In-Home Fatal Medication Errors Rising RapidlyJul 29, 2008 | Parker Waichman LLP
The Chicago Associated Press (AP) is reporting that deaths linked to in-home medication mistakes—such as what we saw with actor Heath Ledger's—have risen markedly in the past 20 years, based on a review of U.S. death certificates. Study authors say the increased availability and “home use of prescription painkillers and other potent drugs” is to blame and many of these potent medications were typically administered in hospitals 25 years ago. "The amount of medical supervision is going down and the amount of responsibility put on the patient's shoulders is going up," said lead author David P. Phillips of the University of California, San Diego.
The findings were based on a study of about 50 million U.S. death certificates and can be found in yesterday’s Archives of Internal Medicine. Of those certificates studied, over 224,000 involved fatal medication errors that included overdoses and mixing prescription drugs with alcohol or street drugs. Deaths from in-home medication mistakes “increased from 1,132 deaths in 1983 to 12,426 in 2004.” Figures were “adjusted for population growth” for “an increase of” over “700 percent during that time.” The greatest increase was seen from mixing medicine with alcohol or street drugs at home, which rose from 0.04 per 100,000 people in 1983 to 1.29 per 100,000 people in 2004; suicides, homicides, and deaths related to side effects were excluded.
There was a five percent increase in fatal medication errors away from home, including in hospitals and not involving alcohol or street drugs. Prescription drug abuse is involved, but its role is unclear. Experts say, “valid prescriptions taken in error, especially narcotics such as methadone and oxycodone, account for a growing number of deaths.” Also, experts feel multiple prescription drugs taken at once, such as sleeping pills, painkillers, and anxiety drugs are to blame.
"When we see overdoses, we're seeing many more mixed drug overdoses," said Dr. Jeffrey Jentzen, president of the National Association of Medical Examiners and director of autopsies at the University of Michigan in Ann Arbor. According to the AP, Jentzen said autopsies are much more likely to include toxicology tests today than 25 years ago, which would contribute to finding more fatal medication errors as cause of death. Phillips disagreed, saying there were no significant increases in other poisonings “like suicidal overdoses or homicides, so more testing doesn't explain the huge increase.
There is a growing trend among doctors looking at pain management for healing, which many feel may be linked to the growth in home medication fatalities. And, according to Cynthia Kuhn of Duke University Medical Center, who was not involved in the study, often patients ignore the risk of mixing alcohol with prescriptions, "They think, 'Oh, one drink won't hurt.' Then they have three or four," she said.
Prescription sharing is also on the rise. A recent study found 23 percent of people say they have loaned their prescription medicine to someone else; 27 percent say they have borrowed prescription drugs. Michael R. Cohen, president of the Institute for Safe Medication Practices, said in the AP report that “more states should require pharmacists to teach patients about dangerous drugs and insurers should pay pharmacists to do so.”