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MONDAY, July 28 (HealthDay News) — Researchers have discovered a soaring increase in the number of fatal medication errors that occur in people's homes.
The report incidentally follows the death earlier this year of Heath Ledger, the 28-year-old actor who died from an accidental overdose of prescription drugs in his apartment in New York City.
"[There was] large-scale evidence that the death rate from prescription errors was going up very fast, but I didn't know until this paper that they were going up extremely fast in particular circumstances, namely at home and when alcohol and/or street drugs are involved," said study author David P. Phillips, a professor of sociology at the University of California at San Diego.
"I also didn't know from this paper that the number of years of potential life lost from potential medication errors are greater than the number of years of potential life lost from all accidents combined, including falls and drowning," he said.
According to background information in the paper, published in the July 28 issue of the Archives of Internal Medicine, there has recently been a dramatic shift in fatal overdoses away from inpatient settings to outpatient settings. More and more medications are taken outside of the hospital or clinic, with far less oversight from health-care professionals, the researchers said.
At the same time, more medications that once were available only by prescription are now bought over-the-counter, and more people are taking more than one medication.
All of this makes it easier for individuals to combine medications with alcohol and/or street drugs. But despite this shift, few if any studies have looked at drug errors outside clinical settings.
Almost 50 million death certificates were filed in the United States between Jan. 1, 1983, and Dec. 31, 2004, 224,355 of them involving fatal medication errors (FMEs). After examining all of these documents, the authors discovered that the overall death rate from fatal medical errors increased by 360.5 percent during that time period.
The surge in FMEs differed by type. FMEs occurring at home and combined with alcohol and/or street drugs increased the most, by 3,196 percent. FMEs not happening at home and not involving alcohol and/or street drugs showed the smallest increase, at 5 percent.
Meanwhile, at-home FMEs not involving alcohol and/or street drugs increased by 564 percent, while at-home FMEs involving alcohol or street drugs increased by 555 percent.
Overall, the increase in FMEs was particularly pronounced among people aged 40 to 59, where the increase was 890.8 percent.
Dr. Andrew Kolodny, chairman of psychiatry at Maimonides Medical Center in New York City, believes most of the deaths can be attributed to misuse of prescription opioid pain medications and that, in turn, is probably due to wider prescribing by doctors of such drugs.
"Prescribing practices have changed to the point where physicians are much more liberal, largely through marketing," Kolodny said. "We've trained a whole generation of physicians to believe that if you prescribe opioids to patients who have legitimate pain that there's little or no risk of addiction or misuse. I think we have to provide physicians and the public with better education about the true risks of some of these medications."
For his part, Phillips agreed that the focus of concern has shifted to the outpatient arena.
"People should no longer just focus on medication errors in clinical settings and caused by clinical staff," Phillips said. "There's a whole new world out there that needs to be investigated, that is to say, fatal medication errors occurring at home and not in clinical settings, and apparently influenced by patients and not by staff."
Another expert agreed.
"Most of the information we have about medication errors and their effect take place within the hospital setting," noted Lisa Killam-Worrall, director of drug information and assistant professor of pharmacy practice at Texas A&M Health Science Center Irma Lerma Rangel College of Pharmacy.
But she said there's a real challenge in finding out exactly what substances people might be taking along with their prescription medications.
"As pharmacists, we always try to counsel people when medications could interact with alcohol or other medications, but there aren't that many studies looking at interactions with street drugs," Killam-Worrall said. "We normally don't ask people, 'Are you using street drugs and which ones are you using?' We normally try to ask people, "What other medications are you taking, prescription, over-the-counter, herbal supplements?' But usually with illicit drug use, you're not going to garner a lot of information."
The findings also have policy implications in terms of patient care , Phillips added.
"Asking patients to be part of the quality-control team is not something you can just automatically do," he said. "It's true that keeping shorter times in hospitals saves money, but it apparently loses lives, and a way to try to ameliorate that would be to spend more time in educating the patient about the risks of taking these powerful medicines and the risks, particularly, of taking these powerful medicines in conjunction with alcohol and/or street drugs."
SOURCES: David P. Phillips, Ph.D., professor, sociology, University of California at San Diego, La Jolla; Lisa Killam-Worrall, Pharm.D., BCPS, director, drug information and assistant professor, pharmacy practice, Texas A&M Health Science Center, Irma Lerma Rangel College of Pharmacy, Kingsville, Tex; Andrew Kolodny, M.D., chairman, psychiatry, Maimonides Medical Center, NewYork City; July 28, 2008, Archives of Internal Medicine
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