All of these drugs can be fatal when misused, either by consuming too much or by consuming them in lethal mixtures. Each substance poses a different level of immediate and long-term risk based on its chemical composition as well as how it tends to be used.
For instance, alcohol and tobacco are tied to far more deaths than any other drug. Alcohol is linked to approximately 88,000 deaths per year, and smoking is linked to as many as 540,000 deaths. There were 64,000 drug overdose deaths recorded in 2016. However, with use rates considerably higher for alcohol and tobacco than for opioids, a per-user death rate would reveal a different comparison.
Every drug, even those that are frequently made and sold illicitly, are useful in certain cases. Cocaine has several medical uses to this day. MDMA, commonly known as ecstasy, is being considered for its therapeutic properties in psychiatric patients. And with alcohol and tobacco, it is overuse that leads to adverse effects and deaths (although any level of tobacco use is considered overuse). With illicit and legal opioid products, it is misuse that leads to danger to the individuals and society.
Many of the problems with misuse in illicitly produced drugs exist with legally prescribed drugs. Schnoll noted that even in the instance of a prescription drug overdose, the victim often is not the same person who was prescribed the drug. “[O]ne way or another, the drug is leaking outside of the normal system,” he said.
While the problems of controlled and illicit substances stem from very different sources, the individuals most vulnerable to either set of substances share the same stigmatization. The already high risk of adverse drug outcomes among individuals with substance use disorders is amplified in a climate where drug users are criminalized and where addiction is considered a personal failing.
To illustrate the problem, Schnoll gave the example of payment mechanisms for treatment programs for patients with diabetes and patients with a substance use disorder. In the former case, when patients do not take their insulin or start eating foods they should not eat, the insurance company pays for an intensified treatment program. By contrast, patients failing regimens in drug addiction treatment programs are cut off immediately.
One of the factors making many of these drugs the most dangerous is not conscious misuse, but a lack of information for doctors and patients alike. Some potentially deadly combinations are only now being discovered, and not all physicians are fully aware of the potential consequences. Also, doctors have little control over the over-the-counter drugs their patients take, and patients may not have all the information about the risks of combining a prescribed medication and an over-the-counter drug like Aspirin or Tylenol.
While the drug-death problem cannot be traced simply to the practice of improperly prescribing medication, nearly half of all opioid overdose deaths involve a prescription opioid. The Drug Enforcement Administration (DEA) reported in November a record during its semi-annual National Prescription Drug Take Back Day. The agency received 912,305 pounds of potentially dangerous, expired, unused prescription drugs, up significantly from the previous year’s event, bringing the total since 2010 to well over 9 million pounds.
Nationwide in 2016, more than 4 billion pharmaceutical products were filled by retail pharmacies, including new and refill prescriptions, according to the non-profit health policy organization Kaiser Family Foundation.
To identify the 25 most dangerous drugs, 24/7 Wall St. reviewed a variety of data and sources, including injury and death statistics for illicit and controlled substances from the Substance Abuse and Mental Health Services Administration (SAHMSA), deadly combinations of pharmaceutical drugs and other substances from MedScape and other sources, and deadly combinations of illicit and prescribed substances from DrugAbuse.com. These combinations are selected due to their prevalence in society and the severity of their adverse effects. Items on this list are in no particular order. Many of the drugs on this list are safe for the vast majority of users.
The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) serves as the most authoritative text on the classification of mental and substance use-related diseases. In the latest volume, the set of symptoms named substance abuse and substance dependence are now called substance use disorders.
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