Evidence is mounting that Prince may have died of a drug overdose. While the medical examiner hasn’t given definitive proof of that, drug overdose in middle age is actually more common than some of us might think. Here's why this group is at high risk.
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 Brown University epidemiologist Traci Green, this is one of the most dangerous crossroads.
“We often times see that the dose will increase with an individual over time or they might rotate or switch to another medication to experience pain relief," says Green. "And so at each rotation or change there’s a risk because you’re moving from one drug to another.”
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.
“There’s wonderful medications used for treating anxiety," says Green. "However, in the presence of an opioid, they can potentiate the other. So we have a combination or synergistic effect 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.”
Opioids can depress the drive the 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 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: “It is indeed a demographic to keep an eye on.”
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.
“If something happens, if no one’s there to revive you then you’re more likely to die of that experience.”
University of Rhode Island Pharmacy professor Jeff Bratberg says the way people in this age group take drugs is also putting them at higher risk.
“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.
Conditions like chronic obstructive pulmonary disease or even the flu can amplify opioids’ ability to depress breathing.
“Some percentage of them are also developing substance use or opioid use disorder from those opioids.”
So why are doctors prescribing so much, in such combinations? Bratberg says it’s how they were trained.
“If you have a physician who’s also in that age group, they were taught the fifth vital sign, and over-marketed to," says Bratberg.
The fifth vital sign is pain –and it’s something hospitals and doctors were expected to pay attention to starting about 20 years ago. Bratberg says opioids began to be heavily marketed.
"And they had patients who were successful," Bratberg says. "So I think it’s really difficult to say, ‘You’ve prescribed these things, and they’ve worked, and the patients seem to not complain about them being out of pain. Now we’re going to take away this effective therapy.’"
So millions of people are on opioids – most of them over 45 – and that means some are at risk of overdose. Bratberg says Rhode Island is ramping up efforts to reduce that risk, including visiting physicians’ offices and beefing up the state’s online prescription drug monitoring database.
“We’re really making a push nationally and regionally to educate prescribers about those risks and to use tools to warn folks about that.”
Those tools include naloxone, the overdose rescue drug. And medication, such as buprenorphine or methadone, to assist people who have become addicted.