Researchers Find Chronic Drug Users in Idaho Prescribed a Dangerous Mix that Could Lead to Overdose

Fourteen years ago, Sarah Hill got hooked on opioids —

hydrocode, Norco, Vicodin — anything that would numb the physical pain and postpartum depression she suffered after the birth of her daughter.

“Basically I was super mom when I was on them, but my kids suffered through my addiction,” said the Boise mother of five. “It got to the point where it took all of my energy, all of my money and all of my time.”

Attempts at sobriety were unsuccessful. Hill started scoring the pain killers—once prescribed by her doctor—on the streets of Boise, then she started using meth. She lost her kids, her health and got into trouble with the law.

“My liver was shutting down. I thought I would die. I am a Christian and I reached out to God for help,” she said. That was back in 2014 and Hill has been sober since, thanks to Chrysalis, a faith-based recovering program for women coming out of incarceration and addiction, and personal vigilance.

Hill is one of the lucky ones. In January 2019, the National Institute on Drug Abuse reported that more than 130 people die every day in the United States after overdosing on opioids.

Opioid addiction and the risk of overdose can happen to anyone, says Cathy Oliphant, a professor in Idaho State University’s Department of Pharmacy Practice in Meridian.

Oliphant and James Berain, a doctoral pharmacy candidate at the time, found that in 2017, a quarter of chronic opioid users in Idaho were at risk for an overdose due to a risky combination of pain killers and central nervous system depressants prescribed by doctors. Those depressants include a frequently prescribed medication called benzodiazepine or BZD, used to treat anxiety, sleep disorders and alcohol withdrawal.

A chronic opioid user is defined as someone who has used an opioid for more than 90 days, say the researchers. In 2016, the Centers for Disease Control and Prevention issued new guidelines, highlighting the risks of prescribing opioids and central nervous system depressants together. The danger of the cocktail is respiratory depression—where a person’s breathing lowers to such a level that coma or death can result. The CDC estimates more than a third of overdoses nationally involve a co-ingestion of an opioid and a BZD.

Berain, who completed his Doctor of Pharmacy degree this spring, led the research as a class project; Oliphant, who has been involved in opioid research since 2009, served as his faculty adviser. They spent close to two years, reviewing prescriptions for controlled substances written by Idaho doctors and reported to the Prescription Drug Monitoring Program. Prescribers are required to report their dispensing records to the PDMP. They can also access the PDMP before writing prescription, but are not required to do so.

After examining prescriptions written for thousands of patients in 2017, the two found that 56 percent of the risky combinations were written by single providers, meaning the same doctor who wrote a prescription for the opioid wrote the prescription for the depressant.

“It’s hard to postulate why. We weren’t able to determine if the prescriber did a risk benefit analysis, saying ‘yes, I know the risks, but this is the best way to treat the patient now,’” said Berain.

Their next task is to review prescriptions before and after the CDC recommendations to see if patterns in Idaho have changed.

Oliphant and Berain say education on numerous fronts can ease the risk of accidental overdose. They recommend policy makers and community leaders discuss funding drugs like naloxone that can reverse the effects of an opioid overdose. They urge patients to share their medication history with their prescribing physician and talk to their pharmacist when filling prescriptions.

 “Patients need to be informed on multiple levels. When you go in to see a provider and they write you an opioid prescription or one for a BZD or depressant, ask ‘is that the best choice for me? Are there non-opioid or non-BZD options?’” said Oliphant.

As for Sarah Hill, she is rebuilding her life now—reconnecting with family and working in community outreach for Chrysalis, the recovery program that aided in her sobriety.

She says solving the opioid crisis is complicated, but education is key. She’s eager to share her story of addiction and recovery with those who seek her help.