Like tens of millions of Americans, rock star Tom Petty took prescription medications, including opioids, to alleviate pain. The recent announcement by the Los Angeles County Medical Examiner that Petty’s death on Oct. 2 was caused by an accidental drug overdose as a result of mixing medications that included opioids underscores the risks associated with taking prescription pain medications, particularly for patients who use multiple prescription drugs, doctors say.
“No doubt about it, pain medication, particularly the powerful opioids that are used for severe or chronic pain, are a true double-edged sword,” says Dr. Marc I. Leavey, a primary care specialist at Mercy Personal Physicians in Lutherville, Maryland. “Used properly, they can provide relief of pain and allow the patient to regain productivity; improper use can lead to death.”
The risk of overdose is greatest for people who are taking multiple prescription medications, agreed Dr. Marvin Seppala, chief medical officer of the Hazelden Betty Ford Foundation based in Center, City, Minnesota. For example, taking benzodiazepines — which many physicians commonly prescribe for anxiety, sleep problems and agitation — in combination with pain-killing opioids such as hydrocodone or oxycodone slows down the patient’s breathing, which could lead to cardiac arrest and death, Seppala says.
Petty died of cardiac arrest at his home in Malibu a week after he’d completed a 40th anniversary tour with his band the Heartbreakers, which included 53 concert dates. The medical examiner’s autopsy report said Petty’s system had traces of eight medications, including fentanyl, oxycodone and temazapam. Petty’s wife, Dana, and daughter, Adria, posted a message on the singer’s Facebook page saying he suffered from “many serious ailments” including emphysema, knee problems and a fractured hip. The statement did not say when or how Petty had suffered the hip injury. Rolling Stone reported that Petty’s manager, Tony Dimitriades, said Petty was suffering from a hairline fracture in his left hip during his final tour. “I don’t know how it happened,” Dimitriades said. “I don’t think he even knew when it happened.”
“On the day he died he was informed his hip had graduated to a full on break and it is our feeling that the pain was simply unbearable and was the cause for his overuse of medication,” they wrote. Petty had been using fentanyl patches, which are are prescribed to treat severe pain. “As a family we recognize this report may spark a further discussion on the opioid crisis and we feel that is a healthy and necessary discussion and we hope in some way this report can save lives,” Dana and Adria wrote.
[See: On a Scale of 1 to 10: Most Painful Medical Conditions.]
In 2015, about 98 million people in the U.S. age 12 or older used a prescription pain reliever, according to the National Survey on Drug Use and Health by the Substance Abuse and Mental Health Services Administration.
While Petty’s physical pain may have led him to take prescription opioids, his history of substance misuse likely increased his risk of overdosing, says Howard Samuels, owner and chief executive officer of The Hills Treatment Center, an alcohol and drug rehabilitation facility in Los Angeles. In the book “Petty: The Biography,” released in 2015, the rocker disclosed he used heroin during the 1990s. Petty’s overdose “didn’t surprise me at all,” Samuels says. “Tom had a history of heroin addiction. Unfortunately it makes all the sense in the world. If someone has a history of opiate abuse and then they’re using fentanyl, you are dancing with the devil.”
Petty’s death is part of the lethal opioid epidemic raging across the country. Nearly 63,600 people in the U.S. died of drug overdoses in 2016, a 21 percent increase from 2015, according to a report by the National Center for Health Statistics, which is part of the Centers for Disease Control and Prevention. Most of the 2016 overdose deaths — 42,249, or 66 percent — involved opioids.
If you’re taking opioids for chronic pain or for an acute short-term condition, here are seven strategies to avoid the fate that befell Petty:
1. Try every other treatment approach first. Before turning to opioids, exhaust other pain management options, such as over-the-counter medications, physical therapy, acupuncture and working with a pain psychologist, says Dr. Eric Buchner, a physiatrist with the Physical Medicine & Rehabilitation Management unit of Sinai Hospital of Baltimore. “I’ve had countless patients, family members or friends come to me for advice never having tried ice, heat or over-the-counter medications for their pain issues,” Buchner says. An array of procedures can help reduce pain, including joint or trigger pain injections, in which a physician injects a numbing agent, such as lidocaine, or a steroid, which reduces inflammation, directly into a painful area such as a knot of tight muscles to alleviate pain; pain injections, spinal cord stimulators and epidural steroid shots, he says. “Opioids should never be used as a first line of treatment in chronic pain issues and should be limited to brief periods of use during acute pain,” he says.
2. Accept that you’ll have to live with some pain. “Have realistic expectations that some degree of persisting pain will have to be lived with, and that complete alleviation of pain through the use of medication comes with an increased level of risk to your health and of possible accidental death,” says Bruce Hillenberg, director of psychology at the Centers for Pain Medicine at Beaumont Hospital in Royal Oak, Michigan. “Acceptance that some pain could be present despite treatment encourages patients to be open to a variety of self-management and physical rehabilitation treatments.”
[See: 11 Ways to Cope With Back Pain.]
3. Get all of your pain medication prescriptions from one doctor. If you’re being treated for cancer and depression, your oncologist may prescribe opioids to treat your pain while your psychiatrist provides medication for your mood disorder. Taking multiple medications prescribed by different physicians increases the chances you’ll have a negative drug interaction, says Dr. Vernon Williams, a sports neurologist and director of the Kerlan-Jobe Center for Sports Neurology and Pain Medicine at Cedars-Sinai Jobe Institute in Los Angeles. “It’s best to have only one physician prescribing all your pain meds,” Williams says. If you have multiple prescriptions from different doctors, keep an updated list of them and make sure all of your physicians and your pharmacist have a copy, Williams says. Doctors and pharmacists could flag any potentially dangerous drug interactions, he says.
4. Keep a pain journal. Document the kind of pain you’re having, rate it on a scale of 1 (least) to 10 (worst), and keep track of what medications you took to relieve the pain and how effective they were. Share the journal with your physician so he or she can devise the best ongoing course of treatment, says Sharon Roth Maguire, a registered nurse and chief clinical quality officer at BrightStar Care, a private duty home care and medical staffing franchise with more than 300 locations nationwide.
5. Have a relative or friend nearby the first time you take an opioid painkiller. Opioids affect everyone differently, so it’s a good idea to have a someone you trust with you the first time you take a particular opioid. That way, if you have a bad reaction, they can call 911 or a drug hotline, says Dr. Luga Podesta, a sports medicine and regenerative orthopedic specialist at Bluetail Medical Group in Naples, Florida. “The physician may give you a dosage that’s too much for you, or it may have a different effect than expected,” he says.
6. Keep naloxone in your home. If you’re taking powerful prescription opioids, keep naloxone — a medication that blocks the effects of opioids and can reverse an overdose — available, says Dr. Ezekiel Fink, medical director for pain management at Houston Methodist in Houston, Texas. It’s important that the family member or friend knows how to administer naloxone, also known as Narcan, because if you’re overdosing you won’t be able to do it yourself, Fink says. Narcan can be administered by injection or nasal spray. The medication is available without a prescription at a number of pharmacies in most states.
[See: 5 Products Health Professionals Keep in Their Medicine Cabinets.]
7. Tell your doctors if you have an addiction. If you’re in recovery from misusing drugs or alcohol, particularly heroin or opiates, tell your doctor. He or she may conclude the risk of relapse isn’t worth the risk and devise another treatment plan, Samuels says.
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7 Strategies for Avoiding the Kind of Overdose That Ended Tom Petty’s Life originally appeared on usnews.com
