AMA Morning Rounds Annotated on Opioids and Other Drugs

American Medical Association (AMA) Morning Rounds noted that opioids such as Vicodin (acetaminophen and hydrocodone), Percocet (acetaminophen and oxycodone), and Oxycontin (oxycodone) are among the most prescribed drugs in the U.S. An editorial in the Archives of Internal  Medicine points out there’s very little medical evidence to support this trend of long term use of opioids. In response, three physicians in California are telling peers to reconsider the practice of prescribing “potent narcotics” for patients who suffer from chronic pain. The issue is even bigger than that with the danger of accidental overdose on acetaminophen-containing products, which can lead to complications that can be life-threatening and lead to the need for liver transplant. And combining these agents with benzodiazepines can be deadly as well (see shortlink

Further, drug deaths now exceed motor vehicle accident (MVA) deaths according to the U.S. Centers for Disease Control and Prevention. In 2009, drugs were a cause of death in 37, 485 persons nationwide. This deserves to be called an “epidemic” because this is the first time drugs have caused more fatalities than traffic accidents since 1979. The increase comes mostly from prescription drugs for pain and anxiety which “now cause more deaths than heroin and cocaine combined.”

It’s ironic that we spend so much money on protecting our borders from the influx of illegal drugs when we are prescribing drugs that are killing more and more Americans. I’m regularly called to our intensive care units to evaluate patients who are lucky enough to survive accidental and deliberate overdoses of prescription opioids and benzodiazepines. Sometimes it’s hard not to believe these drugs don’t cause more death and sorrow then they alleviate.


Author: Jim Amos

Dr. James J. Amos is Clinical Professor of Psychiatry in the UI Carver College of Medicine at The University of Iowa in Iowa City, Iowa. Dr. Amos received a B. S. degree in Distributed Studies (Zoology, Chemistry, and Microbiology) in 1985 from Iowa State University and an M.D. from The University of Iowa in Iowa City, Iowa in 1992. He completed his psychiatry residency, including a year as Chief Resident, in 1996 at the Department of Psychiatry at The University of Iowa. He has co-edited a practical book about consultation psychiatry with Dr. Robert G. Robinson entitled Psychosomatic Medicine: An Introduction to Consultation-Liaison Psychiatry. As a clinician educator, among Dr. Amos’s most treasured achievements is the Leonard Tow Humanism in Medicine Award.