As published on Practical Pain Management’s website…
To prevent fatal drug-drug interactions, a clinician who suspects illicit drug use should rule out their presence before prescribing pain medications, as well as other commonly known CYP450 inhibitors or inducers.
Fatal drug interactions between opioids and benzodiazepines, alcohol, and other sedative-hypnotic drugs have been well publicized and studied. Less publicized, however, are serious and potentially fatal drug interaction between pain medications and illicit drugs, including the ever-growing number of novel street drugs. In fact, the specific pharmacologic interactions between prescription medications commonly prescribed for pain and habitually abused illicit drugs have not been studied extensively.
When a person dies from a drug overdose, medical examiners frequently look at results from a standard detectable prescription drug(s) panel and a standard illicit substance of abuse panel. This latter panel includes commonly abused chemicals that are predetermined by specific manufacturers’ test kits. Closer scrutiny, however, could help clarify a patient’s opioid tolerance level by reviewing prescription drug history—a simple task that, in the authors’ experience, generally is not considered. But… (click HERE for the complete story or contact Dr. Fudin, firstname.lastname@example.org, for PDF version).
As always, comments are welcome!