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Dangerous drugs

Study shows alarming spike in prescription drug deaths at the beginning of each month

Monday, November 21, 2005 by: Ben Kage
Tags: dangerous drugs, pharmaceuticals, hospital safety

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David Phillips, Ph.D., has conducted a number of studies on mortality in his career, but one of the most recent has gained significant attention, as it shows the rate of deaths caused by prescription drugs climbs roughly 25 percent at the beginning of each month. The study is notable not only for its revelations about the dangers of prescription drugs, but also for the uncommon amount of media coverage it has received.

Inspired by a New England Journal of Medicine paper that found death in general increased at the start of every month, Phillips began to study specific causes for the phenomenon. In those studies, Phillips found that alcohol-related deaths and street-drug deaths contributed to the surge at the beginning of the month, and those deaths turned out to be connected to the influx of government monies for example, welfare or Social Security checks that some consumers obtain at the beginning of the month. This left Phillips wondering what other causes might contribute to the increased death rate at the start of the month.

Phillips, along with co-authors Jason R. Jarvinen a University of California at San Diego sociology student and wife Rosalie Phillips executive director of the Tufts University Health Care Center began to look at other specific causes related to the trend, and they came across some interesting facts. "I noticed, rather to my surprise, that deaths from medication errors were producing a stronger month-boundary effect than any other cause of death we could examine," Phillips said.

Phillips and his co-authors studied 131,952 death certificates connected to accidental poisoning through prescription drugs and found at least part of the 25 percent surge was attributable to an increased number of people having access to government funds, which they then used to buy prescription drugs they were told they needed. When this huge influx of customers hits the pharmacies, mistakes are made.

"Because of this increased busyness of the pharmacist at the beginning of the month, they are overworked, and because they're overworked, they make more mistakes," Phillips said. "The pharmacist is rushed. We know he's rushed at the beginning of the month and, therefore, he doesn't have time to say slowly to the patient, 'Be careful and don't take alcohol with this medicine. Please listen to me slowly. If you don't understand, let me say it again.'"

It seems reasonable to assume that there are always a number of prescription drug-related deaths and that the number simply rises at the beginning of the month when more people are buying prescription drugs. However, if this were true, the death rate would be more noticeable among the poor and the elderly who rely on government funds to buy their drugs at the beginning of the month. To check this, Phillips, his wife and Jarvinen examined the socioeconomic status of those named on the death certificates, and they discovered that the spike in deaths remained consistent, regardless of whether the deceased relied on government money or not, which suggests medication error is more likely to be the culprit since it is something that affects all consumers.

Drug consumers may be ignoring warnings

Phillips does not think pharmacy error is the only factor, however. He believes that even the consumers have some culpability in the death toll spike, as they are in as much of a hurry as any pharmacist. This means they do not pay as much attention to pharmacist consultations, nor do they ask the pharmacy staff to repeat information if it was not understood. "There may be a combination of people involved," Phillips said. "Possibly the nurse, maybe the doctor, possibly the patient; it doesn't need to be just the pharmacist that's involved here."

Death certificates that showed the victim's death was clearly caused by intentional poisoning (suicide or homicide) through prescription drugs were not included in the study.

As with any study, the quest to find why death from prescription drugs jumps so significantly at the beginning of the month plays a role in the ultimate goal of solving the problem. Phillips does not think himself the answer man for the dilemma, but he does have some suggestions on how to take the initial steps toward the solution.

"One (solution) would be for the patient to check more carefully their prescriptions; another would be for the pharmacist to check the prescriptions more carefully," Phillips said. He also suggested the government stagger its distribution of funds, so that fewer patients were trying to fill their prescriptions simultaneously.

Furthermore, Phillips feels that there are some other causes for the phenomenon and hopes his findings will inspire researchers to examine it from a more focused perspective, maybe by checking a smaller and more detailed sampling such as pharmacy and hospital records to get more information on how the prescription drug deaths related to increased death rates.

Phillips notes that the number of people who were dead on arrival, or died from prescription drugs as outpatients, was bigger than the number of people who died as inpatients at a hospital. The number of inpatients who died from prescription drugs still spiked, but it was impossible to tell when the error occurred with the data that Phillips studied.

"It might be, for example, that I make the error at home, and then I get taken to the hospital, and then I die as an inpatient," Phillips said. "So, we don't know if the month boundary effect for the inpatient is occurring because the errors were made when he was an inpatient, or if the errors were made before he was an inpatient."

How Big Pharma contributes to unnecessary drug deaths

Although Phillips did not say drug companies were to blame for the death rate, he did mention it was doubtful that pharmacists where solely responsible. It seems reasonable to suggest that the drug companies themselves also have a measure of culpability in the phenomenon, since their drugs are doing the actual killing. Some evidence of this is shown in Phillips' research, which found a percentage of consumers died even when they were given the correct amount of the correct medication; however, this number is extremely small (3.2 percent) when compared to the number who died from incorrect doses or incorrect drugs. Still, the fact that these drugs are so risky that they need to be strictly controlled should speak volumes to those who rely on them on a daily basis.

It could be that some people are ignorant of the dangers presented to them by prescription drugs because advertising and media has a strong tendency to focus on the positive aspects of the drugs, while completely discounting the negatives, not to mention the alternatives. Phillips' study, however, offers us hope, as it has received unusually wide media coverage, and Phillips' interview with USCD News has been reprinted on medical news sites across the internet. Phillips suggests the usual media ignorance of systematic trends, such as the prescription drug death spike, is due to America's concern with much more dramatic events, like a homicide.

"They do say that Americans are much more alarmed by the wolf at the door than by the termites in the basement," Phillips said, which is why he is so pleased that his findings have been reprinted in so many media outlets; an uncommon occurrence for information that paints drug companies in a negative light.

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