Steep Rise In At Home Deaths As Patients Fail To Manage Their Medications

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Article Date: 29 Jul 2008 - 3:00 PDT

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The sad loss of 28-year old movie actor Heath Ledger in January this year, who died from an accidental overdose of a prescription drug, brought to public attention the potential dangers of patients managing their own medications, which when combined with alcohol and street drugs, has resulted in a more than 3,000 per cent rise in home deaths due to medication errors, said US researchers in a new study.

The study is published online in the 28th July issue of the Archives of Internal Medicine and was the work of sociology and biology researchers at the University of California, San Diego.

The motive for the study was that despite the increasing trend for medications to be consumed outside of clinical settings without professional supervision, there have been few studies on medication errors outside of clinical settings.

Principal author David P Phillips, professor of sociology at UC San Diego, and colleagues said:

"Increasingly, people take their medications at home, away from hospitals and clinics. But most studies of fatal medication errors have focused on those clinical settings. We wanted to know three things: how many of these fatal errors happen at home; how many involve alcohol and/or street drugs; and are these numbers going up?"

For the study, the researchers examined all US death certificates from 1st January 1983 to 31st December 2004 (over 49.5 million), and particularly those citing fatal medication errors (FMEs, nearly 225 thousand).

They classified the deaths into 4 types of FME: domestic or non-domestic, with and without alcohol/street drugs and examined them with respect to the relative importance of alcohol or street drugs and the relative likelihood of professional supervision in the use of the medications.

The four FME types were:

Type 1 = domestic FMEs combined with alcohol and/or street drugs,
Type 2 = domestic FMEs not involving alcohol and/or street drugs,
Type 3 = nondomestic FMEs combined with alcohol and/or street drugs, and
Type 4 = nondomestic FMEs not involving alcohol and/or street drugs.

The results showed that:

• Overall FME death rate went up by 360.5 per cent during the 1983 to 2004 period.


• This is an order of magnitude higher than the 33.2 per cent for deaths from adverse medication effects, and 40.9 per cent for deaths from alcohol and/or street drugs.


• The increases in FME varied markedly by type, with Type 1 showing the largest, Type 4 the smallest, and Types 2 and 3 somewhere in between.


• FME Type 1 showed the largest increase: 3,196 per cent.


• FME Type 4 showed the smallest increase: 5 per cent.


• FME Type 2 increased by 564 per cent.


• FME Type 3 increased by 555 per cent.

The researchers concluded that "domestic FMEs combined with alcohol and/or street drugs have become an increasingly important health problem compared with other FMEs", adding that:

"These findings suggest that a shift in the location of medication consumption from clinical to domestic settings is linked to a steep increase in FMEs."

They suggested deaths due to fatal medication errors could be brought down by focussing interventions not only on clinical but also on domestic settings.

"It also seems advisable to expand research on medication errors. Much of this research has focused on elderly patients and clinical settings. The present findings suggest that more research should be devoted to middle-aged patients and domestic settings," they added.

"A Steep Increase in Domestic Fatal Medication Errors With Use of Alcohol and/or Street Drugs."
David P. Phillips; Gwendolyn E. C. Barker; Megan M. Eguchi
Arch Intern Med. 2008;168(14):1561-1566.
Vol. 168 No. 14, July 28, 2008

Click here for Abstract.

Source: University of California San Diego, journal abstract.

Written by: Catharine Paddock, PhD
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