A few extra pills can kill

'Can you give me some extra pain pills, just in case I need them later?"

Jeff is a 38-year-old electrician. I met him in the emergency room after he twisted his ankle playing football. The small fracture I saw on his X-rays would not need surgery, but it would be painful. As I immobilized his ankle with a splint, we discussed his care plan: use crutches, take high-dose ibuprofen for pain, and see an orthopedist in a week.

I also wrote a prescription for 12 tablets of Percocet, which combines the painkillers acetaminophen (Tylenol) and oxycodone, and instructed him to use it only if his pain was severe. "Healing takes two months," I said, "but the pain diminishes a lot in just a few days."

Jeff was skeptical and asked for extra pills.

His question was not unexpected. Patients with painful injuries want to go home with confidence their pain will be controlled, and would rather have too many pills than not enough.

But as a physician, I worry about those extra pills. They make it easy for patients to use more medication than is safe, and leftover pills can get into the wrong hands. This feeds into a national epidemic of addiction and overdose.

This year, more people in the U.S. will die from drug overdoses than from vehicle crashes. Yet the drugs causing most of these deaths don't come from a dealer; They come from prescriptions from your doctors and pharmacies. And for many teenagers and young adults, they often come from a parent's medicine cabinet.

More than 20,000 people die from prescription drug overdoses each year, and painkillers such as oxycodone (Percocet) cause most of them. These drugs are opioids, in the same class as heroin.

Since 1999, the annual tally of painkiller overdose deaths has quadrupled. Pennsylvania has the 14th-highest rate of overdoses. Philadelphia had a 45 percent jump in overdose deaths from the painkiller codeine last year. In Bensalem, 63 people overdosed on prescription opioids in just one month.

Opioids can cause drowsiness and confusion and loss of consciousness at high doses. The effect may be so strong that victims stop breathing, especially when taken with alcohol or sedatives. Most people who overdose that way do not intend to die; they just take a few extra doses, go to bed, and never wake up. For young children, a single dose can be fatal.

Everyone who uses opioids long enough will become dependent on them. When people stop using the pills, cravings and stomach cramps signal the onset of withdrawal. To avoid that feeling, people may seek leftover pills from family or friends - or steal them. As their addiction grows, they may visit multiple doctors to get prescriptions.

Others turn to a cheaper alternative: heroin. Between 2010 and 2012, the rate of heroin overdose deaths tripled in the Northeast. In 2010, Pamela Stouch of Aston died from a heroin overdose two years after becoming addicted to Percocet provided by friends. She was 19.

Only rarely do doctors tell patients how to dispose of leftover pills. The FDA recommends they be crushed or dissolved, then mixed with coffee grounds or cat litter and sealed in a plastic bag before going in the trash. Flushing pills down the toilet is not appropriate for most drugs but opioids are dangerous enough that the FDA allows it for them.

Most drugs can be returned to pharmacies for disposal, but Drug Enforcement Agency rules have restricted their ability to take back controlled substances such as opioids - until now. Starting Thursday, pharmacies and hospitals will be authorized to take back controlled-substance prescriptions through collection bins or mail-back programs. Contact your local pharmacy for details.

In the ER, I described the risks of keeping extra pills. Jeff shook his head. "That isn't going to be a problem." Were there kids at home? Yes, a son, 15, and a daughter, 12, "but they're not involved with stuff like that."

I took a deep breath. The prescription painkillers were offered in case his pain was severe during the first few days, I explained, and beyond that time it was safest to use non-opioid alternatives. "I'm doing you and your family a disservice if I prescribe any more." Jeff wasn't happy, but he seemed to understand.

Nobody ever thinks they could become addicted. Parents don't want to think their kids could, either. The thousands of Americans who overdose on painkillers each year probably thought so, too.