Dr. Zorba Paster: Be on lookout for possible drug interactions

In case you missed it, and I doubt you have, we’re in the middle of an opioid epidemic.

It’s not just illegal narcotics like heroin, but also the abuse of oxycodone, hydrocodone and fentanyl. Add to that the overuse of so-called “benzos” – benzodiazepine tranquilizers meant to treat anxiety, such as Xanax and Valium – and we clearly have a mess on our hands. The Centers for Disease Control and Prevention estimates that 91 Americans die every day from an opioid overdose.

If you think young people are the only ones affected, you are terribly wrong. Middle-age and older adults are at risk of overdose from some combination of the drugs they are on. It’s not just the street drug overdose that’s at fault, but the prescription drug overdose, too.

Recent research indicates that taking just a few drinks with an opioid may put you at a risk you never thought of, especially if you’re over 65. Researchers publishing in Anesthesiology, the Journal of the American Society of Anesthesiologists, took on a project to see just how dangerous it is to mix booze and narcotic pain killers.

Two dozen healthy volunteers were recruited. Half were young, and half were older than 65. Some had been on opioids before, while others were opioid naive, meaning they had never taken a pain killer like that before. All were hooked up to monitors, had IVs placed and were carefully monitored by doctors who knew what they were doing, ready to step in with advanced CPR should the occasion arise.

On three separate occasions, all were given 20 milligrams of oxycodone, a common dose for people with significant chronic pain such as back pain, neck pain and even fibromyalgia. The oxycodone was followed by an IV infusion – a placebo the first time, and then increasing amounts of alcohol the next two times, equivalent to one to four drinks. The reason they used IV alcohol was to control exactly how much booze each participant was getting.

The most significant result of mixing alcohol with opioids was shown to be reduced ventilation. Reduced breathing can lead you to black out or, even worse, to drop the oxygen level in your body, precipitating a stroke or a heart attack.

We know that all narcotics reduce your desire to breathe. If you’re on the borderline of good health, that minimal reduction could be catastrophic. These researchers discovered that when alcohol was added to the mix – and that means spirits, wine or beer, to be absolutely clear – respirations were reduced by another 20 percent. Shockingly, some of the seniors in the study had periods of time when they stopped breathing entirely.

It turns out that the benzo tranquilizers I mentioned above have this same additive effect. And the challenge is that many patients are on both of these drugs, prescription opioids and anxiety medications, because pain and anxiety go hand in hand.

My spin: If you’re on opioids, you need to be aware of drug interactions that can be a danger to your health. Good sources of information are your pharmacist, your doctor, your physician’s assistant and your nurse practitioner.

If you find yourself taking a combination that might be a problem, talk to your prescriber to set up a program to get off the drugs that might harm you. For seniors, this is an especially important thing, as they don’t have the resilience of a younger body. Stay well.