Signs of a Pain Medicine Overdose

October 9, 2013November 17, 2015 / Thomas Cohn, MD

All medications can cause problems when not taken correctly. Pain medications, even those sold over-the-counter, can have deadly consequences when overdosed. Having the right balance of medications for pain and not having significant side effects is the trick that a good pain physician will try to develop for a patient. It is always necessary to keep track of the patient’s medications, even nonprescription to monitor for adverse reactions. This article will discuss the signs of overdose for opioids, over-the-counter meds, and neuropathic medication.

Opioid Overdose

Narcotic/opioid medications have had the most publicity concerning overdose. These are the drugs like Percocet, Vicodin, Oxycodone, and Morphine. These drugs are powerful analgesics and are commonly given for severe pain. Side effects are common and include:

Upset stomach
Constipation
Nausea
A tired or “drugged” feeling

Signs of an overdose of opioid medications include:

Excessive tiredness & sleeping
Low pulse and blood pressure
Decreased breathing

Significant overdose may be treated with a medication called Narcan to reverse these effects. There is a push for all emergency responders to carry Narcan since overdose of these medications is becoming common due to drug abuse.

Neuropathic Medication Overdose

Neuropathic medications include many antidepressants (like amitriptyline, and Cymbalta), and seizure medications (such as gabapentin, Topamax, and Lyrica). These medications often have annoying side effects such as:

Dry mouth
Short term tiredness

If they cause significant changes like memory problems or worsening depression, talk to the physician about problems. Overdose with antidepressants such as amitriptyline can cause severe respiratory problems and needs to be treated with acute hospitalization.

Over the Counter Medication Overdose

Over-the-counter medications like acetaminophen and ibuprofen also have problems if overdosed. Anti-inflammatories like ibuprofen can cause ulcers and stomach bleeds in some people, even at normal doses, but these affects can be treated. Acetaminophen however is very dangerous if taken in to high of a dose. Taking 1.5 times the recommended amount can lead to liver failure and even death. If you have been taking too much acetaminophen the eyes and skin can turn yellow indicating liver damage, and must be treated promptly by a physician.

Pain medicines can be very helpful in managing symptoms. Like all drugs, they need to be taken only as directed. Make sure your physician knows all the medications that you are taking. Additionally, be sure to talk to your doctor about whether you can eat certain foods, or drink alcohol with your medication. If side effects of a medication are a problem, talk to the doctor before stopping the medication, sometimes these drugs need to be tapered off or just changed slightly to be helpful.

Centipede Venom: The New Pain Medicine?

October 7, 2013June 24, 2014 / Thomas Cohn, MD

The search is on throughout the scientific community for new medications for every known disease. Cancer and heart research are often the glamour areas, now a new pain medicine may be on the horizon. Centipede venom has been found on an experimental basis to be a powerful pain killer in mice. It is a toxin that acts on a protein that influences pain sensation. Mice that are given an injection of the purified venom can withstand a significant increase in pain.

The Goal of Research

The goal of research is to find a chemical that helps with pain but does not have the side effects of current strong pain medications like opioids/narcotics. Morphine and similar compounds have many side effects and are addictive with high potential for abuse and overdose. The goal of new compounds is to minimize the bad parts and control pain better. In mice, the new centipede venom appears to be very effective in pain control.

Unfortunately, this is just the first step to determine if centipede venom will be useful in humans. Once a compound is found to be useful, the next step is to determine if it will be useful in mammals and then humans begins. Chemicals that work in mice do not necessarily work in humans.

Further Questions & Testing

Then there are the questions of whether the drug causes other problems, and what dose is safe and effective and for how long. Another issue is how the compound must be delivered to the body to be effective. One of the recent medications, snail venom (ziconotide) is only effective if given to the spinal fluid, which makes this drug very difficult to use. Many compounds cannot be taken orally because the stomach is highly acidic and often will destroy drugs. For a pain medication that is useful, an easy delivery system is essential for every day use.

Research goes on daily to find new medications that help improve our lives. As we live longer, pain is becoming a common problem that most people have to confront. Hopefully, science will find new and effective drugs to take care of pain.

Pain Medication & Alcohol – A Dangerous Mixology

September 27, 2013June 24, 2014 / Thomas Cohn, MD

It is always wise to be careful about drinking alcohol when taking any medication. All medications can interact with other substances you ingest. For example, meds can interact with vitamin supplements, and even certain foods that you eat.

It is no surprise then that one should be careful with mixing alcohol and medications (including pain medications). In this article, I will discuss some of the most common medications and how they interact with alcohol in the body.

Opioids & Pain Meds

The most common concern about alcohol is with opioid/narcotic pain medications. These drugs include:

Percocet
Vicodin
Oxycodone
Oxycontin
Morphine
Codeine
Fentanyl

All narcotics can affect your cognitive ability and judgment, and alcohol can have the same effect. The combination of the two is not always additive, and the alcohol can greatly diminish both of the above. Thus your judgment could become very poor, and the toxicity increased such that either drug can essentially cause death. If one is on a stable dose of narcotic, people can usually function without impairment. An occasional alcoholic drink should be safe. You may feel more impaired then usual, but you should not be toxic.

Neuropathic Meds

Many pain patients also use neuropathic medications like gabapentin, or other seizure type drugs, and antidepressants. These drugs also can affect cognition, and mixing with alcohol can worsen this ability. Alcohol is metabolized and broken down in the body by the liver, and the same process is also used by many of these medications. Therefore, alcohol and these medications can also interact in unpredictable ways. Again, if you have been on these medications long-term, then an occasional drink is likely safe, but heavy drinking is not a good idea.

Ibuprofen, Tylenol, & other Over the Counter Meds

Over the counter pain medications such as ibuprofen and acetaminophen/Tylenol are generally very safe if taken as directed. Unfortunately, people often take a little more than directed in the hopes that they will work better. Mixing alcohol with these drugs can be very dangerous. Anti-inflammatories like ibuprofen can cause stomach irritation. Mixing them with alcohol can cause severe ulcers and stomach bleeding. Acetaminophen alone can easily be toxic to the liver. Mixing this with alcohol has led to fatal liver failure.

The answer to drinking alcohol with pain medications is not simple. If one takes their medications only as directed, and has been stable on them, then having an occasional alcoholic beverage, not daily and not more than one, should be safe. Your judgment, memory, and cognition could be affected even with one drink, and you may not be safe to drive, but it should not be toxic to the body.

FDA Increases Rules for Opioid Prescribing to Cut Down on Abuse

September 16, 2013September 27, 2016 / Thomas Cohn, MD

The FDA recently decided to tighten the labeling requirements for opioid medications. Over the past decade, opioid medications have become increasingly prescribed for pain conditions. Unfortunately, these medications have also become highly abused in the US. From multiple fronts, there has been a push to control the use of opioids and improve their safety.

A Brief History of Opioids

Opioids are strong analgesic medications used for a variety of pain control situations. Initially, they were used to treat short-term, acute pain related to surgery, injury, and illness. Eventually, opioids also became a pain relief option for terminal illnesses such as cancer. As pain became a concern in quality of life, and considered a “fifth” vital sign, opioid medication prescriptions blossomed. As opioid popularity increased, opioid prescription abuse also swelled. Now both the FDA and DEA are working to stem abuse and improve the appropriateness of prescribing by physicians.

Opioid Abuse and Pain Management

Pain is extremely challenging to manage and treat. The complexity of pain has spawned it’s own medical specialty – Pain Management. Twenty years ago, finding a physician who knew anything about pain management was a rarity. Currently, there are some pain specialists, but still very few board certified specialists in the US. Medical school training programs still do not have formal pain education, and most medical residencies have no pain medicine training or experience at all. Pain fellowships train only a small number of physicians yearly.

Pain management is complex, requiring specialized knowledge, and the ability to find a variety of solutions for difficult problems. Opioid medications have been easy to prescribe and often a simple solution to a variety of pain problems. The FDA is trying to change the wave of opioid use through changing the labeling of medications, warning physicians and patients that these drugs may be dangerous. Unfortunately, this is likely to be an overly simplistic solution to a complex problem.

A Better Solution to Opioid Abuse

Improving opioid prescribing is important, but the better starting point may be improving the understanding of pain by doctors as well as patients. Doctors need more training, starting in medical school and progressing throughout residency and practice. Patients would also benefit from the help of physicians trained and specializing in pain medicine. Pain is complex and opioids are only a small part of a solution. It will take multiple efforts to decrease opioid abuse, and improve appropriate prescribing. The FDA is starting the effort, but it will require concerted effort by doctors and the medical community to increase knowledge of opioid use and its potential dangers.