Additional calories burned in
the 14 hours after a 45-minute
bout of vigorous exercise
M.D., a neurologist and pain specialist
at the Palm Beach–based Headache &
Pain Center. But take too many painkillers, or combine them with potent
sedatives—as actor Heath Ledger did
in 2008—and they can be fatal.
Indeed, determining proper dosing,
especially when combining short-and long-acting painkillers, is at the
heart of the problem. It can take many
hours for long-acting narcotics like
methadone and the fentanyl patch to
be broken down by the body. In Mable
Mosley’s case, the doctor prescribed
the second and third, higher-dose
fentanyl patches while other opioid
drugs were still active in her system,
and before the first and second patches had run their full 72-hour course.
“It’s like shooting an ant with an
elephant gun,” claimed Paul Doering, a
University of Florida pharmacy professor who was retained as an expert by
Alvie Mosley’s attorney, Patrick Dekle.
(The hospital declined to comment.)
ILLUS TRATION B Y ALEX EBEN ME YER; EXERCISE SOURCE: AMERICAN COLLEGE OF
SPOR TS MEDICINE; DOSAGE SOURCE: MODIFIED FROM FDA PRESCRIBING INFORMATION
The rise in overprescribing
coincides with a fundamental shift
in how health care practitioners
think about pain. “The pendulum has
swung now to where there’s a push
nationally that patients should be
pain-free,” says Allen Vaida, a phar-
macist and executive vice president
of the Institute for Safe Medication
Practices. “And that’s a good thing,
but it has also led to a situation where
patients go to the hospital for a pro-
cedure, or to the ER or to a doctor’s
office, and they’re put on unnecessar-
ily high doses of pain medications.”
Patients then might go home with
one or more prescriptions for pain-
killers, not fully realizing what they’re
taking. “They seem okay when they
leave,” says Vaida, “but when they get
home, they may take another oral tab-
let and go to bed and not wake up.”
The Food and Drug Administra-
tion’s approval of newer and more
concentrated pain medications
has only compounded the problem.
“We’ve seen a lot of overdoses with
the transdermal fentanyl patch,” says
Vaida. “They’re very potent [80 times
stronger than morphine, according
to the Drug Enforcement Adminis-
tration], and they’re not being pre-
scribed for the correct patients.”
The fentanyl patch has been re-
called multiple times for product de-
fects since its 1996 debut. And in 2005
the FDA gave it a black-box warning
label—the strictest kind—noting the
risk of accidental fatal overdose.
Short-
Acting Drugs
How Much
Do You Need?
MEDICATION TYPICAL STARTING DOSE*
Codeine
15–30 mg every 4 hours
Hydrocodone 5–10 mg every 4–6 hours
Hydromorphone 2–4 mg every 4 hours
Meperidine 50–100 mg every 3–4 hours
Morphine
10–15 mg every 4 hours
Oxycodone 5 mg every 6 hours
Tramadol 25–50 mg every 4–6 hours
Doses may be even lower for the elderly or those
with poor kidney or liver function. Chart compiled by
Errol Green, M. D., R. Ph., associate chief, emergency
medicine, Tufts Medical Center.
Before leaving the ER, hospital,
or doctor’s office, ask questions.
What is the name of the medication?
How much should I take (dosage and
strength)? Is it a long- or short-acting
drug? (Long-acting painkillers—
including the fentanyl patch, methadone, and morphine sulfate—are
typically prescribed for patients who
require around-the-clock pain relief.)
Take the medication only as
prescribed. “What often happens
is that when a pain medicine isn’t
working fast enough, people will
take another pill,” says Vaida. Or they
forget they’ve already taken a pill and
take another, or they put on a second
patch, unaware that the first one is
still stuck somewhere on their body.
Be cautious when first taking a
new medication. Many fatal overdoses happen when people have just
started taking pain medication, when
their bodies aren’t used to it.
Ask your pharmacist about the
risk of drug interactions. Methadone
can be fatal when used with certain
antidepressants, antibiotics, cardiac
medicines, and alcohol. Doctors also
advise getting all of your medications
from the same pharmacy, which can
track possible drug interactions.
Never take someone else’s painkillers. A dose prescribed for one
person can be fatal to another, particularly if that second person is taking
other medications.
Keep a pain/medication diary.
Write down when you take your medicine, how much you take, and what
your pain levels are. This will help
you and your doctor track how well
your medications are working.
In 2010, Alvie Mosley settled his
lawsuit against the doctors who
treated his wife, leaving the case
against the hospital and pharmacists
pending. “Mable didn’t need all that
medication,” Alvie says. “There’s just
no excuse for it.” ;
