Opioids Aren't America's Only Painkiller Problem

TUESDAY, Jan. 30, 2018 (HealthDay News) -- There's a well-known crisis going on with opioid painkiller abuse, but new research reveals a sizeable chunk of Americans are popping far too many over-the-counter pain relievers, too.

Among those surveyed who take over-the-counter ibuprofen (Motrin, Advil), 15 percent admitted to exceeding daily maximum dosage when taking either ibuprofen or other nonsteroidal anti-inflammatory drugs (NSAIDs), the study found.

NSAIDs include popular medications such as aspirin, Advil, Motrin, Aleve (naproxen) and Celebrex, a prescription pain reliever.

The researchers tracked week-long NSAID "diaries" from about 1,300 adults, completed between 2015 and 2016. All had taken an ibuprofen medication at some point in the month before completing their diaries.

Many users said they'd either exceeded the prescribed daily limit of a single NSAID; taken two different NSAIDs together; or had popped a second dose earlier than indicated.

Study author David Kaufman, director of Boston University's Slone Epidemiology Center, noted that ibuprofen and other NSAIDs are among "the most-used medicines in the U.S.

"[But] most NSAID use is over-the-counter," he added, "with users deciding what to take without involvement by health care providers."

Kaufman believes NSAID misuse has the potential for serious side effects, including both gastrointestinal bleeding and/or a raised risk for heart attack.

His team's findings "can help guide programs that will lead to safer NSAID use," he said.

In the study, participants were 45, on average. Three-quarters were white, and about 60 percent were women.

About 87 percent said they took OTC ibuprofen during the week they recorded their usage habits. But about 37 percent also took other types of NSAIDs, with aspirin being the most popular, followed by naproxen.

That said, less than 40 percent actually understood that the NSAID medications they were taking were, in fact, NSAIDs.

What's more, 11 percent of ibuprofen users reported exceeded daily dosage instructions at least once during the week. That figure hit 23 percent among naproxen users.

Overall, 15 percent of participants were found to have exceeded dosing recommendations for at least one NSAID on one or more days throughout the week.

The team further observed that the risk for excessive NSAID use appeared to be higher among those respondents who were in poor physical condition while also struggling with chronic pain. Having a relatively poor knowledge about proper dosing also upped risk.

The findings were published online Jan.26 in the journal Pharmacoepidemiology and Drug Safety.

Kaufman downplayed the notion that users might be popping too many NSAIDs to avoid using addictive opioid painkillers.

"My guess," he said, "is that while avoidance of opioids may influence prescribing decisions by doctors, it may not affect consumer behavior very much."

Instead, Kaufman believes some consumers may simply decide to take an excessive number of pills -- regardless of label instructions. But that behavior is "potentially modifiable with better education of users," he added.

But another expert does think there could be a link between excessive OTC painkiller abuse and the current opioid epidemic.

Dr. David Katz directs the Yale University Prevention Research Center in New Haven, Conn. He said that "the nation's highly publicized opioid crisis is really just a window to a less-publicized crisis of chronic, inadequately managed pain" among an unhealthy portion of the American public.

"When narcotics are not being used to manage such pain, NSAIDs often are," said Katz, who wasn't involved in the study. "That a substantial subset of those relying on NSAIDs are using them ill-advisedly or excessively is rather to be expected under these circumstances."

One solution, according to Katz, is to boost "health literacy," so that patients know the risks of taking any medicine.

But a longer-term solution to all painkiller abuse requires refocusing attention on the benefits of a healthy lifestyle, Katz said, with the goal being "the prevention and management of chronic pain by means other than medication."

More information

There's more on NSAID safety concerns at U.S. Food and Drug Administration.

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