Ignorance — not intent — is likely the cause of drug overdose deaths that claim the famous and not-so-famous equally, doctors frustrated with the problem of multiple medications said this week.
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On the heels of actor Heath Ledger’s death last month from the effects of six painkillers and sedatives, U.S. Army medical experts said Thursday they’re also investigating a series of similar overdoses among wounded and recovering soldiers.
The incidents are accidental, officials insist. But they've raised questions among skeptics who wonder how ingesting a half-dozen powerful prescription medications could be anything but intentional.
It shouldn’t be surprising, said Dr. Edward V. Craig, an attending surgeon at the Hospital for Special Surgery in New York. Many patients, particularly older people suffering from multiple health problems, may take six or seven medications to combat their symptoms. Even young people may accumulate a considerable pharmacopoeia.
“I see people come in and they’re on 10 or 12 medications,” said Craig. “A surprising number of people are on over-the-counter or herbal medications as well.”
The problem isn’t that they’re suicidal, noted Dr. Laurence M. Westreich, a psychiatrist who specializes in addiction and mental health at the New York University School of Medicine. Instead, some people may not know the risks of mixing pills or they're simply too overwhelmed by the symptoms they’re seeking to relieve.
“When you’re on that many medications that have a depressant effect, you might forget what you’ve taken,” Westreich said.
Spike in accidental deaths
Many patients get medications from several doctors, often with little oversight or advice about interaction, the experts said. In addition, too many patients pay too little attention to the type of drugs they’re taking.
The result has been an exponential rise in the number of unintentional drug poisoning deaths, which spiked nationwide by more than 68 percent between 1999 and 2004, according to a 2007 study by the federal Centers for Disease Control and Prevention. The increase was fueled primarily by overdosesfrom legal prescription opiates such as oxycodone.
Many of the pain drugs are long-acting medications that take a while to deliver relief, said Steve Saxe, a former pharmacist who directs the pharmacy board for the state of Washington. People who are impatient or impaired by pain, depression or anxiety may ingest higher dosages or several drugs in hopes of faster relief.
“Someone may take something for pain and the dose may be every 12 hours but they take another one in three hours,” he said. “Then you’ve got the combined effect of two or three doses on board.”
Add an additional medication — a common cold medicine, or even a glass of wine — and the effects can be lethal. Typically, the drug interaction depresses respiration — meaning that patients fall asleep, stop breathing — and never wake up.
Better oversight by doctors and the development of portable electronic medical records that don’t rely on patients for accuracy are solutions to the growing problem, Craig said. In addition, patients must become their own best advocates and insist on being informed of the potential effects and interactions of any drugs they take.
That may prevent tragedies like Ledger’s in the future, said Westreich.
“The bottom line is there should be some physician monitoring every drug you’re taking,” he said. “Either that didn’t happen or hewasn’t taking their advice.”
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