“What we’re doing now—in terms of patient education both in the office and through drug labeling—it isn’t working,” said Charles Argoff, MD, professor of neurology at Albany Medical College and director of the Comprehensive Pain Center at Albany Medical Center, in New York.

Each year, of every 1 million Americans, 35 die from acetaminophen overdose, 64 succumb to ibuprofen overdose and 118 die from naproxen sodium overdose (Adv Pharmacoepidemiol Drug Saf 2013;2:1-5). Besides the risk for death, NSAIDs can cause gastrointestinal bleeding and damage to the esophagus and small intestine, while improper use of acetaminophen is associated with liver damage and liver failure, said Anne Larson, MD, clinical professor of medicine at Northwest Hospital/University of Washington Medicine Liver Clinic, in Seattle, during a recent webinar when she and others presented findings from the AGA’s survey.
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“The chronic pain community, in particular, is of the greatest concern because they reach for medications more often and use many types of prescription and OTC medications,” said Dr. Larson, noting that there are more than 900 NSAID-containing OTC and prescription medications and over 500 acetaminophen-containing OTC and prescription drugs.

Drug–drug interactions, older age, preexisting GI and hepatic illness, and consumption of more than three alcoholic beverages per day are risk factors for overdose and complications, according to Dr. Larson.

To gain a full picture of how patients use NSAIDs and acetaminophen and how gastroenterologists understand patient use of these agents, the AGA, with the support of McNeil Consumer Healthcare, surveyed 251 GIs and 1,015 consumers, including 479 individuals with chronic pain.

The findings indicated that GIs treat an average of 90 patients annually who overdose on acetaminophen- or NSAID-containing medications. Eighty-four percent of GIs said they had treated patients with abdominal pain as a presenting symptom related to improper use of NSAIDs or acetaminophen; 69% had patients present with NSAID- or acetaminophen-related nausea; and 66% said patients had presented with ulcers related to improper use of these agents.

“Ninety percent of the gastroenterologists included in the survey said patients do not often connect their overdose symptoms with the pain medications they take,” Dr. Larson pointed out.

“We’re seeing people both knowingly and unknowingly take too much medication,” Charles Melbern Wilcox, MD, professor of medicine, Division of Gastroenterology and Hepatology at the University of Alabama at Birmingham, emphasized during the webinar.

Indeed, 43% of surveyed patients said they knowingly self-administered more than the recommended dose of acetaminophen or NSAIDs, and the same percentage of patients said labeled directions are “just guidelines.”

Dr. Argoff, who is not involved with the AGA’s campaign, noted that the FDA is trying to curb the incidence of adverse events related to use of these medications through stricter regulations on the prescribing of acetaminophen-containing combination medications. He is hopeful that additional FDA measures consistent with that step might further reduce complications and mortality.

“However, at the moment, the fact is that there are millions of people suffering from pain, and they are doing what they think they need to do to get through the pain,” said Dr. Argoff. “The job of the health care industry is to make safe options available, and right now we could certainly use safer, effective options to meet the needs of our patients.”

Visit GutCheckFacts.org for additional results from the AGA’s “Gut Check: Know Your Medicine” survey and patient education resources