Tag Archives: overdose

Tramadol: The most dangerous drug in the world

Over the years, as often happens, a difference between clinical trials and the real world started to emerge.

Imagine a prescription medication that relieves pain just as well as narcotics like Oxycontin, but isn’t addictive. Too good to be true?

Turns out, yes.

For years, that was the case with Tramadol, a synthetic opioid drug that was released in 1995 under the brand name Ultram to great expectations. This new drug seemed to offer all the benefits of more powerful, more addictive drugs, but with fewer of the downsides of dependency — at least in clinical trials. This was apparently in part because trials examined tramadol use by injection, but it is manufactured — and far more potent — in pill form.

And if the drug was unlikely to make people dependent, it was not likely to be abused, unlike other opioid alternatives like Vicodin (also known as Norco), Percocet — let alone be as dangerous as high potency opioid medications like morphine, Dilaudid, or Fentanyl.

So for many years, Tramadol was widely prescribed by doctors as a “safer” alternative to narcotics for pain. The difference between narcotics and opioids is subtle, but opioids are natural or synthetically made drugs that function metabolically in the body like opium derivatives derived from poppy plant, while narcotics is more often used as a legal term, classifying drugs that blur the senses and produce euphoria, including cocaine and other non-opiates.

Indeed, unlike other opioid drugs, the Drug Enforcement Agency didn’t classify Tramadol as a controlled substance, because the FDA believed it had a low potential for abuse.

Though there were concerns about tramadol abuse in the years after release, the FDA repeatedly determined that the drug was not being widely abused, and so left it as an unscheduled drug.
This made Tramadol a particularly dangerous drug — because it was, in fact, highly addictive and prone to abuse. But because it was easier to obtain and had less concerns from physicians, it was more widely prescribed. Over the years, as often happens, a difference between clinical trials and the real world started to emerge. Emergency rooms began to report a growing number of overdoses related to Tramadol ……..

full article here

Heath Ledger – awareness

Overdose awareness Day!

Heath Ledger, Prescription drugs and overdose.

‘It was [10] years ago … but to me it’s like it was yesterday.’

These are the words of Kim Ledger as he recalled the loss of his son Heath to an opioid overdose in January 2008.

The 28-year-old actor had been caught up in a punishing production schedule, flying between three different countries and filming scenes at night in the bitter cold. He contracted a chest infection that developed into pneumonia, and experienced insomnia.

Heath visited a variety of doctors on his travels to help deal with these problems, collecting a veritable cornucopia of prescription medications, including opioids and sleeping pills.

In combination, the opioids, sleeping pills and the chest infection itself had a depressing effect on Heath’s respiratory system, causing it to shut down. This made him a high-profile casualty of what was emerging as a prescription opioid epidemic, which includes the use of legal drugs such as codeine, fentanyl and oxycodone.

This phenomenon has claimed thousands of lives in Australia and around the world.

While Heath’s death was the result of a medication mix he didn’t realise would exact such a heavy toll, other opioid users have a more long-term relationship with these types of drugs, often becoming unexpectedly addicted after using them as a treatment for chronic non-malignant pain.

‘The accidental addict. In a very short space of time, people can become addicted to oxycodone and products like that,’ Kim said.

Such was the case of 30-year-old nurse and mother of two, Katie Howman, found dead following a fentanyl overdose in her Toowoomba home just before Christmas in 2013. Investigations revealed she had visited 20 different doctors and 15 different pharmacies over the previous 13 months in her search for opioids.

Opioids – a category that includes pharmaceuticals such as oxycodone and fentanyl, as well as illicit versions such as heroin – remain the main cause of accidental overdose death in Australia. Opioid-related deaths hovered at around 450 per year at the turn of the century, but these numbers have risen sharply since 2006 to hit over 1100 per year since 2014.

What has led us to this epidemic, and what can GPs do to help curb it?

Too good to be true
In the late 1990s, prescription opioids seemed like an ideal answer to the often-difficult problem of chronic, non-malignant pain.

‘There was an increased demand to treat chronic pain. There were very few options and very little research that had been done on this problem,’ Dr Evan Ackermann, a GP with a special interest in opioids, told the RACGP.

‘This was mixed with a situation of some fairly aggressive drug company marketing of opioids and a change of clinical attitude towards pain. Normally, pain would be part of the healing process, but people started to say we should be looking at pain as the “fifth sign” and treating it aggressively.

‘It was a cultural shift across the healthcare sector, across the board, from pharmacy right through to general practice, specialists and hospitals.’…………….
‘There is a sense out there sometimes that it’s just people choosing to do this, that there’s a dichotomy between the genuine-pain patient and the bad drug user,’ she said. ‘My experience is that they’re the same group of people.

‘Opioids interact with us as a species in a particular way; all of us are at risk of side-effects and one of those major side-effects is dependency and addiction.’

………….

full story

Exerpt from:https://www.racgp.org.au/newsGP/Clinical/Agony-and-ecstasy-Prescription-drugs-and-overdose

Woman dies of drug overdose after using fentanyl patches for pain relief

A woman lay dead in her car in a hospital car park for a whole night after she used fentanyl patches to ease pain in her dislocated knee, an inquest has heard. Hazel Gough’s lifeless body was found slumped in her car by a receptionist the morning after she saw a doctor at Fountain Way Hospital in Salisbury, Wiltshire. The 41-year-old delivery driver was last seen getting into her Renault Kadjar at 4.30pm following the appointment.

Hospital receptionist Adrian Lock initially thought she was sleeping and tried shaking her awake, but when he got no response he called paramedics. She was pronounced dead at the scene at 9.04am on December 14 last year.

The inquest at Salisbury Coroner’s Court heard Miss Gough had fatal amounts of fentanyl in her blood after she was prescribed the opioid patches to help relieve the pain of a dislocated knee. Doctors had reduced the dosage of the patches and had discussed lowering it even further. Senior coroner for Wiltshire and Swindon David Ridley gave the cause of death as fentanyl toxicity and recorded a verdict of misadventure.

Mr Ridley said: ‘It’s likely, having got in her car after the session ended with her doctor at 4.30 pm, that the effects of the drug caused respiratory depression and Hazel’s death inside the car.’

 

Full article: https://metro.co.uk/2018/07/20/woman-dies-of-drug-overdose-after-using-fentanyl-patches-for-pain-relief-7738782/

 

 

Adverse drug reactions – (NICE)

Assessment

  • Assess the nature and severity of the reaction.
  • This will determine whether urgent action is required or whether the person can be managed in primary care. For example, a cough due to an angiotensin-converting enzyme inhibitor can be troublesome but not life threatening, but an anaphylactic reaction is a medical emergency.
  • The nature of the presenting condition may strongly suggest that it is an adverse drug reaction (ADR). For example, the following conditions are often ADRs:
  • Acute dystonias
  • Blood dyscrasias
  • Skin reactions, such as Stevens–Johnson syndrome and toxic epidermal necrolysis
  • Neuroleptic malignant syndrome
  • Take a history of the presenting symptoms, including:
  • When it started:
  • The time from when use of the drug was started to when the reaction develops may be characteristic of the reaction (for example anaphylaxis usually develops within a few minutes of parenteral drug administration).
  • If the drug was stopped, the time it took for the reaction to abate will often be related to the known duration of action of the drug.
  • Relationship to dose:
  • ADRs are often dose related and may be minimized by reducing the dose of the drug.
  • If the symptoms resolve when the drug is withdrawn, they may have been associated with the drug, although it could still have been coincidental.
  • If a drug is reintroduced and symptoms recur, the drug is most probably responsible for the adverse reaction. However, deliberate re-challenge is only very rarely justified (clinically and ethically) after serious ADRs, because of the risks involved.
  • Other possible causes:
  • The symptoms may be a manifestation of the person’s underlying illness or another disease.
  • Other medications (including self-medication and herbal remedies) could be responsible.
  • Consider the possibility of drug interactions (including with food and drinks).
  • Consider the drug history, and review any history of allergy or previous ADRs.
  • Take a complete drug history, including when the drug was started, what dose is being taken, what other drugs are being taken, and whether the person is also taking over-the-counter (OTC) or herbal medicines.
  • Check whether the person has ever had similar symptoms or presentation in the past with other drugs (from the same or a different drug class) or has a history of atopy or of ADRs with different presentation(s).
  • Be aware that even if a drug was stopped some time before the ADR, it may have been responsible if it has a very long duration of action (for example amiodarone).
  • Review the adverse effect profile of the drug and consider:
  • Whether the signs and symptoms are in keeping with the documented adverse effect profile of the drug.
  • Whether the ADR been reported before. This can be checked in the readily available sources of information, including:
  • The British National Formulary (BNF).
  • The electronic Medicines Compendium (www.medicines.org.uk).
  • Interactive Drug Analysis Profiles(iDAPs) — a complete listing of suspected ADRs for individual drugs that have been reported to the Medicines and Healthcare products Regulatory Agency (MHRA) through the Yellow Card scheme by health care professionals, members of the public, and pharmaceutical companies.
  • Regional and district medicine information services. Details of regional centres and other useful contacts can be found in the front of the BNF and BNF for Children (or online). Local services can found by contacting the medicines information department or the hospital pharmacy in major hospitals.
  • How common the suspected adverse reaction is.

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