Interactions between Pain Medications and Illicit Street Drugs

zodiazepines, alcohol, and other sedative-hypnotic drugs have been well publicized and studied. Less publicized, however, are serious and potentially fatal drug interaction between pain medications and illicit drugs, including the ever-growing number of novel street drugs. In fact, the specific pharmacologic interactions between prescription medications commonly prescribed for pain and habitually abused illicit drugs have not been studied extensively. When a person dies from a drug overdose, medical examiners frequently look at results from a standard detectable prescription drug(s) panel and a standard illicit substance of abuse panel. This latter panel includes commonly abused chemicals that are predetermined by specific manufacturers’ test kits. Closer scrutiny, however, could help clarify a patient’s opioid tolerance level by reviewing prescription drug history—a simple task that, in the authors’ experience, generally is not considered. But, additive or synergistic effects from untested synthetic compounds, such as cathinones (bath-salts) or JWH-type cannabinoids, increasingly are the unsung culprits causing or contributing to death.1 Medical examiners, unfortunately, don’t routinely test for these; if they do, commercially available assays have not reliably kept up with frequent chemical alterations by savvy street chemists that make it more difficult to determine causation.2,3 In the end, cardiorespiratory collapse and other findings often are attributed to opioids without considering other factors, FEATURE