A description of Medical Examiner prescription-related deaths and prescription drug monitoring program data

Abstract

Background: The Centers of Disease Control and Prevention have declared prescription drug abuse an epidemic in the United States. However, demographic data correlating prescription-related deaths with actual prescriptions written is not well described. The purpose of this study is to compare toxicology reports on autopsy for prescription-related deaths with Prescription Drug Monitor Program (PDMP) data. Methods: This is a retrospective analysis comparing 2013 San Diego Medical Examiner data on 254 unintentional prescription-related deaths obtained for 12 months before death with data from the California PDMP. Data were analyzed on age, sex, whether there was information on the PDMP, types and quantities of prescribed medications, number of pharmacies and providers involved, and whether there was a match between the Medical Examiner toxicology report and data from the PDMP. Results: In 2013, there were 254 unintentional prescription-related deaths; 186 patients (73%) had PDMP data 12 months before death. Ingesting prescription medications with illicit drugs, alcohol, and/or over-the-counter medications accounted for 40% of the unintentional deaths. Opioids were responsible for the majority of single medication deaths (36; 70.6%). The average number of prescriptions was 23.5 per patient, and the average patient used 3 pharmacies and had 4.5 providers. Chronic prescription use was found in 68.8% of patients with PDMP data. Conclusions: The PDMP data highlight important patterns that can provide valuable insight to clinicians making decisions regarding types and amounts of medications they prescribe. Although there is no guaranteed solution to prevent prescription-related deaths, PDMP data can be useful to prevent coprescribing and medication interaction and by following best clinical practices.

Non‐medical use of psychoactive prescription drugs is associated with fatal poisoning

“…In a systematic review on unintentional drug overdoses, none of the included studies on the drug overdose mortality included any information on whether the deceased had been using the drugs for therapeutic purposes . There is, however, one publication from the United States in which death cases were linked with prescriptions of the same individuals during a period of 1 year in the general population . In this study, the researchers looked specifically at deaths that were caused by scheduled prescription drugs.…”

“…To our knowledge, our study is one of the first to combine postmortem toxicology findings to prescriptions for all suspected unnatural deaths in one country during a certain period of time . Our aim was to provide a more comprehensive understanding of the associations between non‐medical prescription drug use and death.…”

A Systematic Review of Interventions and Programs Targeting Appropriate Prescribing of Opioids

“…In California, out of the 254 unintentional prescription-related deaths, 186 (73%) had PMP data 12 months before death. Although opioids were responsible for the majority (70.6%) of single medication deaths, 40% of unintentional deaths were due to the ingestion of prescription medications along with illicit drugs, alcohol, and/or over-the-counter medications (58). Very few community interventions were identified.…”

Opioid prescribing and dispensing: Experiences and perspectives from a survey of community pharmacists practising in the province of Quebec

“…This may be an indication of abuse or poorly controlled pain. A prescription drug monitoring program, currently nonexistent in Quebec, could thus be beneficial to all professionals, [26][27][28][29] helping Original research to reduce misuse and abuse while also addressing many pharmacotherapy-related problems reported by pharmacists in our study.…”