--- title: Painkillers: Nation in Pain Report Shows Americans Taking Deadly Doses description: More Americans are taking potentially deadly doses canonical: https://time.com/3624308/painkillers-dangerous/ author: Alexandra Sifferlin article:opinion: false article:content_tier: free article:published_time: 2014-12-09T14:48:18.000Z article:modified_time: 2026-02-22T02:40:16.248Z article:section: Health og:title: Here's How Big America's Painkiller Problem Is og:description: More Americans are taking potentially deadly doses og:url: https://time.com/3624308/painkillers-dangerous/ og:site_name: TIME og:image: https://static.time.com/v3/assets/bltea6093859af6183b/blt95e08f373b0e5011/6986a609cd6848ca98096b73/painkiller-pills.jpg?branch=production&width=1200&quality=75&auto=webp&crop=16:9 og:image:width: 5057 og:image:height: 2845 og:image:alt: painkiller pills og:type: article twitter:card: summary_large_image twitter:title: Here's How Big America's Painkiller Problem Is twitter:description: More Americans are taking potentially deadly doses twitter:image: https://static.time.com/v3/assets/bltea6093859af6183b/blt95e08f373b0e5011/6986a609cd6848ca98096b73/painkiller-pills.jpg?branch=production&width=1200&quality=75&auto=webp&crop=16:9 ---  # Here's How Big America's Painkiller Problem Is by [Alexandra Sifferlin](https://time.com/author/alexandra-sifferlin/) ## Alexandra Sifferlin Dec 9, 2014 2:48 PM UTC  Studio shot of various pills in bottle Studio shot of various pills in bottleGetty Images by [Alexandra Sifferlin](https://time.com/author/alexandra-sifferlin/) ## Alexandra Sifferlin Dec 9, 2014 2:48 PM UTC The rate of Americans using pain medications like codeine, morphine, oxycodone and hydrocodone long term has remained stable in the last five years, but the amount of medication they take has increased, according to [a new report](http://lab.express-scripts.com/publications/a-nation-in-pain). The report, called [_A Nation in Pain_](http://lab.express-scripts.com/publications/a-nation-in-pain), comes from pharmacy benefit manager Express Scripts and shows that almost half of chronic painkiller users are taking short-acting combinations that increase the risk for addiction, and often these cocktails are very dangerous. Sixty percent of Americans on pain treatments for longterm conditions were prescribed potentially dangerous mixtures. One in three patients were taking a combination of an opiate and an anti-anxiety benzodiazepine, which is the most common combo in multiple drug overdose deaths. Eight percent were taking what’s called a “Houston Cocktail”: an opioid, muscle relaxant and a benzodiazepine. And nearly 30% were taking multiple painkillers together. Use was most rampant in small Southeastern cities, and two-thirds of patients were prescribed the drugs by two or more physicians. About 40% filled their prescriptions at multiple pharmacies. “There could be instances when prescribing these combinations of drugs is appropriate, but not at this scale,” said Jo-Ellen Abou Nader, the senior director of Fraud, Waste and Abuse at Express Scripts in a statement. 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