Taking oxycodone at the same time as certain selective serotonin reuptake inhibitors (SSRIs), a commonly prescribed class of antidepressant, can increase the risk of opioid overdose, according to a study my colleagues and I published.
Doctors prescribe the opioid oxycodone to treat moderate to severe pain after surgeries and injuries or certain conditions like cancer. Opioids are also a common drug of abuse. In the U.S., over 70% of drug overdose deaths in 2019 involved an opioid.
Because many patients with depression also experience chronic pain, opioids are often coprescribed with antidepressants like SSRIs. Prior research has shown that certain SSRIs, namely fluoxetine (Prozac or Sarafem) and paroxetine (Paxil, Pexeva or Brisdelle), can strongly inhibit a liver enzyme crucial to the proper breakdown of drugs in the body, including oxycodone. The resulting increased concentration of oxycodone in the blood may lead to accidental overdose.
To see whether different types of SSRIs might affect a patient’s risk of overdosing on oxycodone, my colleagues and I examined data from three large U.S. health insurance claims databases. We included over 2 million adults who began taking oxycodone while using SSRIs between 2000 and 2020. The average age of the group was around 50, and a little over 72% were women. A little over 30% were taking the SSRIs paroxetine and fluoxetine.
We found that patients taking paroxetine or fluoxetine had a 23% higher risk of overdosing on oxycodone than those using other SSRIs.
About 30% of patients with chronic pain experience adverse drug interactions while taking opioids. Other types of drugs have been shown to increase the risk of overdose and other harmful interactions. These include some muscle relaxants commonly used to treat pain, benzodiazepines commonly used to treat anxiety or poor sleep and some antipsychotics commonly used to treat schizophrenia or bipolar disorder. Similarly, in 2019, the Food and Drug Administration required drugmakers to include new warnings on using gabapentinoids, a class of drugs commonly used to treat epilepsy and pain, concurrently with opioids and other drugs that suppress the central nervous system. This mandate was due to an increased risk of dangerously reduced breathing rates that can result in overdose and death when these drugs are taken together.
The findings from our study offer insight on which of the most commonly used antidepressants could most likely lead to opioid overdose. Further investigation of how other drugs interact with opioids could help doctors and patients better understand which drugs are safe to take at the same time.
Ismaeel Yunusa does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
This article is republished from The Conversation under a Creative Commons license.
Taking certain opioids while on commonly prescribed antidepressants may up overdose risk
AP
A bill that would enhance health care and disability benefits for millions of veterans exposed to toxic burn pits hit a snag in the Senate last week, angering advocates like comedian Jon Stewart who say help from the government is long overdue.
Lawmakers have been hearing increasingly from constituents with respiratory illnesses and cancers that they attribute to serving near burn pits in Iraq and Afghanistan. The military used the pits to dispose of such things as chemicals, cans, tires, plastics and medical and human waste.
Veterans groups say servicemembers who were exposed to the pits have waited long enough for enhanced health benefits, and lawmakers largely agree. The Senate is ultimately expected to send the measure to President Joe Biden's desk. It's just a question of when.
Where the issue stands:
AP
A bill that would enhance health care and disability benefits for millions of veterans exposed to toxic burn pits hit a snag in the Senate last week, angering advocates like comedian Jon Stewart who say help from the government is long overdue.
Lawmakers have been hearing increasingly from constituents with respiratory illnesses and cancers that they attribute to serving near burn pits in Iraq and Afghanistan. The military used the pits to dispose of such things as chemicals, cans, tires, plastics and medical and human waste.
Veterans groups say servicemembers who were exposed to the pits have waited long enough for enhanced health benefits, and lawmakers largely agree. The Senate is ultimately expected to send the measure to President Joe Biden's desk. It's just a question of when.
Taking certain opioids while on commonly prescribed antidepressants may up overdose risk
AP file
First, veterans who served near burn pits will get 10 years of health care coverage through the Department of Veterans Affairs upon their separation from the military rather than five.
Second, the legislation directs the VA to presume that certain respiratory illnesses and cancers were related to burn pit exposure. This takes the burden of proof off the veteran, allowing them to obtain disability payments to compensate for their injury without having to show the illness was a result of their service.
Roughly 70% of disability claims related to burn pit exposure are denied by the VA due to lack of evidence, scientific data and information from the Defense Department.
AP file
First, veterans who served near burn pits will get 10 years of health care coverage through the Department of Veterans Affairs upon their separation from the military rather than five.
Second, the legislation directs the VA to presume that certain respiratory illnesses and cancers were related to burn pit exposure. This takes the burden of proof off the veteran, allowing them to obtain disability payments to compensate for their injury without having to show the illness was a result of their service.
Roughly 70% of disability claims related to burn pit exposure are denied by the VA due to lack of evidence, scientific data and information from the Defense Department.
Taking certain opioids while on commonly prescribed antidepressants may up overdose risk
AP file
Yes. For example, hundreds of thousands of Vietnam War-era veterans and survivors also stand to benefit. The bill adds hypertension, or high blood pressure, as a presumptive disease associated with Agent Orange exposure. The Congressional Budget Office projected that about 600,000 of 1.6 million living Vietnam vets would be eligible for increased compensation, though only about half would have severe enough diagnoses to warrant receiving it.
Also, veterans who served in Thailand, Cambodia, Laos, Guam, American Samoa and Johnston Atoll will be presumed to have been exposed to Agent Orange. That's another 50,000 veterans and survivors of deceased veterans who would get compensation for illnesses presumed to have been caused by their exposure to the herbicide, the CBO projected.
AP file
Yes. For example, hundreds of thousands of Vietnam War-era veterans and survivors also stand to benefit. The bill adds hypertension, or high blood pressure, as a presumptive disease associated with Agent Orange exposure. The Congressional Budget Office projected that about 600,000 of 1.6 million living Vietnam vets would be eligible for increased compensation, though only about half would have severe enough diagnoses to warrant receiving it.
Also, veterans who served in Thailand, Cambodia, Laos, Guam, American Samoa and Johnston Atoll will be presumed to have been exposed to Agent Orange. That's another 50,000 veterans and survivors of deceased veterans who would get compensation for illnesses presumed to have been caused by their exposure to the herbicide, the CBO projected.
Taking certain opioids while on commonly prescribed antidepressants may up overdose risk
AP
The bill is projected to increase federal deficits by about $277 billion over 10 years, the CBO said. Lawmakers did not include offsetting spending cuts or tax increases to help pay for the spending.
AP
The bill is projected to increase federal deficits by about $277 billion over 10 years, the CBO said. Lawmakers did not include offsetting spending cuts or tax increases to help pay for the spending.
Taking certain opioids while on commonly prescribed antidepressants may up overdose risk
AP
Both the House and the Senate have approved the bill overwhelmingly. The Senate did so in June, but the the bill contained a revenue-related provision that must originate in the House, requiring a do-over to make a technical fix.
The House approved the fixed bill by a vote of 342-88. So, now the measure is back before the Senate, where the previous iteration had passed by a vote of 84-14. Biden says he will sign it.
AP
Both the House and the Senate have approved the bill overwhelmingly. The Senate did so in June, but the the bill contained a revenue-related provision that must originate in the House, requiring a do-over to make a technical fix.
The House approved the fixed bill by a vote of 342-88. So, now the measure is back before the Senate, where the previous iteration had passed by a vote of 84-14. Biden says he will sign it.
Taking certain opioids while on commonly prescribed antidepressants may up overdose risk
AP file
When the CBO scored the bill, it projected that nearly $400 billion slated to be spent on health services would move from discretionary spending to mandatory spending, which is mostly sheltered from the bruising battles that occur each year over where to spend money in appropriations bills.
The Committee for a Responsible Federal Budget, a nonpartisan fiscal watchdog, said a reclassification of nearly $400 billion from discretionary to mandatory would "both reduce the pressure to keep those costs under control and make it easier for appropriators to spend more elsewhere in the budget without offsets."
Those dynamics also applied to the bill when the Senate approved it in June. Nevertheless, senators voted for the measure overwhelmingly.
But, last week more than two dozen Republicans who voted for the bill in June voted against advancing it this time. They sided with Republican Sen. Pat Toomey (pictured) of Pennsylvania, who is seeking a vote on an amendment that he says would not reduce spending on veterans but would prevent spending increases in other nondefense programs down the road.
Senate Majority Leader Chuck Schumer has offered to let the Senate vote on the Toomey amendment with 60 votes needed for passage, the same number that is needed to advance the bill itself.
It's unclear how the delay will be resolved, though Senate GOP leader Mitch McConnell predicted Monday that the bill will pass this week.
Advocacy groups for veterans, a key voting bloc in the upcoming midterm elections, are furious and ramping up the political pressure on lawmakers to act. At a Capitol Hill news conference the day after last week's procedural vote, speakers used terms such as "villains" and "reprehensible" to describe the Republican senators who voted against advancing the measure last week but voted for almost the exact same bill in June.
"Veterans are angry and confused at the sudden change from those they thought had their backs," said Cory Titus of the group Military Officers Association of America.
"You just screwed veterans yesterday," added Tom Porter of the group Iraq and Afghanistan Veterans of America. "Now, we're going to hold them accountable."
AP file
When the CBO scored the bill, it projected that nearly $400 billion slated to be spent on health services would move from discretionary spending to mandatory spending, which is mostly sheltered from the bruising battles that occur each year over where to spend money in appropriations bills.
The Committee for a Responsible Federal Budget, a nonpartisan fiscal watchdog, said a reclassification of nearly $400 billion from discretionary to mandatory would "both reduce the pressure to keep those costs under control and make it easier for appropriators to spend more elsewhere in the budget without offsets."
Those dynamics also applied to the bill when the Senate approved it in June. Nevertheless, senators voted for the measure overwhelmingly.
But, last week more than two dozen Republicans who voted for the bill in June voted against advancing it this time. They sided with Republican Sen. Pat Toomey (pictured) of Pennsylvania, who is seeking a vote on an amendment that he says would not reduce spending on veterans but would prevent spending increases in other nondefense programs down the road.
Senate Majority Leader Chuck Schumer has offered to let the Senate vote on the Toomey amendment with 60 votes needed for passage, the same number that is needed to advance the bill itself.
It's unclear how the delay will be resolved, though Senate GOP leader Mitch McConnell predicted Monday that the bill will pass this week.
Advocacy groups for veterans, a key voting bloc in the upcoming midterm elections, are furious and ramping up the political pressure on lawmakers to act. At a Capitol Hill news conference the day after last week's procedural vote, speakers used terms such as "villains" and "reprehensible" to describe the Republican senators who voted against advancing the measure last week but voted for almost the exact same bill in June.
"Veterans are angry and confused at the sudden change from those they thought had their backs," said Cory Titus of the group Military Officers Association of America.
"You just screwed veterans yesterday," added Tom Porter of the group Iraq and Afghanistan Veterans of America. "Now, we're going to hold them accountable."
Certain SSRIs can inhibit the breakdown of opioids in the body. Glasshouse Images/The Image Bank via Getty Images