Evidence is mounting that opioid pain medication may have played a role in the death of pop legend Prince. While the medical examiner hasn鈥檛 yet released the results of the autopsy and toxicology tests in this case, opioid overdose in middle age is all .
In 2013 and 2014, according to the The Centers for Disease Control and Prevention, people ages 45 to 64 accounted for 聽of all deaths from drug overdose. Prince died on April 21 at his home and music studio Paisley Park in Minneapolis. He was 57.
Experts say there are a number of scenarios that increase risk of overdose, which is often accidental,聽for people over 55. Imagine you are in that age group and you injured your shoulder a while back. It just hasn鈥檛 gotten better, so you take prescription painkillers 鈥� an opioid like OxyContin 鈥� to help with the pain. Let鈥檚 say you鈥檝e been taking it for a couple of years. Your body has built up a tolerance to the drug, and now, you need to change it up to get the same amount of relief. When it comes to the potential for overdose, said Boston Medical Center epidemiologist , this is one of the most dangerous crossroads.
鈥淲e oftentimes see that the dose will increase with an individual over time or they might rotate or switch to another medication to experience pain relief. And so, at each rotation or change, there鈥檚 a risk [of accidental overdose] because you鈥檙e moving from one drug to another,鈥� she said.
Your body might not be used to that high dose, she said, or that different medication. She continued: Let鈥檚 say you also suffer from anxiety. Benzodiazepines can help with that. But taking opioids and benzodiazepines, or 鈥渂enzos,鈥� together is a .
鈥淭here are wonderful medications used for treating anxiety,鈥澛爏he said, but there鈥檚 a different calculus when they are taken with opioids.
鈥淥ne opioid plus one benzo doesn鈥檛 equal the effect of two in the individual,鈥� Green said. 鈥淚t鈥檚 like one plus one equals four, or six.鈥�
Opioids can depress the body鈥檚 drive to breathe and so can benzodiazepines. Combine them and that effect mounts. You could stop breathing and never wake up. And lots of people are taking these drugs in combination. In fact, people in their mid-40s to mid-60s are more likely than any other group to be prescribed opioids with benzodiazepines, according to the National Center for Health Statistics.
鈥淚t is indeed a demographic to keep an eye on,鈥� Green聽said, partly because of another risk factor. People in this older age range may be likely to live alone or be otherwise isolated 鈥� maybe from divorce or because their kids have moved out.
So, Green said, 鈥淚f something happens, if no one鈥檚 there to revive you, then you鈥檙e more likely to die of that experience.鈥�
University of Rhode Island pharmacy professor said the way people in this age group tend to take drugs is also putting them at higher risk.
鈥淭hey鈥檙e taking longer-acting opioids,鈥� he said. 鈥淭hey鈥檙e taking doses that, at certain thresholds, are associated with increased overdose death.鈥�
Also, Bratberg said, they鈥檙e more likely to have chronic health conditions that put them at higher risk of respiratory depression.
Medical conditions like chronic obstructive pulmonary disease or even the flu can amplify opioids鈥� ability to depress breathing. And some percentage of these drug users, he said, will develop a .
So why are doctors prescribing so much, in such combinations? Bratberg said it鈥檚 how the physicians were trained.
鈥淚f you鈥檙e a primary care prescriber and your patients are doing OK, maybe you鈥檙e just not thinking about that,鈥� he said. 鈥淧lus there鈥檚 difficulty in telling the person whose pain may be controlled by opioids, and their anxiety may be controlled by benzodiazepines, to say, 鈥楴ow we鈥檙e going to taper you off because this is harmful.鈥� 鈥�
So millions of people are on opioids 鈥� most of them over 45 鈥� and that means some are at risk of overdose. Bratberg said we should be educating patients and doctors.
鈥淲e鈥檙e really making a push nationally and regionally to educate prescribers about those risks, and to use tools available to warn folks about that.鈥�
Tools that help lower the risk include , the overdose rescue drug. There鈥檚 also medication, such as or , to assist people who have become addicted to painkillers to stop their use safely. In essence, those drugs keep a low level of opioids in the system to keep someone from going into withdrawal without getting them high.
This story is part of NPR鈥檚 reporting partnership with local member stations and聽.