        There have been reports of inadvertent overdose with OxyContin after health care practitioners crushed the drug in order to administer it to patients who could not swallow the tablet.

        Tampering with tablets is also popular among individuals seeking OxyContin’s euphoric properties. By crushing and snorting, or dissolving and injecting, individuals received a much higher and immediate dose of oxycodone than they would if they swallowed the tablet whole.

        The reformulated version of OxyContin is intended to prevent immediate access to the full dose of oxycodone via cutting, chewing, or breaking the tablet. Attempts to dissolve the tablets in liquid result in a gummy substance that cannot be drawn up into a syringe or injected. The new formulation of OxyContin reduces the likelihood that this drug will be misused and abused, although it can not completely eliminate this possibility.

        The new formulation can still be abused or misused and result in overdose simply by ingesting or administering it in higher than recommended doses. Health care professionals need to remind their patients of the risks associated with using OxyContin not-as-directed.

        1. We had a similar thing in Scotland. Temgesic tablets were replaced by gel capsules,”Jellies” and STILL people tried to shoot them up. Cue massive abcesses and amputations.

  2. Oxycodone is no better, no worse than any other opioid. Opioids in general have overdose potential through respiratory depression, and also kill patients through the side effect of colonic obstruction. (I consider it little short of malpractice to prescribe them without monitoring and prescribing laxatives as needed.)  They also cause a moderate physical dependence and considerable tolerance; long-term users may require phenomenal doses. (They’re still much easier to kick than alcohol or barbiturates, to say nothing of nicotine.)

    The therapeutic index of opioids is pretty broad; they are actually quite safe as drugs go. Moreover, they’re the only thing that’s effective for severe pain.  Stirring up a moral panic about prescription drug abuse serves only to convert the War on Drugs into a War on Pain Relief. Most of the support of the “assisted suicide” movement comes from people who have seen loved ones doomed to months or years of intractable pain because doctors cannot prescribe effective doses of pain medications – the police know better than the physicians what patients need. Hysteria that “prescription drugs are worse than marijuana” will not help you get marijuana legalized; it will only condemn more patients to unneccessary ain and suffering.

    And meds like Lortab and Vicodin are unspeakable fallout from the drug war. Unlike opioids, the acetaminophen that is in those has a very narrow therapeutic index – even a mild overdose condemns a patient to an ugly death from liver failure. But because of that, these compound formulations are deemed as “less risk of abuse” and considerably more widely prescribed than safer pain relievers. There are a lot of medical emergencies resulting from accidental and deliberate overdoses of Vicodin or Tylenol #3. This idea that “pain relievers are all right only as long as an effective dose runs a significant risk of poisoning the patient” is truly perverse and must be resisted.

  3. I have to wonder how ‘accidental’ many of the overdoses among chronic-pain-often-comorbid-with-psychiatric-or-other-unpleasant-diseases patients actually are. 

    This story does seem to suggest an alarming gap in terms of doctor/patient communication and follow up(if your doctor only knows that you died because a journalist calls him up to ask about it, there is a problem) though. That’s the part that really surprised me. 

    1. There’s a lot of overlap.  At least depression can involve pain and chronic pain can cause depression if not treated or if inadequately treated.  The hysteria about pain meds and how so many states and various government agencies (along with insurance companies) are sticking their noses into the doctor/patient relationship only encourages pain to go under-treated – and many patients ALREADY have a LOT of trouble getting doctors (including “pain specialists”) to take them and their pain seriously.  I have arthritis and nerve pain. I’ve failed every non-narcotic pain med – most of them in very glaring manner and the rest are contraindicated.  The exceptions are marijuana (and I’m not sure I want my name and other info on a registry as a user, not even a medical user until the federal/state thing is clarified) and opiates – unless you want to count outpatient surgical interventions starting at radio frequency ablation of nerves and getting increasingly like some sort of medieval torture from there, just for partial, temporary relief.  I keep having to “opt” for the outpatient surgical stuff because all the local doctors tell me that I’m “too young” for the kinds of pain I have and for opiates – as if bodies knew there was some sort of age they had to wait to reach before letting these things occur.  It’s going to be a very long, hell-like winter.

      1. I’m in the same boat as roseviolet. The blunt truth is that you can’t function when your pain reaches a certain level, and there are many kinds of pain that NSAIDs, &c., simply don’t touch. Pain-relieving medications other than opiates (e.g., antiseizure drugs such as Topamax, Neurontin, Depakote, …) often have side effects, including cognitive fuzziness, that are worse than the original symptom.

        I’ve undergone some of the medieval tortures mentioned by roseviolet for both migraines and post-herpetic neuralgia (excruciating pain that lasts for months, sometimes years, after a case of shingles). One spinal injection left me bedridden for five days, curled into the fetal position, sobbing uncontrollably from pain and depression (the steroid apparently went straight to my brain and kicked my neurotransmitters completely out of whack). The “pain management” specialist I was seeing was of no help and finally told me to go to the ER, where they treated me as though I were a junkie and kept asking why I was crying. Gee, doc, sorry if I’m disturbing your calm, but you might be a bit distressed too if you’d felt as though you were undergoing unanesthetized surgery for 120+ hours straight.

        Getting back to pain preventing function, the PHN eventually wound up getting me illegally fired for “unexcused” work absences that were, in fact, covered under both FMLA and ADA. I pray that the asshat who canned me someday undergoes the same unassuaged torture.

        1. I know what you mean about ER’s.  I learned a long time ago not to go unless my DOCTOR told them to expect me.  Otherwise, I get the sort of patronizing brush off you describe and that’s even when I go to the ER of the hospital where my doc works and they can see my electronic medical records for the associated condition.  It’s just not worth the misery of schlepping across town to the ER to get a patronizing lecture and shuffled back out the door in the same condition or worse.  I’ll wait until my normal doc works me in or figures something else out (my neuro sends me to the infusion clinic).

          Were you able to do anything about your employer? Like wrongful termination or discrimination?

  4. Interestingly, when I started on my last (generic) Vicodin refill, the tablets looked different for the first time in 15 years.  Turns out that my doctor, or Kaiser or somebody with a brain has switched from 5mg of Hydrocodone with 500mg of Acetaminophen to 5 / 325.  Which is good, since the Acetaminophen is more dangerous than the opiate.

    1. Not sure if this is old hat common knowledge, or off-limits taboo, but given the length of time involved (15 yrs?), I’d still recommend a CWE (cold water extraction) to be rid of as much of the remaining APAP as you can.

      It takes a bit of time and effort, but it’s an accessible option for most.

      I’d even offer that there’s a degree of satisfaction in the undermining of such a highly engineered corruption.

      In the case of Vicodin et al., it could be far more than mere insult added to injury.

      1. The trouble with CWE is that you lose proper dosage control of the opiate, because you end up with a pile of undifferentiated powder instead of a tablet. Which isn’t a problem if you’re just trying to get your kicks, but it can cause difficulties for medical use.

        One thing I would recommend for anyone who has to take a daily dose of anything that contains APAP is an accompanying daily dose of standardized milk thistle extract (80% sylmarin). It’s a gen-yoo-wine hepatoprotective agent. (A reputable source is key. Swanson Vitamins sells, IMO, the best standardized milk thistle product. Don’t get “whole” or “full spectrum” milk thistle, ’cause it’s crap.)

        You don’t need to use the massive 10-13g doses that are required to counter acute conditions like mushroom poisoning, but 500-1000mg a day really does give the liver some much-needed assistance in countering the damage caused by chronic APAP ingestion.

        It’s all such a puritanically neurotic regulatory clusterfuck. “Somebody somewhere might be getting high, so we’ll just increase your liver’s toxin load to ensure that everyone knows We Do Not Approve.”

        Meanwhile: the USA consumes 99% of the world’s hydrocodone (the stuff in Vicodin and Norco). Perhaps Americans are just in more pain than the rest of the world, but the fact is that Abbott Labs, Watson Pharmaceuticals, et al. make a tidy profit on every pill, whether it goes to grandma for her hip or to some Bill Burroughs wanna-be in the East Village. I estimate the companies’ true level of interest in reducing the total number of opiate prescriptions to be somewhere around zero.

  5. This LA times story, and the others it links to, don’t report how many deaths are reasonably attributed to prescription drugs.  The article implies that people are taking prescription pain killers, becoming addicts as a result, and dying of overdoses.  The problem I have here is that the numbers in the article don’t back this up.  I’m not arguing that they are wrong, rather I cannot find anything that shows that this argument is valid.  The same is true for NYTimes articles on this subject.  Anybody got a link to better data?

  6. I run a website about legal cognitive enhancing drugs. I think that the culture of drugs in this country are just completely ridiculous. Thankfully the people in charge are starting to slowly see that we need to provide treatment instead of just punishment. Anyway, if you’re interested in information about cognitive enhancers check out Smarter Nootropics

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