Fatal Drugs, Uneducated Patients

"Abuse?" Or "mistake?" As reported widely today the death rate from perfectly legal medications, both prescription and over the counter, jumped 360 percent between 1983 and 2004. Many of the deaths involved a mix of alcohol and drugs, which has led some of the coverage to refer to drug abusers.

That's wrongheaded. In the first place, the researchers who analyzed all of the nearly 50 million U.S. death certificates filed from 1983 to 2004 excluded deaths caused by street drugs alone, such as heroin, methamphetamine, and crack cocaine. The aim was to find out whether the steadily growing numbers of patients taking multiple medications—many of which originally were available only by prescription but then moved to the other side of the counter—and getting less medical supervision were suffering the consequences of this potentially deadly combination. They were, especially when alcohol was involved; deaths from medications plus alcohol rocketed from 92 in 1983 to 3,792 in 2004, a bounce of nearly 3,200 percent.

But were these type 1 fatal medication errors, as the researchers called them, examples of abuse? All of these deaths occurred at home. It is far more likely that they were accidents—people who did not realize the risk of having a few drinks after swallowing potent drugs.

Not enough attention, moreover, is being paid to type 2 fatal medication errors, defined by the researchers as medication-related deaths that occurred at home with no alcohol involvement. Over the period of the study, the number of these fatalities soared from 1,040 to 8,634. It is hard to imagine that the victims were looking for a high. They may have been taking more than one painkiller for a bad back because no one emphasized to them that it's not a good idea. They may have taken medications that interact in dangerous ways. We don't know.

Talk about medication errors and how to prevent them usually focuses on the clinical setting: the wrong drug or the wrong dose administered in a hospital, for example. But more than 22,000 annual deaths of individuals outside a medical environment should awaken the healthcare community that patient education doesn't stop at the hospital's or the doctor's door.