Medication Safety, Addiction and
Dependency
By
Ilene Corina, Patient Safety Advocate,
Pulse
Center for Patient Safety Education & Advocacy
September
2017
Community
education, including high school programs and health classes on medication
safety should include other patient safety information such as:
· -The
importance of the patient/ clinician relationship,
· -Preparing
for a doctor’s visit,
· -Hospital
discharge planning, and
· -Communicating
with a clinician for the best possible outcome.
Case Study
On September
19, 2017, a 60-year-old woman was hospitalized for a one-day surgery. After the
procedure, she told nursing staff that she did not have uncontrolled pain and
was OK with minimal pain medication.
I
interviewed her following her hospital stay, after she went home with her
husband. Her husband did not have any
training as an advocate and did not know what he was to look out for. When the
patient was released, she was told her pain medication was at the
pharmacy. She was given very little
instruction.
Below are
some questions and her responses:
Q. What pain
medication were you prescribed?
A. I was told it would be Percocet
but when I got the prescription it was for oxycodone/Acetominephin. Nobody told
me that that is the same thing until I asked. Percocet is the brand name.
Q. Were you
given your prescription and instruction about its use while you were in
the hospital?
A. They called it into the pharmacy
and a family member had to pick it up. Very little instruction was provided in
the hospital.
Q. How many
pills were you prescribed?
A. Thirty pills each from two
different doctors with seemingly no coordination between them.
Q. Did the
physician or pharmacist talk to you about safe use of this medication?
A.
No.
Q. Were you
or your family member told about any possible side effects or dangers of
the long term use of pain medication?
A.
No.
Q. Do you
think if you requested another prescription for pain medication your
doctor would give you more?
A.
Yes
Q. Anything
else you want to add?
A. The biggest issue I had was the
lack of coordination between doctors within the same hospital facility. They
almost appeared to be pushing the pain meds on me, even though I told the nurse
I didn't think I would need them, didn't want them and could probably get away
with just Tylenol or ibuprofen. The response was, “Better to have the pain meds
and not need them than to need them and not have them”. The prescriptions just
showed up at my pharmacy and were filled automatically even though I didn't
request them.
I
got two prescriptions for the same meds. The labels were really confusing and
didn’t tell me how much to take and when.
Here's
what one label says: “1 tablet orally every 4 hours as needed for moderate
pain - for severe pain MDD: 4 tabs.”
The other label says: “1 tab orally
every 4 hours as needed for moderate pain. ”MDD:6
Both
medications are exactly the same thing, why are the labels different and what
does that first label mean? Do I take 4 tablets if I have higher pain?
I
don't remember seeing either of the doctors who prescribed these medicines so
wouldn't even know who to call. It was just "the hospital."
With two bottles of the exact same medication, were the
patient to follow directions, she would be taking double the dose of pain
medication. When a patient is prescribed a medication under one name and then
given another, such as what happened here, the patient should be told this to
avoid the patient taking both medications.
News and editorials repeatedly report that there is an
“epidemic” of medication dependency, misuse, abuse and overdoses.
Opioid Addiction and
Adults
• Almost one-third
of all Medicare patients — nearly 12 million people — were prescribed
opioid painkillers by their physicians in 2015.
• That same year,
2.7 million Americans over age 50 abused painkillers, meaning they took them
for reasons or in amounts beyond what their doctors prescribed.
• The
hospitalization rate due to opioid abuse has quintupled for those 65 and older
in the past two decades
Nearly
14,000 people age 45-plus died from an opioid overdose in 2015 — 42 percent of
all such deaths in the U.S., according to the Centers for Disease Control and
Prevention (CDC).
There is
no real way to determine how many older adults overdose. When an older person
does not wake up it is usually attributed to natural causes even when the cause
was accidental overdose of opioids
Medication
errors, misuse and abuse are not only about older Americans.
A study in
2014 found that male teens who played sports were more likely to abuse opioid
medication, compared to their peers who didn’t participate in sports.
Teenagers
who abuse opioid drugs, in most cases began when they received the medication from
their doctor. Studies show that teens start taking drugs for medical reasons
and then continue when they are no longer needed.
The Bergen
County, New Jersey Prosecutor’s Office found that the “vast majority” of heroin
buyers caught in a 2015 sweep began abusing heroin after misusing pain
relievers that were overprescribed for a medical or sports-related injury.
Between 67
percent and 92 percent of patients reported that, after a surgical procedure,
they had unused opioids left over from the prescription.
The 2013
and 2014 National Survey on Drug Use and Health (NSDUH) found that 50.5 percent
of people who misused prescription painkillers got them from a friend or
relative for free.
Conclusion
The public
- patients and their family members - have the most at stake when it comes to
patient safety: they face challenges regarding diagnosis, infection prevention,
communication, health literacy, and medication management. Yet, too often,
patient safety groups are left out of the educational process of informing
other members of the public about patient safety initiatives and programs. It is imperative that the general public
becomes informed about patient safety which includes medication safety.
As the
stories and statistics in the newspaper confirm, medication errors can start
when the prescription is written, leading to addiction and dependency or worse.
Communities need to have educational programs about “safe” medication use and
encourage all people who receive prescription medication to have someone they
trust to help with medications. A designated person, assigned by the patient,
can help ask these important questions:
· -How
addictive is the medication?
· - What
are other options?
· -Is
the dosage prescribed the minimal need?
· -How
long does the physician want the individual
drug
· -When
and how does the physician plan to wean the patient off the pain medication?
· -What
is the plan if the pain persists after the pre-determined period?
· -What
are some signs that the patient may be getting dependent on medication?
· -What
should be done to help with any withdrawal symptoms?
To learn
more contact Pulse Center for Patient Safety Education & Advocacy
Ilene
Corina
Phone:
(516) 579-4711
Fax:
(516) 520-8105
E-mail:
icorina@pulsecenterforpatientsafety.org
