Health

‘Death Tables’: ‘Notoriously Inaccurate’ Medical Reference Tool Could Be Killing Thousands

A widely used medical reference tool for administering drugs, is so inaccurate, two prominent doctors call it “the death table” because of the more than 15,000 estimated deaths from overdoses they associate with it each year.

Dr. Perry Fine of the University of Utah and Dr. Lynn Webster of Lifetree Clinical Research in Salt Lake City co-authored a review of medical literature and forensic reports published in the journal Pain Medicine that evaluates “equianalgesic conversion tables” — a tool that helps physicians calculate dosage when a patient switches from one pain medication to another.

Doctors Say Equianalgesic Conversion Tables for Opioid Medication Are Resulting in Overdose Deaths

Equianalgesic conversion table example. (Image: Global RPH)

According to Desert News, the two men are well-known and respected in the field, as Fine was the past president of the American Academy of Pain Medicine and Webster is president-elect.

Desert News reports Webster as saying the tables are “notoriously inaccurate”:

“We’ve been taught that these equal analgesic tables are reasonably safe, as a guide,” Webster said. “And they’re not.”

[...]

“And that‘s why we’re basically on a campaign nationally to make sure that every physician who prescribes an opioid understands they can’t use these conversion tables,” he said.

The equianalgesic conversion tables are used when a patient needs to switch opioid pain medications for reasons that can include side effects, tolerance and insurance matters. Doctors use these tables to prescribe another drug at the proper dose to try and achieve a similar effect as the previous medication.

Opioids are used for moderate to severe pain. According to the Food and Drug Administration, 33 million Americans age 12 and older misused extended-release and long-acting opioids in 2007. The FDA estimates that opioids were responsible for nearly 50,000 emergency room visits in 2006.

When you hear the word opioid, which includes methadone, morphine, and oxycodone, you may be thinking these death rates are attributable to those who are addicts or long-term users. Webster said this isn’t the case:

“It could be somebody who‘s been on pain medication after a hip operation or a knee operation for several weeks and it’s not working any more,” Webster said. When a physician uses the conversion tables to estimate the proper dose, “It could be very far off from what’s safe.”

To help combat this problem, Webster suggests a gradual phase in of the new drug and reducing the recommended dose.

“Our primary objective is to increase understanding of the major risk factors associated with opioid-related deaths and exploring methods that mitigate the adverse effects involved in treating patients with analgesics that are potentially lethal,” Webster said in a statement.

Comments (38)

  • ContinentalArmy
    Posted on April 5, 2012 at 12:55am

    I see all sorts of Pain Pill user’s around in my area, they can become quite violent from these Meds. Doctors Prescribe these damn pills for the money. I know first hand about one Dr. who will at the mention of back, leg and feet pain will give a Pain Prescription without any type of Physical! $60.00 for Office visit, $40.00 at the Pharmacy and walla: Good to go, their doped up again! These dope heads can sell these pain pills and make more than I can working 40 hrs. a week! Pathetic!

    Report Post »  
  • birdlady
    Posted on April 4, 2012 at 1:28pm

    Went to a Rheumatologist Monday. He put me on Sulindac 200MG twice a day and Prilosec to help with stomach aches from taking it. I took it one day. Tore me up inside.
    Nurse called my hemoglobin count is low. Looked up Prilosec and it interferes with iron absorption.
    I am not going down this road.
    Tuesday I went out and dug up dandelion roots. I boil them and drink dandelion root tea. I have been drinking it 3 times a day.
    I am moving better already and NO side effects. It helps with inflamation from arthritis and it is very high in iron. I am sticking with my dandelion tea. It doesn’t cost anything either.

    Report Post »  
  • loveliberty83
    Posted on April 4, 2012 at 12:27pm

    as a nurse I prevented many serious problems with medication, If I did not lnow a drug I looked it up ,others would make fun of me but any drug is dangerous tyleno destroys the kidneys Motrin the liver, Doctors order all sorts of drugs & do not know a lot about side effects, some antigas pains can cause EPS symtoms the same as antipyscotic drugs -twitching drooling etc- please look up all medication you are given esp ones your elderly family menbers are on some drugs can kill them

    Report Post »  
    • Quitlyingtome
      Posted on April 4, 2012 at 8:52pm

      Try looking up Tylenol then. It is one of th most toxic substances known for the LIVER., not the kidneys. Sheesh.

      Report Post »  
  • MrKnowItAll
    Posted on April 4, 2012 at 11:08am

    Let’s talk about the Drug Dealer Dr.’s who get you on them and then call you a Drug Addict because you want off of them and they will not tell you how to get off Pain Meds. I’ll tell you…..COLD TURKEY and Medimusul four times a day. Brand new in Three Days. Don’t take any in the first place. Doctors make money by Prescribing you ADDICTIVE Medications.

    Report Post » MrKnowItAll  
    • Ruler4You
      Posted on April 4, 2012 at 12:32pm

      I’m not sure I buy this argument, with all due respect. I’ve had HUGE pain problems which cause huge sleep problems. The two things doctors have THE worst time prescribing for. I tried for over 15 years to convince my doctor I was in serious pain and lack of sleep was causing me problems with concentration at work and on the road.

      But, since he KNEW better, I got scrod. Two years ago, while trying to keep from being evicted after losing my job, I went to a regionally recognized OTR driving school. When I went to get my medical card, the doctor rushed in and told me to go directly to the ER. I had serious blood and protein in my urine.

      Well, the urologist told me I was about three days from dying due to a kidney stone that had become impacted and my body was attacking it. Surgery was scheduled, pronto. I’m still here, but that was a stroke of luck. That’s #7 for me. Two more.

      The medical system “IS” broken and politicians are complicit as are insurance companies. We don’t need a new system. We need TORT reform of the existing system. We need that to expose the corruption and abuse, not a new system so we can hide it (corruption) and perpetuate it ad infinitum by making it part of the foundation of a new corrupt system.

      Politicians, insurance and medicine have all worked to screw up the system we have. We should dissect that system and prevent it from happening again by learning from it.

      Report Post » Ruler4You  
  • G-WHIZ
    Posted on April 4, 2012 at 10:56am

    Sounds like annother progressive-hidden-agenda item inserted to help get rid of “undesireables”…of which there are many….thousands of these “items” and ….it looks sooooo random, to.

    Report Post »  
  • silentme63
    Posted on April 4, 2012 at 8:20am

    1000 mg of methadone what?

    Report Post »  
  • LouC57
    Posted on April 4, 2012 at 7:29am

    After 19 years in the medical business…IMO please, seek alternatives like physical therapy, acupuncture, acupressure, even heat or ice (ice isn’t just a good pain reliever, use it for nausea–ice pack placed where your ribs come together, 5 minutes and it’s gone). Avoid doctors/hospitals as much as possible.

    “qzak491
    Posted on April 4, 2012 at 2:01am

    .
    ScienceIsNotEvil

    In Israel they care about the people, here they care about the government control of the people.”
    That doesn’t surprise me one bit.

    Report Post »  
    • Libertyluvnmomma
      Posted on April 4, 2012 at 9:35am

      That last statement about Israel isn’t exactly accurate. Let’s not use generalities.
      Israel like ALL countries is run by the ever fallible man.

      Report Post » Libertyluvnmomma  
    • pavnvet
      Posted on April 4, 2012 at 10:36am

      I was recently hospitalized and it is scary how meds are dispensed. During my stay, I had three different roommates. Fortunately, all of us are of sound enough mind to let them know that the medications were either improper dosage, or not administered at all, although ordered by a doctor. My stay lasted 5 days. On day one, I told them that the blood pressure medication I was on, was only once a day. Everyday, including the last they attempted to give me an additional dose.

      The oldest of my roommates was 83, they had him on Celebrix 2x daily and Vicadin ES 4x a day. At one point a nurse said to him let me see if I can get the doctor to make you more comfortable. He asked how and she said I will see if i can get you some hydromorphone to administer by IV. She left the room and I told him what it was and when she came back (with the hydromorphone) he refused it. It seems all the hospital wanted to do was keep you in a narcotic stupor so they wouldn’t have to deal with you. Make sure you know what your medications are (both by generic and brand name as well as the dosage and times you take the medication. If you are taking an unusual medication, it may not be in the hospital’s formulary (what drugs they have in their pharmacy). Bring if at all possible your medications with you and find out if they have it. If they don’t, hand over your drugs and they will dispense them. I have one life sustaining drug, that had I not brought with me, I probably would be dead.

      Report Post » pavnvet  
    • ScienceIsNotEvil
      Posted on April 5, 2012 at 12:35am

      Libertyluvnmomma,

      What part is wrong? Don’t say I am lying then refuse to backup your statement.

      Report Post »  
  • 1956
    Posted on April 4, 2012 at 6:58am

    This is how my father died. Given too much morphine.

    Report Post » 1956  
  • qzak491
    Posted on April 4, 2012 at 2:01am

    .
    ScienceIsNotEvil

    In Israel they care about the people, here they care about the government control of the people.

    Report Post »  
  • Kerstile
    Posted on April 4, 2012 at 1:43am

    My gosh, the conversion table is a GUIDE. Any clinician that relies on it for his entire decision is a fool. There are dozens of other factors to evaluate when switching a patient. Wholesale substitution should be a last resort due to a life threatening reaction such as severe allergic reaction or idiosyncratic respiratory depression. As a pharmacist, I utilized a table like this dozens of times when advising physicians. GO LOW. GO SLOW. FOLLOW THE PATIENT CLOSELY. Better to have the patient suffer an hour of mild withdrawal or a bit of pain than having them CTB (cease to breath) and subsequently “carried by six”. These tables are NOT the problem. Idiot pharmacists (yes, my colleagues) and doctors are the problem. The practice of Medicine is not a cook book. No one recipe matches ALL the patients. This is first year medical/pharmacy school knowledge, aka everypatientisunique 101.

    Report Post » Kerstile  
    • Joel Knows
      Posted on April 4, 2012 at 10:01am

      I wish you were my neighborhood pharmacist! I also wish there was a list some place of MD’s that actually consulted the pharmacist before prescribing something. Pharmacists are the second line of defense for the medical consumer, a check and balance to MDs, to make sure prescriptions are correct. I’ve used 3 different pharmacies that are in my area, and at times asked at each one about intereactions when prescribed something new. Each time they just told me the MD wouldn’t have prescribed it if there was a problem, never looking up anything about what I am taking or why. Do pharmacists have access to the MIB (Medical Information Bureau) as the insurance companies do?

      My point is, Kerstile, you seem to be an exception and not the rule out there, or at least that is my experience and opinion!

      Report Post » Joel Knows  
    • fb274
      Posted on April 4, 2012 at 11:58am

      A lot of reading about alternatives to Rx and no fear to try them keeps one free of a doctor’s office or hospital. Medical research has found theraputic lemon oil will kill E-coli; Lavender is a natural anti-histamine, etc,, etc. Rx treats a symptom, but does it cure?

      Report Post »  
  • GusMcRae
    Posted on April 4, 2012 at 12:34am

    Don NOT think Texas doesn’t have problems. We do.

    Report Post »  
  • welovetheUSA
    Posted on April 3, 2012 at 11:12pm

    Its taken this long before they notice………….my lord why do bad things take so long to end? Hopefully Obama the other bad thing will end in 11 months.

    Report Post » welovetheUSA  
  • HorseCrazy
    Posted on April 3, 2012 at 11:02pm

    Yes thank you for calling that chart out Dr’s! Standardized medicine isn’t a fix all sheet to replace actual hands on assessment of patients and their bodies and history. Each individual body is different that you treat. almost died myself when they switched me to morphine. Glad someone is speaking up to the medical community

    Report Post »  
  • whatthecrazy
    Posted on April 3, 2012 at 10:53pm

    D@mn the bad luck.I do enjoy my pain meds when i have to visit the hospital but what a way to go.

    Report Post »  
    • TXPilot
      Posted on April 3, 2012 at 10:59pm

      Good news everyone!! Obama and his cronies are making sure that the drug companies will not be producing much in the way of pain medications in the near future, so there’s no reason to worry about your doctor overdosing you, when he soon won’t be able to get his hands on anything stronger than Tylenol.

      Report Post » TXPilot  
    • HorseCrazy
      Posted on April 3, 2012 at 11:04pm

      tx they will put everyone on methadone which is far more deadly than any of the opiods. my father is a research md now that he is retired and showed me the graphs where state welfare medicine and high medicare are on county maps is where they put the old and poor on methadone. it is far more fatal than the opiods and much cheaper. it is truly sad and disturbing.

      Report Post »  
    • TXPilot
      Posted on April 3, 2012 at 11:27pm

      @HORSECRAZY……Yes, I’m sure that anything the government can do, to be cheap and shorten your life, is something they will be quite eager to do……and btw, I’m guessing from your handle, you are a horse person……me too…. I have a buckskin Quarter gelding…16hands…..and if gas gets much more expensive, he is going to become my “plan B” commuting alternative…lol…

      Report Post » TXPilot  
    • HorseCrazy
      Posted on April 4, 2012 at 10:37am

      tx pilot me too on the commuting. I am a kiger mustang, ottb, aqha owner (and 2 snotty old retired arabs). I have a barn full but they are paying their way right now by giving lessons for some 4h’ers and working our cows but I am not sure how long that will last. I grow my own hay so it hasn’t been too bad except for the machinery but own a large land management co and spend a great deal of time driving, I wish I could ride on my appointments! this gas price is killing me! looks like you are still flying I can’t afford to anymore and my husband is not happy about being grounded!

      Report Post »  
  • Itsjusttim
    Posted on April 3, 2012 at 10:51pm

    The sun is slowly fading in the western sky
    Sometimes it takes forever for the day to end
    Sometimes it takes a life-time
    [ Sometimes I think I'll never see the sun again]

    It really is too bad you missed him.

    Report Post » Itsjusttim  
    • Itsjusttim
      Posted on April 3, 2012 at 11:10pm

      There’s a heavy smog between me and [ my mountains]
      It’s enough to make a grown man sit and cry
      It’s enough to make you want to learn
      It’s enough to make the world roll-up and die

      You people just don’t really know much of anything.

      Report Post » Itsjusttim  
    • whatthecrazy
      Posted on April 3, 2012 at 11:54pm

      @tim duuude i think you may be overdosing nightly before you log in to the blaze.Come back tomorrow with a clear mind and show us what you got.Seriously when i read your post i feel like im on drugs and i don’t mean the good kind.

      Report Post »  
  • Itsjusttim
    Posted on April 3, 2012 at 10:44pm

    Well it’s just time to stop being a doped up society. Besides if people really want to live forever, then you better get to fine-tuning your soul.

    Report Post » Itsjusttim  
    • HorseCrazy
      Posted on April 3, 2012 at 10:55pm

      you are an idiot using generalizations like that. we should over regulate something that allows me to work and function along with 1000′s of other disabled folks because some dumb kids and adults want to overdose by abusing drugs? nope.

      Report Post »  
  • KangarooJack
    Posted on April 3, 2012 at 10:40pm

    In this overmedicated world {not 3rd world countries} what else do you expect? Geeze, Michael Jackson would still be chasing little kids around if we had a conscience.

    Report Post » KangarooJack  
  • Darmok and Jalad at Tanagra
    Posted on April 3, 2012 at 10:34pm

    What are they worried about, the only painkillers that will be handed out under Obamacare will be, Rat Poision and Drain Cleaner.

    Report Post » Darmok and Jalad at Tanagra  
    • 1casawizard
      Posted on April 3, 2012 at 10:41pm

      @D&JatT. Oh, My.

      Report Post » 1casawizard  
    • Captain Crunch
      Posted on April 3, 2012 at 10:45pm

      Happy Hour….a shot of liquid Draino with a Decon chaser…complements of Obamacare.

      Report Post »  
    • ScienceIsNotEvil
      Posted on April 3, 2012 at 11:04pm

      Why doesn’t Israel have any problems with their medical system?

      Health care in Israel is universal and participation in a medical insurance plan is compulsory. Health care coverage is administered by a small number of organizations, with funding from the government. All Israeli citizens are entitled to the same Uniform Benefits Package, regardless of which organization they are a member of, and treatment under this package is funded for all citizens regardless of their financial means. Generally, health care in Israel is of high-quality and is delivered in an efficient and effective manner. Partly as a result of this, at an overall 82 years, Israelis enjoy the fourth-longest life expectancy in the world as of 2010.

      Report Post »  
    • Darmok and Jalad at Tanagra
      Posted on April 3, 2012 at 11:14pm

      @ScienceIsNotEvil
      That arguement is tired. We have a country of 300+ million, Isreal is what, 6 Million? People look at Denmark and say the same thing, but there again, a small population. The problem isn’t making everyone get healthcare, get rid of the state by state mandates, and let all insurance companies compete across state lines, get rid of tort laws and healthcare prices come down. Why is Texas having no problems and doctors are going to that state in droves? Hawaii just tried to do Keiki care, all kids would be covered, guess what parents did, drop insurance for their kids, enrolling “Free” healthcare by the state. It went bankrupt in 6 months. When you can show me a country that has socialized medicine with a population over 150 million, then I will listen. Otherwise all you are talking about is small experiments that work, but have never been tried on a large, aging society.

      And by the way, Canada is about 40 Million people and their healthcare sucks, but if you like waiting 3 months for a doctors appointment, I guess its great, or if you are young and healthy, great care.

      Who want’s pie?

      Report Post » Darmok and Jalad at Tanagra  

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