ROBERT SIEGEL, HOST:
This week, we learned that, before he died, the musician Prince was supposed to meet with a doctor specializing in chronic pain and drug addiction. And while the medical examiner hasn't yet released the results of the autopsy and toxicology scans, it has further fueled speculation that Prince died of an opioid overdose. Rhode Island Public Radio's Kristin Gourlay reports this kind of overdose in middle age is all too common. And she explains why that age group is at high risk.
KRISTIN GOURLAY, BYLINE: Imagine you're in your 50s. You injured your shoulder a while back, and it just hasn't gotten better. You take prescription painkillers - an opioid like OxyContin to help with the pain. Let's say you've been taking it for a couple of years. Your body built up a tolerance, and now you need to change it up. When it comes to the potential for overdose, says Boston Medical Center epidemiologist Traci Green, this is one of the most dangerous crossroads.
TRACI GREEN: We oftentimes see that the dose will increase for an individual over time, or maybe they might rotate or switch to another medication to experience pain relief. And so at each rotation or change, there's a risk because you're moving from one drug to another.
GOURLAY: A risk of accidental overdose because your body might not be used to that high dose or different medication. Let's say you also suffer from anxiety, says Green. Benzodiazepines can help with that, but taking opioids and benzos together is a dangerous combination.
GREEN: There's wonderful medications used for treating anxiety. However, in the presence of an opioid, they can potentiate the other such that one opioid plus one benzo doesn't equal the effect of two in the individual, but it's like one plus one equals four or six.
GOURLAY: Opioids can depress the drive to breathe - so can benzos. Combine them, and the effect mounts. You could stop breathing and never wake up. And lots of people are taking this combination. In fact, people in their mid-40s to mid-60s are more likely than any other group to be prescribed opioids with benzos, according to the National Center for Health Statistics. And it's taking a toll. The Centers for Disease Control and Prevention says that in 2013 and 2014, people ages 45 to 64 accounted for about half of all drug overdose deaths. Green says there's been an increase for people over 55.
GREEN: It is indeed a demographic to keep an eye on.
GOURLAY: Green says there's another risk factor for overdose. People in this older age range also can be isolated - maybe from divorce or kids moving out.
GREEN: If something happens, if no one's there to revive you, then you're more likely to die of that experience.
GOURLAY: University of Rhode Island pharmacy professor Jeff Bratberg says the way people in this age group take drugs is also putting them at high risks.
JEFF BRATBERG: They're taking longer-acting opioids. They're taking doses that, at certain thresholds, are associated with increased overdose death. They have conditions that put them at higher risk of respiratory depression.
GOURLAY: Conditions like chronic obstructive pulmonary disease or even the flu can amplify opioids' ability to depress breathing.
BRATBERG: Some percentage of them are also developing substance-use or opioid-use disorders from those opioids.
GOURLAY: So why are doctors prescribing so much in such combinations? Bratberg says it's how they were trained.
BRATBERG: You know, if you're a primary care prescriber and your patients are doing OK, maybe you're just not thinking about that. Plus I think that there's difficulty in telling the person whose pain may be controlled by opioids and their anxiety is controlled by benzodiazepines to say, well, now we're going to taper you off because this harmful.
GOURLAY: So millions of people are on opioids, most of them over 45. And that means some are at risk of overdose. Bratberg says we should be educating patients and doctors.
BRATBERG: We're really making a push nationally and regionally to educate prescribers about those risks and to use tools available to, you know, warn folks about that.
GOURLAY: Those tools include naloxone, the overdose rescue drug, and medications such as buprenorphine or methadone to assist people who've become addicted. For NPR News, I'm Kristin Gourlay.
SIEGEL: And that story is part of a reporting partnership with local member stations and Kaiser Health News.
NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.