Doctors kill thousands due to ‘death tables,’ Utah expert says in new study

Reference tool responsible in death toll from prescription painkillers

A pill box with various medications in it.

SALT LAKE CITY — A standard reference tool used by the medical profession is so inaccurate that doctors across the country are accidentally killing patients by the thousands each year, according to an expert in Utah who co-authored a disturbing new study.

The study found that the faulty reference tool is responsible for a significant portion of the growing death toll from prescription painkillers.

“I think it could be thousands, nationally, for sure,” said Dr. Lynn Webster of Lifetree Clinical Research in Salt Lake City. He believes dozens of Utahns die each year for the same reason.

At issue are so-called “equianalgesic conversion tables.” Physicians use the tables to calculate the proper dose when a patient is switching from one “opioid” painkiller to another. The tables display equivalent doses of various drugs.

“They’re notoriously inaccurate,” Webster said. “In fact, I call them ‘the death table.'”

Webster and Dr. Perry G. Fine of the University of Utah co-authored the new study, which is a review of medical literature and forensic reports from around the country. It’s published in the April edition of Pain Medicine, the official journal of the American Academy of Pain Medicine.

The study may cause a stir because of the prominence of the two researchers. Fine is immediate past-president of AAPM and Webster is the organization’s president-elect.

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

Patients who need pain medication frequently switch from one drug to another. Doctors often prescribe a change because of side-effects such as nausea. Patients also switch drugs because they develop a tolerance for a given painkiller or because insurance companies won’t continue covering an expensive drug.

The prescribing physician typically figures out the proper equivalent dose by consulting the published conversion tables.

They’re often flat wrong, according to Webster.

“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.

Nationally, an estimated 15,000 people die each year from overdoses of opioid pain medicine. That includes such familiar painkillers as Oxycontin, oxycodone, Percocet, morphine, and methadone.

“A lot of the deaths have been attributed to using these conversion tables and starting patients on too high of a dose,” Webster said.

“Methadone is the riskiest,” he said, but all the opioids can be deadly if the prescribing physician gets the dosage wrong.

He emphasizes that it’s not just drug addicts and long-term patients who are at risk.

“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.”

As a solution to the problem, Webster recommends that a prescribing physician gradually phase in the new drug instead of abruptly switching from one to the other. He said the original dose should be reduced by 10 to 30 percent while the new drug is used at the lowest available dose. Then the original drug should be reduced by 10 to 25 percent each week while the new drug dosage is gradually increased.

Webster says physicians share the blame for the situation with the U.S. Food and Drug Administration and pharmaceutical manufacturers which encourage doctors to use the conversion tables.

“We came up with these estimates about how to determine what would be safe,” Webster said, “but they’re really not scientifically based.”


I can honestly say that I have nearly died twice just in the last year from overdoses that where prescribed to me by a doctor visiting my home.
A simple overdose of medication took me to the hospital as I hadn’t slept for four days solid and had a constant migraine throughout, upon arriving at the hospital they said if I had slept I would have probably died.

On the other occasion a visiting doctor gave me some neurotriptaline, sorry for the spelling.
I again ended up in accident and emergency this time with serotonine syndrome a deadly near death experience was had that day.

There must be tens of thousands of people dying each year from pharmaceuticals.

Namaste, Stu.


  1. Ok, I am not “liking” the content, just liking that you shared it. I had horrible troubles with narcotics about a dozen years ago. I think pharmacists are much better equipped to answer questions about medication than doctors. I always double check any RX with my pharmacist. My doctor doesn’t seem to know much, but I don’t think that’s unusual. I also frequently get blood work done to make sure nothing is harming my organs. All the meds for pain are pretty rough on the body. In May I am going to a homeopathic doctor to see if I can find more natural remedies. I don’t like taking all these pills. Good post, very informative. I know how hard it is to deal with pain. I empathize!

    • Stuart Otway-Smith · April 4, 2012

      Empathy is the capacity to recognize and, to some extent, share feelings (such as sadness or happiness) that are being experienced by another sentient or semi-sentient being. Someone may need to have a certain amount of empathy before they are able to feel compassion.

      For this I bow to you graciously and appreciate your interactions.

      I hope your virtual house move (blog) is working out for you and that you have a fantastic day of pain free joy.
      I pass a healing light to you today in the hope that you can use the energy of loving kindness to ease your pain.

      Nearly dying twice from prescribed overdoses and becoming sicker and iller from using them is not my idea of fun, a prisoner in my own body I become due to the tablets withering away my soul.

      My doctor is about as useful as a chocolate fireguard and the only way for me to get proper treatment is to pay for it myself, the UK sucks with Fibromyalgia treatment and I would love to just start a proper healing centre charity or something, so that people could come and get the treatment they need.

      Just a dream I suppose as I have no idea how to even begin!

      Thanks of your comments and support =)

  2. halfwaybetweenthegutter · April 4, 2012

    Very much agree that the UK is lacking when it comes to fibromyalgia treatment; we just don’t seem to have a clue in this country. The standard method seems to be to hand out some amitriptyline and a prescription for opiates, and the doctors hope you’ll go away.

    I’ve suffered from painkiller and tranq addictions for many years. It stuns me how happy most doctors are to just hand out these medications without any thought to the future and possible addiction. Although my GP is fully aware that I have severe mental health problems and a history of addiction in the family, he has never once questioned me on my painkiller use. It was up to me to say that I wanted to never be prescribed codeine again, and although I said I was having a problem with addiction, no help was offered.

    On the subject of nearly dying from medications, I was given a tramadol overdose by staff in A&E. In A&E! My heart stopped, and I had to be given adrenaline to restart it. There’s nowhere near enough communication between staff handing out medications, and it’s a dangerous situation.

    • Stuart Otway-Smith · April 4, 2012

      Maybe it is time people like us try and do something about it!

      Thank you for sharing and caring.

  3. halfwaybetweenthegutter · April 4, 2012

    I think people do need to change things, I’m just not sure how it could ever be done. Medicines are almost seem in a blasé way, like they’re not highly dangerous things. I picked up a supply of late antidepressants today, and the phamacist in Boots didn’t even check my ID, even though I didn’t have any sort of prescription with me. I could have been anyone.

    • Stuart Otway-Smith · April 4, 2012

      Pharmaceuticals companies unfortunately make billions in profits, governments hence make millions from taxes, legalised drug dealers in my opinion, time for the governments to stop sticking plasters on amputated wounds and seek to cure instead of continuously only treating the symptoms, by way of prescription.

      Thanks again for your contributions.

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