"Overdoses involving prescription painkillers are at epidemic levels and now kill more Americans than heroin and cocaine combined," according to Thomas Frieden, director of the Centers for Disease Control and Prevention (CDC). Although some overdoses are suicides (at most 1 in 4), usually the deaths are unintentional -- accidents that perhaps could have been prevented.
If you or someone in your family needs a prescription painkiller to manage pain -- as many people do -- you and your doctor can take steps to avoid accidental overdoses.
1. Take non-opiate painkillers if at all possible: Nearly 75 percent of deaths due to overdoses of prescription painkillers involve opiate painkillers such as hydrocodone, oxycodone or methadone. Although acute pain due to injuries, surgery or cancer is often best treated with an opiate, chronic pain not due to cancer often responds as well to non-opiate painkillers or even non-pharmacological pain management. Ask your doctor whether the painkiller he or she is prescribing is an opiate and, if so, whether there is an alternative worth trying first.
2. Ask your doctor to start at the lowest possible dose: Although starting with a low dose may result in not getting your pain under control immediately, it may work. Particularly if your pain is chronic and likely to continue for some time, starting at a low dose can be an important protection. The lower the dose, the lower the risk of becoming addicted or of taking an overdose.
3. Ask your doctor to provide a small supply: Particularly if you are experiencing acute pain that is likely not to continue for a long time, ask your doctor to provide only enough medications for a few days or at most a week. This reduces the chance that you will take a lethal overdose if you become confused. It will also reduce the chance that you will have unused drugs in your medicine cabinet that may be an irresistible temptation to other members of your household -- especially adolescents.
4. Be careful about other medications you are taking: About half of opiate-related overdose deaths also involve another drug. Sometimes this is an illegal substance -- such as heroin or cocaine. Sometimes it is alcohol. Often it is a barbiturate, such as Xanax. Barbituates are particularly dangerous in combination with opiates because both can suppress breathing. It is very important to discuss potential drug interactions with your doctor and/or your pharmacist.
5. Drive cautiously, if at all: Prescription painkillers can make you dizzy, affect your vision, impair your judgment or reduce your reaction time. While dizziness or blurry vision are apparent, loss of judgment or reduced reaction times often are not. Your driving may be impaired without your feeling in the least bit high. Keep in mind that in addition to endangering your own life and the lives of others, driving under the influence of a prescription painkiller is as much a violation of the law as driving drunk.
6. Store your medications safely and dispose of unused medication: Recent reports indicate that the family medicine cabinet is rapidly becoming the main source of drugs that kids are using to get high. If you have children or adolescents in your household or if they come to visit, lock your prescription painkillers (and some cough medicines for that matter) up. In addition, if you have medication left unused, flush it down the toilet if you don't know of a convenient disposal site. (This is a bit controversial because of the potential for contamination, but many public health experts think it is preferable to leaving it around at home.)
7. Do not share or sell prescription painkillers: About 5 percent of Americans over the age of 12 use prescription drugs for non-medical purposes -- to get high -- often at great risk to themselves. If someone you care about tells you their prescription has run out or something of the sort, do them a favor and don't give them some of your pills.
8. Do not use prescription painkillers for non-medical purposes: Although it is not clear how many overdoses of prescription painkillers are due to non-medical use and how many due to taking too much of a prescribed drug, but it is clear that using prescription painkillers to get high can be dangerous -- more dangerous than many people who use them realize.
These eight steps can help to reduce deaths due to overdoses of prescription painkillers in the United States. Of course, individual action alone is not going to reverse this epidemic. The CDC and other public health agencies are calling on local and state governments to monitor the use of prescription painkillers, and they are calling on doctors to be more cautious in the way they prescribe them. In addition, I would argue that our nation's antiquated and moralistic drug policies, which overstate the dangers of illegal drugs and understate the risks of legal ones, need to be made responsive to the realities of the 21st century. But in the meantime, do what you can to protect yourself and your family.
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 Centers for Disease Control (CDC). "Prescription Overdoses At Epidemic Levels." Press Release November 1, 2011. http://www.cdc.gov/media/releases/2011/p1101_flu_pain_killer_overdose.html
 and  CDC. "Vital Signs: Overdoses of Prescription Opiod Pain Relievers: United States 1999-2008" in Weekly Mortality and Morbidity Report, November 4, 2011. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6043a4.htm?s_cid=mm6043a4_w
, , , ,  New York City Department of Health and Mental Hygiene (NYCDOHMH). "Preventing Misuse of Prescription Opiod Drugs". City Health Information Report, December 2011. http://home2.nyc.gov/html/doh/downloads/pdf/chi/chi30-4.pdf
 CDC. "Increase in Fatal Poisonings Involving Opioid Analgesiscs in the United State, 1999-2006". National Center for Health Statistics Data Brief, September 2009. http://www.cdc.gov/nchs/data/databriefs/db22.htm
 Valenti, K. "Drugged Driving" in The Journal News January 22, 2012. http://www.lohud.com/apps/pbcs.dll/article?AID=2012301220055
  CDC, "Prescription Painkiller Overdoses In the United States" in Vital Signs November 2011. http://www.cdc.gov/vitalsigns/PainkillerOverdoses/
 Sederer, L. "Prescription Drug Abuse: The New Killer on the Block" in The Huffington Post, November 8, 2011. http://www.huffingtonpost.com/lloyd-i-sederer-md/prescription-drug-abuse_b_1076166.html
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