Recognizing patients who use recreational drugs takes on added urgency in light of a recent study by sociologists at the University of California, San Diego (UCSD).

They found that fatal medication errors (FMEs) among patients who used recreational drugs or alcohol while taking prescribed or OTC medicines increased more than 3,000% over two decades.

“Increasingly, people take their medications at home, away from hospitals or clinics,” says principal author David P. Phillips, PhD, professor of sociology at UCSD.

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That shift from clinical to domestic settings is linked to a dramatic increase in FMEs, Dr. Phillips’ team concluded. Add “street drugs” or alcohol to the mix and “an increasingly important health problem” results (Arch Intern Med. 2008;168:1561-1566).

Scanning almost 50 million computerized U.S. death certificates from 1983 to 2004, the team focused on the more than 200,000 that listed FME as either the primary or secondary cause of death. They then divided these certificates into four categories:

• Deaths at home from combining medications with alcohol and/or street drugs (increased 3,196%)
• Deaths at home that did not involve alcohol and/or street drugs (up 564%)
• Deaths away from home involving alcohol and/or street drugs (up 555%)
• Deaths away from home that involved neither alcohol nor street drugs. These were basically stable, rising only 5%.

Because the researchers looked only at deaths ruled FMEs by clinical codes, the methodology automatically excluded accidental overdoses involving recreational drugs or alcohol consumption; homicides and suicides; and unavoidable adverse reactions, such as unsuspected allergy, to properly administered medications.

The FME designation applies to both prescription and OTC medicines, but death certificates do not provide details. The researchers could not measure or compare FMEs for specific drugs. They don’t know the type of alcohol or recreational drugs involved nor the amount that poses a danger. “For example, we do not yet know whether the increase in FMEs is produced mostly by occasional or heavy drinkers,” the authors write.

However, they do know that middle-aged people are particularly at risk. The age distribution of FMEs shifted dramatically for individuals in their 40s and 50s over the course of the study. In 1983, they constituted only 17.9% of all FMEs; by 2004, they accounted for more than half (53.2%) and their actual number of FMEs soared almost ninefold (890.8%).

The study authors are calling for more research to flesh out their findings. Meanwhile, they suggest clinicians balance the lack of supervision by evaluating individually patients’ ability to manage their medicines, educating them about risks, monitoring their performance, and considering collaboration with local pharmacists.

To minimize the risk of dangerous combinations, clinicians can screen their patients for “use, misuse, or abuse” of alcohol and/or recreational drugs; take additional precautions when prescribing medicines known to interact with these substances; and emphasize the risks of mixing them with medication.