Professor David Phillips has recently authored a paper entitled, “A Steep Increase in Domestic Fatal Medication Errors With Use of Alcohol and/or Street Drugs” (co-authored with UCSD undergraduates Gwendolyn E.C. Barker and Megan M. Eguchi)
In the past few decades medications have been increasingly taken in domestic rather than clinical settings. Thus, the patient has been expected to take an increasing role in managing the safety of medication consumption. In this study, Professor Phillips and his students provided the first large-scale evidence showing that many patients cannot handle this responsibility.
Their study, the first to focus on deaths from home medication consumption, found a 3,196 percent increase in fatal domestic medication errors involving alcohol/street drugs. The study examined nearly 50 million U.S. death certificates from 1983 to 2004 and focused on a subset of 200,000 deaths from medication errors. The study appeared in the July 28, 2008 issue of the Archives of Internal Medicine, an official journal of the American Medical Association. They examined trends in four types of fatal medication errors and found that the increase in fatal errors varies remarkably, depending on where the errors occur and what drugs are involved.
Type 1 errors — accidental deaths at home from a combination of medications and alcohol/street drugs. The death rate from this Type increased by 3,196 percent.
Type 2 errors — accidental deaths at home from medications with no involvement of alcohol/street drugs. The death rate from this Type increased by 564 percent.
Type 3 errors — accidental deaths outside the home from a combination of medications and alcohol/street drugs. The death rate from this Type increased by 555 percent.
Type 4 errors — accidental deaths outside the home from medications with no involvement of alcohol/street drugs. The death rate from this Type increased by 5 percent.
This data reveals that medication errors most likely to be affected by patient behavior (Type 1) increase very steeply, while medication errors least likely to be affected by patient behavior (Type 4) increase very little.
The paper was the first to show that domestic fatal medication errors, especially when combined with alcohol/street drugs, have become an increasingly important health problem. There have been thousands of studies of medication errors, but almost all of them have examined the role of clinical staff in clinical settings. The paper suggests that research on medication errors needs to be substantially expanded to cover the role of patients in domestic settings.