More Americans than ever are dying because they misuse prescription or over-the-counter medications by mixing them at home with alcohol, street drugs or both. The percentage of deaths attributed to this cause has risen nearly 3,200 percent over the past two decades.

JOHN R. McCUTCHEN / Union-Tribune A study led by UCSD sociologist David Phillips, shown in his garden last week, urged health providers to warn patients about the dangers of mixing alcohol or street drugs with prescription or over-the-counter medications.

That's the major finding from a study led by famed mortality researcher David Phillips, a sociologist at the University of California San Diego.

Phillips stressed that health providers must aggressively warn patients about the dangers of mixing alcohol or street drugs with everything from sleeping pills to aspirin. He said the need is especially urgent because medications are increasingly being taken at home instead of in a hospital, clinic or doctor's office.

While so much health care has shifted from inpatient to outpatient settings, resulting in less medical supervision of medication use, “we've just assumed that the patient can handle this responsibility,” Phillips said.

The study is being billed as the most comprehensive analysis conducted on this topic. It was published yesterday in the journal Archives of Internal Medicine.

Phillips' report is “groundbreaking,” said Dr. Joseph Scherger, spokesman for the San Diego County Medical Society. Scherger said its conclusions should prompt government agencies to investigate which interactions between medications, alcohol and/or street drugs are causing the most deaths.

Recommendations In his study about fatal medication errors, David Phillips and his research team at the University of California San Diego suggested the following prevention measures: Before prescribing certain medications, health providers should screen patients for potential misuse or abuse of alcohol and street drugs. They also need to do follow-up monitoring. Doctors, nurses and pharmacists must emphasize to patients the risk of mixing medicines with alcohol or street drugs. They should focus not only on seniors and the elderly but also middle-aged patients. Hospitals, medical groups and other health providers should identify which drugs, types of alcohol and street drugs are most likely to cause death or serious injury when taken together.

Scherger also called for greater restrictions on when doctors should prescribe potent drugs and encouraged medical examiners to more closely scrutinize and report deaths resulting from medication errors.

He said physicians are prescribing potentially lethal drugs, including the narcotic pain relievers oxycodone and fentanyl, more now than in past decades. A recent report said a street version of fentanyl killed more than 1,000 people in the United States between 2005 and last year.

Phillips pointed out that one high-profile victim was actor Heath Ledger, who died in January from an accidental overdose of painkillers, sleeping pills and other prescription drugs while at home.

The skyrocketing increase “calls for mandatory, scripted patient education when patients obtain certain prescription drugs,” said Michael Cohen, a pharmacist and president of the Institute for Safe Medication Practices in Horsham, Pa.

Educating the public can be tough, said John Cronin, an Escondido pharmacist and former legal counsel for the California Pharmacists Association.

“You can tell people. You can put it in writing on the label. But you can't make them read it or listen,” Cronin said.

“The health care system today does not allow for either physicians, nurses or pharmacists to sit down with people for the period of time necessary to drive this home. And even if they could, anecdotally we know that people don't comply.”

Although California requires education of patients before health providers dispense prescriptions, that doesn't always happen, Cohen said.

“A pharmacist could spend an hour educating the patient, working by phone with the doctor, and not receive one cent” other than a fee for filling the prescription, he added.

For his study, Phillips reviewed a federal database of nearly 50 million deaths between 1983 and 2004. He focused on the roughly 200,000 files that listed “fatal medication error” as causing or contributing to a fatality.

Phillips and co-authors Gwendolyn Barker and Megan Eguchi defined “fatal medication error” to include cases in which patients died from overdoses, mixing medications with alcohol and/or street drugs and taking the wrong medications – prescription or over-the-counter.

The researchers divided the medication-related deaths into four categories:

Deaths caused by misuse of prescription medications while at home, typically when a person combined the medicine with alcohol and/or street drugs. The number of these deaths rose 3,196 percent during the 22-year period.

Deaths resulting from medication mistakes at home but not involving alcohol or street drugs. This category registered a 564 percent increase.

Deaths from non-home medication errors involving alcohol and/or street drugs. The total in this bracket went up 555 percent.

Deaths from medication errors in a health care or other setting, which rose 5 percent.

The increase across all four categories was 360 percent.

In a discovery that contradicts popular perception, Phillips and his researchers concluded that seniors and the elderly did not spearhead the growing number of deaths caused by medication mistakes.

Rather, the 40-49 age group showed the largest percentage increase – about 890 percent – followed by the 50-59 age bracket at about 750 percent. The rise in drug-related fatalities was barely perceptible in those 60 and older.

An important caveat to Phillips' study is that he couldn't determine where the affected patients had obtained their medications or whether they got the drugs legally. Some people might have ordered their drugs online, bought them in Mexico, received them from friends or persuaded unscrupulous doctors to write unnecessary prescriptions.

The death certificates confirmed that a large majority of individuals who were harmed or killed by medication errors at home had consumed alcohol or used street drugs. Those documents did not specify the types or amounts of alcohol and street drugs involved.

“Hypothetically, a person was taking an opiate for back pain and either took too much or mixed it with alcohol, or took the right amount of the drug but mixed it with too much alcohol,” said Barker, Phillips' colleague. “In some cases, the patients may have been prescribed two drugs that were incompatible.”

Dr. Glenn Wagner, San Diego County's medical examiner, said the study is “interesting.” Wagner speculated several reasons for the medication-errors trend: physicians failing to develop a thorough medical history for each patient, people buying dangerous drugs over the Internet and “the fair amount of drug sharing within a family or friends.”

He also suggested that some of the increase may be attributed to better detection methods in toxicology.

“Most of my (bodies) that tested positive on toxicology studies are positive for several drugs, often many . . . with ethanol or illicit drugs such as cocaine or methamphetamine,” Wagner said.

Other deaths result from “cocktail” drugs involving antidepressants, painkillers and anti-inflammatory medications such as aspirin, Cox-2 inhibitors, ibuprofen, naproxen and carisoprodol, he said.

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Cheryl Clark: (619) 542-4573; cheryl.clark@uniontrib.com