IDAHO, USA — Saint Alphonsus Dr. Jessica Kroll has seen patients in the emergency department overdose on prescription medication through intentional abuse and by accident.
"The tricky part about prescription drugs is that they're a prescription. So, sometimes there is a misconception they are safe, because a doctor prescribed them to you," Dr. Kroll said. "They can have a confounding effect where you can get more sleepy on them, which then in turn can lead to these unintentional overdoses, which we do see a fair amount. It's why there are a lot of recommendations and restrictions when prescribing these to patients unless truly indicted."
The Idaho Department of Health and Welfare (IDHW) tracks overdose numbers in the state. Their most complete data is from 2021 where 5,058 Idahoans visited the emergency department for a drug overdose of any kind. Opioid specific overdoses make up 1,076 visits.
"This is something we do all the time. We give Narcan and we can reverse [opioid overdose] patients. If it was a light overdose, sometimes can send them home. Sometimes we have to admit them. Sometimes we have to tell their family members they died," Dr. Kroll said. "I had a patient just last week, normal person with a family with a job, that came in and overdosed on their home prescription medications. I could not get them back despite all of the efforts. Yes, street drugs - fentanyl - is a concern. These prescription drugs are a very big deal as well."
Fentanyl is becoming a top concern among law enforcement agencies in Idaho and across the county. Of the 353 total overdose deaths in Idaho, 43% are related to fentanyl, according to the IDHW. A little more than 25% of these overdose deaths are from "other opioids."
It is unclear what percentage of these "other opioid" deaths are specifically from abused - or misused - prescription drugs. Dr. Kroll confirms, however, it is a reality she sees regularly in her work.
"We're pretty restrictive in giving them out. Really low quantities and only under certain circumstances, and some patients are mad at us for not giving them more pain medications," Dr. Kroll said. "I think it’s also about reshaping our view of pain as a society. If you fall down and get hurt you’re gonna have pain for a couple of days, but taking a narcotic or some of these sedating drugs doesn’t help you get better any faster. It makes you feel high and makes you feel good, but it doesn’t go to the area of inflammation and make it get better any faster."
Some patients overdose simply by not taking their prescribed medication in alignment with the physician’s orders.
Other states, including Nevada, restrict a physician’s ability to prescribe an opioid unless the patient has broken a bone or is dying from cancer, according to Kroll. The Idaho State Board of Pharmacy does not have these restrictions in place for the Gem State.
If the physician has concerns - or the patient and their family raise a concern - an opioid prescription can also come with Narcan, according to Dr. Kroll.
Narcan is an opioid reversal agent used to treat a patient who has overdosed.
"It is life-saving," Dr. Kroll said.
Dr. Kroll recommends people who are family members of - or in close contact with - an opioid user have Narcan available in case of emergency.
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