By Pat Anson, Editor
We received a lot of reader reaction to our story about Sherri Little, the 53-year old chronic pain sufferer who committed suicide with an overdose of medication in her Los Angeles hotel room last year (see “Sherri’s Story: A Final Plea for Help”).
“Numerous prescription medications in the decedent’s name were found throughout the hotel room including a bottle labeled Lyrica on the rim of the bathtub next to the decedent’s body,” reads the coroner’s report.
Lyrica has a warning label that states the anti-seizure drug “may cause suicidal thoughts or actions.” At least two other medications Sherri was taking – the sleep aid Ambien and the sedative Klonopin -- also have labels warning they may worsen depression or suicidal thinking.
Several readers wondered – as we did – why doctors would prescribe the drugs to Sherri, who had been suicidal for at least two years.
“The off label use of antidepressants and anti-seizure meds for pain control is criminal. People are dying! And it's not because they're addicts! It's because the healthcare professionals have become compliant and have agreed to go against all common decency and sense,” wrote Arianne Grand-Gassaway, a chronic pain patient.
Many doctors are turning to non-opioid drugs like Lyrica to manage pain because they’re considered safer and less addictive. Worldwide sales of Lyrica topped $6 billion for Pfizer in 2014, up 19 percent from the previous year.
“When a suicide occurs it is hard to know with certainty whether medications like Lyrica contributed to the suicide or pain itself was the primary cause,” said Lynn Webster, MD, past President of the American Academy of Pain Medicine and Vice President of scientific affairs at PRA Health Sciences. “I feel the risk of suicide is many times greater for inadequately treated moderate to severe pain than with patients on these medications.”
Webster says the cocktail of drugs Sherri Little was taking for her pain, anxiety and depression was not unusual.
“It is very common to prescribe an anticonvulsant like Lyrica with a sleep aid. Lyrica is viewed as a safer medication than most options. Most people with moderate to severe chronic pain have difficulty sleeping so drugs like Ambien and Lunesta are routine. Klonopin is also very commonly prescribed for an anxiety disorder or muscle spasm. It is also used to facilitate sleep," said Webster.
The Food and Drug Administration added suicide to the warning labels for Lyrica and Klonopin after a review of nearly 200 clinical studies found that patients taking antiepileptic drugs had almost twice the risk of suicidal thought or behavior than patients taking a placebo.
The risk is small – about 1 in every 500 patients – but don't tell that to the families of the four patients in the clinical studies who killed themselves.
After reading Sherri Little’s story, one reader told us Lyrica made her suicidal.
“I went to my doctor in January after being on Lyrica for a month. It seemed to be helping my nerve pain so she upped my dose to 50 milligrams twice a day,” said Allison Lindsay Shorter. “A couple of days later I started having deep thoughts like I was out of control of my emotions. My anxiety was sky high. I argued for no reason with everyone. I had feelings of hurting myself and whoever got in my way.”
Shorter told her boyfriend she wanted to kill herself and hid his cellphone before swallowing a bottle of muscle relaxers. She was rushed to the hospital and survived.
“I felt out of control when I had all those thoughts and actions, I was scared of myself because I could not control anything. It felt like a demon or evil spirit,” said Shorter. “I knew then it was the damn medication.”
In addition to Lyrica, Shorter was taking 18 other medications to treat a long list of conditions, including fibromyalgia, complex regional pain syndrome, and neuropathy. At one time she was also taking Neurontin (gabapentin), another antiepileptic drug often prescribed for pain that comes with a label warning of suicide, depression, panic attacks and dangerous impulses.
Why do doctors prescribe medication with such risky side effects?
“Most doctors are probably aware of the suicide risks but the general belief is that risk of suicide from the medication is very low and the risk of suicide from undertreated pain is much greater,” says Webster, who recently wrote a column on patient suicide (see “A Doctor’s Perspective on Patient Suicide”).
“The potential risks have to be continually weighed against the potential benefits. Lack of treatment carries significant risk too. Suicide is at least three times more likely in the chronic pain population than the general population. The risk appears to increase with the number of medical diagnoses. In my opinion the risk of suicide due to pain, treated or untreated, far exceeds the risk of suicide from these medications, prescribed alone or in combination.”
Webster fears the current backlash against opioids and efforts to further limit opioid prescribing will lead to more pain going untreated.
“This is a serious topic and I am afraid there are going to be many more suicides due to the anti-opioid movement. Very sad,” Webster wrote in an email to Pain News Network.
Ironically, small doses of an opioid may actually reduce the risk of suicide, according to a recent small study in Israel. Researchers at the University of Haifa gave 40 suicidal patients small doses of buprenorphine and found it reduced their suicidal thoughts after just one week.
Just as opioids reduce physical pain, researchers think it can ease mental pain.
“I think they’re onto something. However, buprenorphine acts on a number of different opioid receptors and it’s still unclear which one or ones are playing a role in the anti-suicidal effects,” psychiatrist Joan Striebel told New Scientist. “I hope this work spurs more interest in what specific molecules could be involved in suicidal thought.”