She drove home and tapped three white tablets out of the sample bottle. Her shrink had specified that this drugÃ¢â‚¬”quetiapine, sometimes prescribed for anxiety disordersÃ¢â‚¬”would act as a sedative, calming her down. Like many women, Rachel had some experience with anti-anxiety meds. She knew that three at once might be more than usual, but she'd taken two or three pills in one day before and been just fine. Plus, right now she was desperate.
The pills dulled her panic, but nowhere near enough. Later that afternoon, she took two more. And finally, peace. Rachel lay on her couch, completely relaxed, her mind mercifully silent after weeks of racing. Until, that is, her arms started spasming.
A tendril of fear wormed its way through Rachel's drug-induced fog. Then the tremors hit her legs. Limbs flopping in all directions, Rachel knew she was in trouble. Oh shit, oh shit, she thought. I must have taken way too many.
She sat up and tried to stand, clinging to the arm of the sofa, fighting to stay conscious. One of the side effects of quetiapine, she would later learn, is low blood pressure (other side effects include slowed breathing and seizures). Her brain wasn't getting enough blood, leaving her on the verge of completely passing out.
Drowning in Meds
"I'm seeing accidental overdoses like this more and more frequently, especially in young women," says ER physician Jane Prosser, M.D., of Weill Cornell Medical Center in New York City. Sometimes, she says, her patients are suicidal and deliberately take excess pills; other times, they go overboard trying to get high. But perhaps the most alarming spike in prescription drug overdoses is in women like RachelÃ¢â‚¬”those with no history of suicide attempts or drug addiction. Those who OD by accident.
The numbers are staggering. A recent report from the CDC found a 415 percent spike in prescription drug overdoses among women since 1999. (The increase for men: 265 percent.) In 2010 alone, more than 940,000 women landed in the ER after taking too many prescription drugs.
Technically, a prescription drug overdose happens any time a person takes too great a dose of a medication, which, in extreme circumstances, can force the body's major systems and organs to slow or shut down. Overdoses can range from super subtle (an extra sleeping pill leads to a too-long, too-deep sleep, but you wake up unaware that you'd taken too much) to super serious (an excessive amount of painkillers causes the heart to stop altogether). Today, a pharmaceutical drug overdose happens roughly every 20 seconds, thanks, in part, to the vast availability of Rx meds.
In 2011, pharmacies dispensed a record-breaking 4.02 billion prescriptionsÃ¢â‚¬”that's nearly 13 for every American. Painkillers made up a huge portion of these scripts; the opioid hydrocodone, for example, was dispensed more than 129 million times in 2011 alone, according to Pharmacy Times. (Mental health meds aren't a slouching business either: In 2011, the quetiapine that Rachel took earned its maker $4.6 billion.)
It's true that such meds, when prescribed and used correctly, can be lifesaving. Problem is, many doctors are so pressed for time that they gloss over instructions. Patients can leave confused about dosages, directions, side effects, or the serious nature of the drugs they're about to take.
Unfortunately, the Web is awash with ready adviceÃ¢â‚¬”some reputable, some dangerous. Anyone who is concerned about going overboard can be reassured by Dr. Google; online, it's easy to find "no big deal" tales about taking a few extra pills.
That lax attitude stems from a much larger cultural shift. Long-term use of prescription painkillers, for example, used to be reserved for patients with severe conditions like cancer, says Leonard Paulozzi, M.D., M.P.H., a medical epidemiologist at the CDC. But since the 1990s, those and other drugsÃ¢â‚¬”for everything from joint pain to chronic stressÃ¢â‚¬”have become commonplace.
"Prescription medications have lost their stigma," says Paulozzi. "We now live in a pill-popping country." But while Rx meds might be more socially acceptable, they haven't become any less precarious. Crossing the fine line between an effective dose and a potentially toxic one remains all too easy.
Rachel realized too late that she had crossed that line. As she staggered into the ER with critically low blood pressure, nurses rushed to hook her up to heart monitors and IVs. They pumped her with saline solution to try to flush out the quetiapine coursing through her bloodstream. Rachel lay on a hospital bed, her arms and legs still twitching.
Faintly aware of the tangle of wires around her and the beep beep beep of the heart monitor, she drifted in and out. Eventually, her spasms subsided, replaced by an overwhelming exhaustion. A psychiatric nurse appeared to ask Rachel whether she had OD'd on purpose. "Definitely not," said Rachel. "I was absolutely not trying to kill myself. I just wanted to calm my panic." It was just a few pills, she kept thinking. Just a few pills.
What Rachel did not know is that she was particularly at risk for an accidental prescription drug overdose. First and foremost because she is, well, a woman.
Females are much more likely to visit a doctor and receive a prescription. (In 2010, 74 percent of women saw a physician versus 57 percent of men, per the Agency for Healthcare Research and Quality.)
Women are also much more apt to be diagnosed with conditions such as chronic pain, insomnia, anxiety, depression, and fibromyalgiaÃ¢â‚¬”meaning that even medically savvy gals might end up with multiple prescriptions that, in the midst of busy day-to-days, are hard to keep straight (see "4 Drug Combinations That Can Be Accidentally Lethal").
And because women's bodies tend to be smaller than men's bodies, ingredients in many meds hit them harder, pound for pound, raising their chances of overdose even higher if they, say, misread a label and take one pill too many.
What's more, due to little-understood brain chemistry, women become dependent on addictive prescription drugs much faster than men do, making them more likely to take more pills, even before they realize they might be hooked (see "Accidental Addictions").
But even if they're not addicted, women are far more likely than men to "doctor shop," or visit multiple M.D.'s for multiple prescriptions of the same or a similar drug, says Silvia Martens, Ph.D., an associate professor of epidemiology at Columbia University. The practice of keeping extra meds around "just in case"Ã¢â‚¬”if back pain suddenly flares up again, or panic attacks reappear without warning, or insomnia returns and there's no time to see a docÃ¢â‚¬”is made relatively easy by prescription-happy physicians.
Sometimes, women don't even need to shop around, says pharmacy professor Michael Zemaitis, Ph.D., of the University of Pittsburgh. Patients are often prescribed far more pills than are actually needed, he says. "After a procedure you might need only four or five pain pills, but a doctor might prescribe a larger amount." A medicine cabinet full of pills only increases the odds that women might swallow a scary combination or take too much of any one drug.
What ultimately saved Rachel was that she stayed aware enough to know she'd overdosed. Many other women aren't so lucky, says psychiatrist Andrew Kolodny, M.D., president of Physicians for Responsible Opioid Prescribing. Too many prescription drugs at once can suppress the body's urge to breathe, as well as bring on a semiconscious stateÃ¢â‚¬”allowing some people to pass out and never wake up. (Mixing Rx pills with alcohol can intensify this effect.)
Stemming the tide of accidental overdoses will require a two-part effort, says Prosser. "Doctors need to clarify instructions and the maximum number of pills that can be taken in one day," she says. And women should make sure they're clear on dosages and timingÃ¢â‚¬”and ask questions if they're not. If you're still confused when you get home, don't go online, says Prosser. Call your doctor and mention any other meds you're taking.
Doctors and patients should also consider nondrug therapies. "There's nothing wrong with needing a prescription medication, even a strong one, to manage your chronic condition," says pain doctor Mark Boswell, M.D., Ph.D., of the University of Louisville. "But make it one of your last options, not your first. And understand the risks, which can be severe." (At press time, the FDA had begun to implement a plan to reduce the volume of painkiller prescriptions doctors can write.)
As Rachel came to find, treatments such as psychotherapy, meditation, exercise, and dietary changes carry fewer risks than some prescription drugs and, in many cases, may work just as well. She now swims regularly to help manage her anxiety. And while she hasn't touched quetiapine since her accidental overdose, she does still take some prescription mental health medicationÃ¢â‚¬”after she triple-checks her doses.
OD Warning Signs
Not all overdoses look or feel the same. But if you recognize any of these symptoms in yourself or a friend, seek immediate medical help, says ER physician Jane Prosser, M.D.
1. Slowed or labored breathing
2. Slowed heart rate
3. Difficulty waking up
4. Loss of consciousness
5. Unusually small pupils
6. Bluish lips or nails
7. Cold and clammy skin
Sometimes, popping a few extra pills becomes a different sort of problem. Prescription drug dependenceÃ¢â‚¬”especially on painkillersÃ¢â‚¬”can sneak up so quickly that you don't realize you're in danger of getting hooked, says psychiatrist Andrew Kolodny, M.D. Watch out for these early warning signs.
You find yourself taking a higher dose of your meds to get the original intended effect.
You're not due for another pill until dinner, but you just can't wait; you down one with your afternoon snack.
Your prescription should last for another two weeks, but when you check the bottle, you're nearly out of meds.
You start thinking about taking your pills for nonprescribed reasons (e.g., you might swallow a painkiller before your big presentation, just to calm your nerves).