Perhaps as many as one in every 5 adults will get a prescription for a painkiller every year, and many more will buy over-the-counter medicines without a prescription. These drugs can do wonders—getting rid of pain can seem like a miracle—but sometimes there’s a high price to be paid.
Remember the heavily marketed COX-2 inhibitors? Rofecoxib, sold as Vioxx, and valdecoxib, sold as Bextra, were taken off the market in 2004 and 2005, respectively, after studies linked them to an increased risk of heart attack and stroke.
The nonsteroidal anti-inflammatory drugs (NSAIDs), like aspirin, ibuprofen (sold as Advil and Motrin), and naproxen (sold as Aleve) seem like safe bets. But taken over long periods, they have potentially dangerous gastrointestinal side effects, including ulcers and bleeding. Kidney and liver damage are possible, too. More recently, some of the NSAIDs have been linked to an increased risk of cardiovascular disease. Low doses of aspirin (usually defined as 81 mg) is an exception and is often prescribed to lower the risk of heart and stroke.
Even acetaminophen, which is often viewed as the safest pain drug and a low-risk alternative to the NSAIDs because it doesn’t have their gastrointestinal side effects, comes with a caution about high doses possibly causing liver failure.
Then there are powerful opioid painkillers, which include codeine, morphine, methadone, and other drugs that are much better known by their brand names. These include Oxycontin, a sustained-release form of oxycodone; Percocet, a combination of oxycodone and acetaminophen (acetaminophen is the active ingredient in Tylenol); and Vicodin, a combination of hydrocodone and acetaminophen.
The number of prescriptions being written for the opioid drugs has skyrocketed in the last 10 years or so, partly because doctors are encouraged to treat chronic pain these days and partly because the problems with the non-opioid painkillers have become more evident.
Of course, the opioid painkillers are not without their problems. People misuse them to get high. The risk of addiction is real. And even when used as prescribed for pain, larger and larger doses may be needed to achieve the same effect. Deaths from overdoses of opioids have been increasing at an alarming rate.
And recently, an opioid called propoxyphene (sold as Darvocet and, when combined with acetaminophen, as Darvon) was taken off the market after the FDA advised doctors to stop prescribing the drug because it can cause fatal heart arrhythmias.