Friday, March 07, 2008

Unintended consequences and accidental death from polypharmacy

Patients are empowered, but lack knowledge.

Health care providers have knowledge, but are stressed, disintegrated, and "disintermediated". Primary care, in particular, is near death (or dead).

The pharmaceutical industry is in a lesser known crisis. Chinese generics drive ferocious price competition, the discovery pipeline is dry, patents are expiring, and the last cash cow, the US, is running out of money. So the advertisement is getting desperate.

The GOP has stripped regulatory agencies of mission and funding.

Add it all up, and you have a storm of unintended consequences brewing. Larry Zaroff tells the story very well (emphases mine)...

Heath Ledger death |By Larry Zaroff, M.D., Ph.D. | Salon Life

...According to the Centers for Disease Control and Prevention, motor-vehicle crashes rank first among unintentional deaths in America. But poisoning is second, most commonly from the abuse of prescription and illegal drugs. Unintentional deaths from accidental drug ingestion rose significantly from 1999 to 2004. This trend is primarily due to increasing use of prescription opioid analgesics, and not heroin, methamphetamines or other illegal drugs...

...After leaving the drugstore, the patient realizes the wise doctor has given her only 30 pills, not enough, since one pill no longer gives her what she requires: deep, worry-free sleep or relief of pain or anxiety. If she has all three problems, she will need more pills or other kinds. She goes to another doctor and gets a second supply. She is set for the moment. But her work requires travel, sometimes out of the country. She can locate other doctors in other places who will prescribe. Now she has a fine stash both in her medicine cabinet and in her suitcase.

She is young, smart, well regarded by her associates. She is the opposite of careless. But she has no understanding of physiology, how the body works, what controls vital functions -- breathing, heartbeat, circulation -- and how drugs can affect these functions. How drugs work, their rate of absorption, their peak level of activity, is of no interest to her. She only wants relief of her insomnia, her pain, her worries. She has no idea that drugs have an optimum dose, that combinations of drugs might be like taking too much of a single drug, that often dissimilar medicines can affect the same organs and stop their activities. Unknown to her, she may even have a genetic abnormality that makes her more susceptible to the synergistic effects of the drugs.

The patient is not an addict and suicide is the last thing she would consider. But she has a tough day ahead of her. She needs her sleep. She decides to take two sleeping pills since one did not work well enough the previous night. Because she strained her back yesterday and feared the pain might keep her awake, she takes a narcotic, a single dose. She feels edgy despite the sleeping pills and the narcotic, and so she takes a tranquilizer. The witches' brew works. She dozes off but awakes in two hours, her mind jumbled. She must sleep. She slips into the bathroom and repeats the doses. She lies down, sleeps soon, too deeply. An hour later she stops breathing. She is alone, no one to aid her...

I don't agree with Dr. Zaroff's recommended solutions (read the article). I think we need to go back to the list I started this post with, and work each one independently. I think we also need a national education program. The modern patient is going to "play doctor" anyway, so they might as well start in on medical skill. "Drugs Kill" might be a good ad slogan, though it might be confused with anti-cocaine ads.

1 comment:

Unknown said...

Gordon, I agree that we have a huge problem with prescription drugs. As the director of Novus Medical Detox, I daily see the ravages caused by prescription drug addiction created by doctors prescribing it to their patients and then the patients either continuing to obtain it or purchasing these drugs on the internet or the street. Probably the worst of these drugs is OxyContin--legal heroin.

Pain is real. I have had to deal with it much of my life first from polio and then from two surgeries. However, there are alternatives to painkillers and they must be tried first. Let's not treat the symptoms but the cause.

Prescription drug addiction is an epidemic and we must do everything we can to stop it before it overwhelms us. Education is a must. Detox and rehab are the only solutions for people who are addicted and have decided that they must change their lives.

Steve Hayes