Study: Doctors Could Do More To Prevent Prescription Drug Overdoses
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March 7, 2016 1:14 p.m.
Study: Doctors Could Do More To Prevent Prescription Drug Overdoses
Dr. Roneet Lev, emergency medicine physician, Scripps Mercy Hospital
Dr. Jonathan Lucas, San Diego County deputy medical examiner
The CDC calls it a prescription painkiller overdose event -- epidemic. About 44 Americans die every day from an overdose of prescription pills. In an effort to reduce that number, California has a online database called CURES. Its purpose is to see if a patient is being overprescribed medication or even Dr. shopping for potentially dangerous drug. A study suggests a lot of drug overdose deaths could be prevented if more doctors used the database. The study is being presented this week at a national conference of drug diversion investigators. Joining me now is Dr. Roneet Lev a KPBS Midday Edition --
A emergency medicine physician, Scripps Mercy Hospital.
Dr. Jonathan Lucas is a San Diego County deputy medical examiner. Both of these doctors are co-authors of the study. Dr. Lucas, the study looked at 254 unintentional prescription related deaths in 2013. Were all these deaths due to overdoses of some kind?
Yes. A were all due to prescription medication causes. The intoxication of the single or multiple prescription medications led directly to a death.
Were many of the names of the deceased licit -- listed on the CURES database?
75%. Three quarters of the people were found to have prescriptions written for prescription medications in the previous year. So 186 of those folks.
What you make of that look
Well, it speaks that this is something we can intervene. We can get the communication back to physicians and potentially how many of those prescriptions could of been written -- or not been written, if the physician had just checked the CURES system prior to doing so.
What kinds of prescriptions does the CURES system monitor? Either one?
The CURES system is an electronic database governed by the Department of Justice and the state of California. It includes all scheduled 2 through schedule 5 prescriptions. From hydrocodone, than a Pat down X, ambient -- any medications that fit the schedule controlled substances are found on the system.
Now Dr. Lev, is it possible some people who died didn't realize it was dangerous to take two different kinds of prescription drugs?
That is true. We asked a common question -- if you take your medication exactly like you are supposed to, you shouldn't die. What we found, in general, that was true. If you took your medications exactly as prescribed, if you're not using alcohol, you weren't using illicit drugs, you weren't Dr. shopping, very few people died. Most people who died were not following directions.
Not bothering directions. For instance, what's the problem with taking a prescription painkiller and an antianxiety drug?
We've been told that mixing pain medications and anxiety medications are dangerous. They have an additive effect. They both suppress the central nervous system. Even incorrect dosages, that be dangerous. We found that more than half of all the medication reports have this combination. And in the morgue, 20% had this commendation their blood.
Dr. Lucas sees these patients when they unfortunately do die. You must see some of these patients in the emergency room Dr. Lev, do you see a lot of problems with prescription drugs in the emergency room?
During the study really affected how I practice. I term the phrase, death diary, to these prescriptions because my job is to keep people alive and keep them away from Dr. Lucas. Going through report after report, telling a story of prescriptions -- of how someone died, was morbid. And the way it affects me now in my practice, when I talk to patients and a review their medications, I will tell them -- all my goodness, your prescription history will be -- reads like someone I just read about that ended up in the morgue.
ASI. That should open some eyes.
Is there any evidence, some of the people who died were Dr. -- Dr. shopping?
We did identify a subset of the folks we looked at in CURES. They did meet what we defined as Dr. shopping. Which was for providers and for Mac -- 4 pharmacies. The patient is motivated to find additional medications and one doctor might not know that the second doctor is perverse -- prescribing medication or medication like an anxiety medication plus a pain medication.
What did you find in general about the people who died from prescription drug overdoses. How many prescription meds were they on -- were there any -- similarity in ages or anything like that?
Sure. When we look at that group, the age range was perhaps striking in that the addiction can start in middle school. The range went from 15 years old 273 years old. With an average of 46. Most people were male. Not by a huge margin. But most were male. When we looked at the combinations -- certainly opiates, the usual pain medications like oxycodone and hydrocodone were common. Antianxiety medications, benzodiazepine are the class. 80% of the people who died had a combination of medications. It wasn't just one medication. Of the 20% that had a single medication, the highest -- the most common medication that was responsible for the death was methadone. Which is used also in addiction therapy and also in pain therapy.
I guess one of the big questions your study asks, is that why aren't more doctors using the CURES a database to check and see what other prescriptions their patients have?.-- Dr. Lev The CURES system has been available since 2008. Until recently it was cumbersome to get her natural to be able to use the system. The password would expire. You could remember what your first dog's name was in order to get your account back in. Cures 2.0 is now available and it will be of required by June for every position to have an account. It's a much better system. Is not as burden some. Hopefully we'll see more use of that.
We asked the California medical Association of doubt the use of the database. Maybe they are talking about the original database, they told us in part -- they support the use of CURES, but the database crashes, can handle the volume of inquiries, and that results in physicians having to choose between prescribing medication or breaking the law. Is that a common complaint about using this database back
Adding technology to your job is definitely a hassle. There is a learning curve to doing that. If you talk to physicians who regularly use it, they would fill almost naked without it. Because how can you write a prescription that could end up killing someone without taking the extra two minutes to check it is safe.
Dr. Lucas, your study is being presented at a national convention this week about the -- prescription drug abuse. What can we learn about this?
The more awareness we have out there -- the first of all, let's step back one bit. This phenomena even exists. Prescription medication abuse and death related to the abuse and overuse even exists. So emphasizing that is one part of the story. The next part of the story is really how to intervene and how to stop the cycle. Really pushing the CURES message -- CURES as you mentioned is just the California system. Every state should have one. These investigators should be able to bring that message back to their state.
I have to end it there. I have been speaking with Dr. Roneet Lev , emergency medicine physician, Scripps Mercy Hospital . And Dr. Jonathan Lucas , San Diego County deputy medical examiner . Thank you both very much.