Questions and Answers - Prescription Painkiller Overdoses
Q: What did the CDC analysis find?
A: Our analysis found that there were nearly 15,000 (14,800) overdose deaths from prescription
painkillers in 2008. This is more than three times the 4,000 people killed by these drugs in 1999.
This amounts to more than 40 people dying every day from overdoses involving these powerful
drugs. Increased nonmedical use of prescription painkillers, combined with growing sales, has
contributed to this skyrocketing increase in overdoses and deaths. According to the Substance
Abuse and Mental Health Services Administration, last year, one in every 20 people in the
United States age 12 and older—a total of about 12 million people—reported that they used
prescription painkillers nonmedically. This means that they were using the drugs without a
prescription, or just for the “high” they cause. In addition, our analysis shows that sales of these
drugs to pharmacies and health care providers have increased by more than 300 percent since
1999.
Q: What information did CDC use for its analysis?
A: CDC analyzed rates of fatal overdose from the CDC/NCHS’s National Vital Statistics
System; non-medical use of prescription painkillers from SAMHSA’s National Survey on Drug
Use and Health; annual drug sales from DEA’s Automation of Reports and Consolidated Orders
System (ARCOS); substance abuse treatment admissions for prescription painkillers from
SAMHSA’s Treatment Episode Data Set (TEDS); and the percentage of the state population
below the federal poverty level by race and ethnicity from the Kaiser Family Foundation.
Q: Why does CDC think there has been such a rise in deaths from prescription painkillers in
the past decade?
A: The supply of prescription painkillers is larger than ever. In fact, the quantity of prescription
painkillers sold to pharmacies, hospitals, and doctors’ offices was four times larger in 2010 than
in 1999. Enough prescription painkillers were prescribed in 2010 to medicate every American
adult around-the-clock for a month.
Even though most of these pills were originally prescribed for a medical purpose, many ended up
in the hands of people who misused or abused them. Improving the way prescription painkillers
are prescribed can reduce the number of people who misuse, abuse and overdose from them,
while ensuring that patients have access to safe, effective treatment.
Q: What does CDC mean by prescription painkillers? What about drugs like Tylenol and
naproxen, etc.?
A: For the purposes of our study, we were looking at overdose deaths involving a class of
prescription painkillers known as opioids, also called opioid analgesics or narcotic analgesics.
These drugs are derived from opium (or are synthetic versions of it) and are used for pain relief.
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Examples include hydrocodone (Vicodin®), oxycodone (OxyContin®, Percocet®), fentanyl
(Duragesic®, Fentora®), methadone, morphine and oxymorphone.
In addition to the opioid prescription painkillers, there are other types of prescription painkillers
available by prescription and over-the-counter such as the non-steroidal anti-inflammatory drugs
naproxen and ibuprofen. However, in this study, we were specifically looking at opioid
painkillers. Our sales data did not include buprenorphine, an opioid primarily used for substance
abuse treatment, though sometimes prescribed for pain. Its inclusion with drugs primarily used to
treat pain would have inappropriately increased sales rates.
Q: Did CDC find geographic differences in death rates? What states or regions have the
highest and lowest rates? Why?
A: Yes. There was significant variation in drug overdose death rates among states; the highest in
2008 were in New Mexico and West Virginia, which had rates nearly five times that of the state
with the lowest rate, Nebraska. Overall, the highest drug overdose death rates were in the
Southwest and Appalachian region. We can’t say exactly why there is such variation among
states, but we do know people in rural counties are about two times more likely to overdose on
prescription painkillers than people in big cities. And our analysis shows that some of the states
that saw the largest increases in overdose deaths between 1999 and 2008 were states that had
some of the highest poverty levels among non-Hispanic whites. In addition, differences in
prescribing habits among states may also account for some of the variation in overdose death
rates.
Regardless of the reasons that some states have higher death rates than others, drug overdoses in
the United States are at an all time high, and all states can take steps to reduce this growing
epidemic. Promising strategies include starting or improving prescription drug monitoring
programs (PDMPs), which are electronic databases that track all prescriptions for painkillers and
other abuseable drugs in the state, as well as holding healthcare providers accountable for
responsible prescribing. Our Vital Signs fact sheet includes a variety of steps that CDC
recommends states put into effect to reduce the problem of prescription drug overdose.
Q: What does CDC think are safe prescribing practices for prescription painkillers? In what
cases, and for how long, should they be prescribed?
A: Organizations such as the American Pain Society/American Academy of Pain Medicine, the
American College of Occupational and Environmental Medicine, and states like Washington and
Utah have developed evidence-based guidelines for responsible prescribing of prescription
painkillers. CDC believes that adopting and enforcing these types of evidence-based guidelines
can be helpful in reducing prescription painkiller abuse. In general, these guidelines recommend:
o Screening and monitoring for substance abuse and mental health problems.
o Prescribing painkillers only when other treatments have not been effective for
pain.
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o Prescribing only the quantity of painkillers needed based on the expected length
of pain.
o Using patient-provider agreements combined with urine drug tests for people
using prescription painkillers long term.
o Talking with patients about safely using, storing and disposing of prescription
painkillers.*
o Using PDMPs to identify patients who are improperly using prescription
painkillers.
Q: Do most people who die from overdoses involving prescription painkillers have
prescriptions for these drugs, or are they getting the drugs from others or using them illegally?
A: Almost all prescription drugs involved in overdoses originally come from prescriptions.
However, once they are prescribed, these drugs are often obtained by people who do not have a
prescription. Data from SAMHSA’s National Survey on Drug Use and Health show that more
than three out of four people who misuse prescription painkillers use drugs prescribed to
someone else. The majority, about 55%, got these drugs, free of charge, from a friend or relative.
A study examining overdose deaths, prescription drug monitoring program data and medical
examiner files in West Virginia found that 63% of the people who died had contributory
prescription drugs that could not be traced back to an actual prescription.
Q: Are most people who die from a prescription drug overdose using these drugs alone or in
combination with other drugs?
A: About one half of prescription painkiller deaths involve at least one other identified drug,
including benzodiazepines, cocaine, and heroin. Approximately 17% of prescription painkiller
deaths between 1999 and 2006 also involved a benzodiazepine. Alcohol is also involved in many
overdose deaths.
Q: What are the estimated costs of prescription painkiller abuse in the United States?
A: Several studies have estimated that prescription painkiller abuse costs between $54 and $72.5
billion each year. In addition, studies estimate that people who abuse prescription painkillers
incur over eight times as much direct health care costs compared to people who do not abuse
these drugs. It is clear that in addition to the significant loss of life and devastation of families
and communities across the country, there is an equally devastating impact on healthcare costs.
Q: Why are there so many more sales of these drugs in some states than in others?
A: There is wide variability among states in terms of the sales of prescription painkillers to
health care providers, hospitals, and pharmacies. Our analysis found that prescription painkiller
sales per person were more than three times higher in Florida, the state with the largest volume
of sales, than in Illinois, the state with the lowest volume of sales. We can’t say for certain why
states vary so greatly in terms of sales. It is likely that prescribers who indiscriminately prescribe
high volumes of prescription painkillers, i.e., pill mill physicians, account for some of the
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differences among states. State variation in sales could also be the result of state policies and
programs like prescription drug monitoring programs, pill mill and doctor shopping laws, and
aggressive prescription claims review programs that identify and address providers
inappropriately prescribing and patients misusing or abusing these drugs. However, it is critical
that additional evaluations of these promising policies and programs are undertaken to further
understand their impact on prescription painkiller sales and overdoses.
Q: Who is most at risk of prescription painkiller overdose death?
A: There are several groups of people who are at more likely to abuse or overdose on
prescription painkillers.
 Many more men than women die of overdoses from prescription painkillers.
 Middle-aged adults have the highest prescription painkiller overdose rates.
 People in rural counties are nearly twice as likely to overdose on prescription painkillers
as people in big cities.
 Whites and American Indian or Alaska Natives are more likely to overdose on
prescription painkillers.
 About 1 in 10 American Indian or Alaska Natives aged 12 or older used prescription.
painkillers for nonmedical reasons in the past year, compared to 1 in 20 whites and 1 in
30 blacks.
 People who obtain multiple controlled substance prescriptions from multiple providers—
a practice known as “doctor shopping.”
 Those who use high-doses of opioids, and those who abuse multiple substances like
opioids, sedatives, and alcohol.
 Medicaid populations have also been shown to be at greater risk of overdose compared to
non-Medicaid populations.
 People who suffer with substance abuse and other mental health disorders
Q: What does CDC recommend that states do to combat this problem?
A: States, as regulators of health care practice and large public insurers, can take the following
steps to help prevent overdoses from prescription painkillers and reduce this public health
burden:
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Start or improve prescription drug monitoring programs (PDMPs), which are electronic
databases that track all prescriptions for painkillers in the state.
Use PDMP, Medicaid, and workers’ compensation data to identify improper prescribing
of painkillers.
Set up programs for Medicaid, workers’ compensation programs, and state-run health
plans that identify and address improper patient use of painkillers.
Pass, enforce and evaluate pill mill, doctor shopping and other laws to reduce
prescription painkiller abuse.
Encourage professional licensing boards to take action against inappropriate prescribing.
Increase access to substance abuse treatment.
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Q: What is CDC doing to help reduce the problem of prescription painkiller overdoses?
A: CDC is committed to taking steps to reduce the prescription drug epidemic in the United
States. In addition to sharing the findings of research and helping to share promising policies and
programs with states, health care providers, health insurers, and the public, CDC is working with
other federal agencies to:
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Track prescription drug overdose trends to better understand the epidemic.
Educate health care providers and the public about prescription drug abuse and overdose.
Develop, evaluate and promote programs and policies shown to prevent and treat
prescription drug overdose and abuse, while making sure patients have access to safe,
effective pain treatment.
Q: What can doctors and other health care professionals do to help reduce this problem?
A: To help combat the problem of prescription drug overdoses, CDC recommends that
healthcare providers:
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Follow guidelines for responsible prescribing, including
o Screening and monitoring for substance abuse and mental health problems.
o Prescribing painkillers only when other treatments have not been effective for pain.
o Prescribing only the quantity of painkillers needed based on the expected length of
pain.
o Using patient-provider agreements combined with urine drug tests for people using
prescription painkillers long term.
o Talking with patients about safely using, storing and disposing of prescription
painkillers.
 Use PDMPs to identify patients who are improperly using prescription painkillers.
Q What can individuals do to help address this issue?
A: Individuals can take the followings steps:
 Use prescription painkillers only as directed by a health care provider.
 Make sure they are the only one to use their prescription painkillers. Not selling or sharing
them with others helps prevent misuse and abuse.
 Store prescription painkillers in a secure place and dispose of them properly.
 Get help for substance abuse problems if needed (1-800-662-HELP).
Q: Does CDC have tips for parents to help prevent children and youth from misusing
prescription painkillers?
A: Yes. Properly storing and disposing of prescription painkillers is an important step in
preventing children and youth from accessing prescription painkillers. In addition, not sharing
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medications with others and explaining to children and youth the dangers of prescription
painkillers may also prevent children and youth from misusing these drugs.
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