June3_Room1_1115_DRUG-RELATED DEATHS IN-UTAH- FROM TRAGEDY TO-PREVENTION-(SUICIDE PREV CREDIT)-Erik D. Christensen, MD |
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Monitoring Multiple Prescriptions from Different Doctors May Cut Overdose DeathsIn Utah, 21 people die every month from… +7 More
December 03, 2014 Aaron: Prescription drug monitoring, that's next on The Scope. Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope. Aaron: I'm here with Peter Kreiner PhD, he's a senior scientist at the Institute of Behavioral Health of the Schneider Institutes for Health Policy, a researcher for the Heller School for Social Policy and Management and he's an expert in prescription drug monitoring. Welcome Dr. Kreiner. Dr. Kreiner: Thanks, Aaron. Aaron: Dr. Kreiner, here in Utah, deaths due to prescription overdose have been increasing since about 2001 and we have about 21 Utahans die from prescription overdose every month. Is this a nation wide problem? Dr. Kreiner: It certainly is, Aaron. Probably from the early 2000's on, public health officials started recognizing opioid and prescription drug overdose death as a huge and increasing problem and recognition has just grown from there. So in the last few years, all federal agencies and national organizations, state governments have grown increasingly concerned with the problem and have started reaching out in a lot of different directions to look for solutions. Aaron: Now what is a prescription drug monitoring program? I understand that's one of the solutions that they're looking at. Dr. Kreiner: Prescription monitoring programs are essentially a data repository. Forty-nine states have now passed legislation authorizing such a program. Forty-eight states have actual operating programs. The hold outs are Missouri for legislation and New Hampshire is just about to have an operating program. They're repositories of filled or dispensed prescriptions for controlled substances that pharmacies are required to submit to each state program. So they are databases that are intended to serve multiple stake holders, typically prescribers and pharmacists and often other individuals can establish an account with a prescription monitoring program and log in and query it about a patient to inform their clinical decision making. Aaron: What sort of data is maintained by these monitoring programs? Dr. Kreiner: It's a record of each prescription that's dispensed, includes information about the patient, the prescriber, and the pharmacy that dispensed it, including dates the prescription was written, the date it was dispensed and info about the specific drug prescribed, the dosage the, date of supply, often whether or not it was a refill or if refills are allowed. In many states it includes information about the payment source. So, kind of insurance, cash, that sort of thing. Aaron: What's the value of the program overall for patient safety? Dr. Kreiner: For patient safety, again if a patient presents a prescriber or their physician, could be an emergency room or could be their primary care physician, that physician may or may not know about the prescription history of that patient. Often physicians think this is a legitimate patient, have legitimate symptoms. I'm interested in prescribing a pain medication opioid analgesics and yet when they check the monitoring program, they find that person may have obtained half a dozen prescriptions from a number of different prescribers in the last month. That's a very different picture of that patient then they might have had. Aaron: So ultimately this can help a health care provider help a patient stop an addiction or at least get help for an addiction before it goes too far. Is that safe to say? Dr. Kreiner: Patients may be obtaining multiple prescriptions for lots of different reasons. So they may be misusing or abusing, they may be addicted, they may be diverting. And certainly the prescriber, it's intended that they might have a discussion with that patient and really try to help that patient to seek appropriate help. It's an ongoing issue about what treatment resources are available and that's an issue in every state. Aaron: Utah has a prescription drug monitoring program. I don't know how familiar you are with Utah's particular program, but based on what you've seen nation wide in your experience, how do you think Utah could better use its prescription drug monitoring program to prevent overdosing? Dr. Kreiner: Our center, so we have a prescription drug monitoring program center of excellence at Brandeis University, studies best and promising innovative practices that monitoring programs are doing nation wide. So we've identified 30 some odd practices that keep increasing all the time. Some of the more impactful ones that we've seen in other states that I believe Utah is not currently implementing include what's called unsolicited reporting where a monitoring program proactively analyzes this data and pushes out a report or sometimes an electronic alert to a prescriber or pharmacist for a patient to bring that information to their attention. Some other practices that seem very valuable that we've been using in Massachusetts is use of de-identified prescription monitoring program for public health surveillance purposes in particular to provide it to counties and communities, we're working to prevent and reduce prescription overdoses, prescription drug related problems. I could go on, but those are some leading practices that I think Utahans could benefit from. Announcer: TheScopeRadio.com is University of Utah Health Sciences radio. If you like what you heard, be sure to get our latest content by following us on Facebook. 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Poison that Looks Like CandySome of the most potent and poisonous substances… +5 More
June 09, 2014
Family Health and Wellness Interviewer: We all know that we have to be careful with prescription medications around the house, but did you know that heart medications are especially dangerous? That's next on The Scope. Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope. Interviewer: I'm here with Dr. Tom Martin. He's the Medical Director at the Utah Poison Control Center. Welcome, Tom. Dr. Tom Martin: Thank you. Interviewer: Today, we're going to be talking a little bit about the dangers of heart medications around the house. Everybody knows that they need to keep medications locked up and away from where small children can get at them, but heart medications, I guess it's especially important we do that. Why is that? Dr. Tom Martin: Well, they are particularly toxic in low doses. That means that they are very potent. They are prescribed to people who have a weakened cardiovascular system. They are often prescribed to older people and that means that many times there's grandchildren around and that's a bad combination. Interviewer: Well, what is it that makes them so dangerous? You said that they're especially potent in low doses. Are the pills themselves always prescribed in low doses? Dr. Tom Martin: No, not necessarily actually. Sometimes a pill can be one day's worth of the medication in a sustained-release preparation. So it actually can be a fairly large dose of medication, but it's made to be slowly dissolved and absorbed in the body. However, in a child that dose which could be appropriate for an adult could be very deadly. Interviewer: When you say that there is sustained-release, a child might not exhibit symptoms right away. Dr. Tom Martin: That's correct. So that's one of the really dangerous things about these, is that they are like time bombs in that a child can ingest one. The parent may just see the child with an open bottle, think they're acting okay, and not be too worried. And then within hours, sometimes as long as four to six hours, the child can become very sick, and maybe much sooner than that too. It just varies. It depends upon the formulation of the particular medication. But the sustained-release preparations really are very problematic for us. Interviewer: What do some of the symptoms look like of a child that's been poisoned by a heart medication? Dr. Tom Martin: Well, there's different types of heart medications, but generally I think the main concerns we have are that there would be severe drop in their blood pressure that can make them feel maybe very weak or dizzy or pass out or very drowsy, and sometimes it can throw their heart into a very abnormal rhythm. That usually would cause a very sudden change generally, although a very slow heart rate can come on gradually or a very rapid heart rate can come on gradually. There are other rhythms that can be very lethal and can come on very rapid and cause a child or an individual just drop down and pass out. Interviewer: Wow. So once you start noticing that a child has symptoms of having being poisoned by a heart medication. How long do you have before things get really, really dangerous? Dr. Tom Martin: Well, certainly we recommend anytime anybody thinks a child or a person who is not on these medications has had exposure, has swallowed any of these medications, they should call the poison center. They should call the 800 number which works throughout the United States and puts you in contact with your closest regional poison center because these can be very deadly. Interviewer: By the time the child may be exhibiting symptoms they probably have already absorbed a lot of what we might call the "active ingredient" that is actually causing these symptoms and poisoning them. Dr. Tom Martin: Yes, so certainly by the time they become obviously symptomatic, so if a layperson can look at them and say, "Oh my goodness, they're sick." they probably are very sick at that point. Now, if they are just a little drowsy that's one thing, but if they are very weak or they are pale looking that would suggest that their blood pressures are very low and that would be very concerning and we wouldn't want that to happen at home if we can avoid. If that's going to happen we want to be in the hospital where we can treat that rapidly. Interviewer: So once these symptoms become apparent in the child, they may have already ingested enough of the medication to, well, they've clearly ingested enough to make them at least sick and symptomatic. How worried should a parent be at that moment? I mean I know they are going to call the poison control center or they're going to go to the ER. I mean what's the prognosis for a child that's ingested some of these heart medications? Dr. Tom Martin: For some of these medications one pill could kill. It's actually very uncommon for children to die from these overdoses because we are so cautious. We get them into the hospital right away, we treat them very expeditiously if they start to show signs and symptoms, and in a hospital setting we can generally support them and get them through this. Interviewer: What sort of treatments might a child encounter when they go to the hospital? Dr. Tom Martin: Well, depending upon how soon afterwards and what kind of preparation they may have ingested, they may have their stomach emptied. So sometimes we might do gastric lavage, sometimes we might give them activated charcoal to bind the toxin and then pass it through their intestines bound to the charcoal. Other times there are special antidotes used for these medications. Some are very unusual. Interviewer: That sounds like that could poison a child if they were to take that on its own. Dr. Tom Martin: They are not innocuous treatments and they have to be watched very carefully. Interviewer: This is an emergency situation, so you do what you need to do in order to save the life of the person that's been poisoned. Dr. Tom Martin: That's right. Interviewer: So it sounds like, based on our conversation so far, I don't personally take heart medication, but if I did this stuff would be in a safe at my house. This stuff sounds really dangerous for kids and I have four children at home. As an expert in poison control, where would you say that heart medications fall on the scale of danger of prescription medications? Dr. Tom Martin: Towards the top of the scale. They are very dangerous. Fortunately we don't get too many children that get into high doses and so we don't see a lot of deaths, but certainly we do see occasional deaths and we certainly see deaths in adults who take them intentionally. Interviewer: So, Dr. Martin, it's very clear that these things are very dangerous. But what are some ways that we can prevent children from getting access to them? Or what are some behaviors that might put kids at risk that we need to watch out for and maybe correct for in order to protect them? Dr. Tom Martin: Whenever we prescribe potent medications we recommend the use of childproof containers. However, older people sometimes have arthritis in their hands and sometimes just have weakness so that they struggle with childproof containers. Interviewer: Wow. So it sounds like this is a good thing to be warned about and it's good for parents to be aware of, and from our discussion it seems that if there is even any suspicion that a child has gotten access to these pills to just call poison control right way. Dr. Tom Martin: Well, I would say not only any suspicion of a child ingesting, but anybody who you think may have taken a potent medication like this that is not prescribed for them that they're not used to it or taken more of that medication. Even a double dose of some of these medications can be very toxic on somebody who takes them all the time, but they are so potent and there's this narrow very therapeutic window that they could get very sick with just a double dose. Interviewer: Can you tell us what the number is, Dr. Martin? Dr. Tom Martin: The number for the poison center is 800-222-1222. Interviewer: So if you even suspect that a family member, a relative, a child, anyone has accidentally or intentionally exposed themselves to this medications in an appropriate way call the poison control center immediately. Dr. Tom Martin: Yes, that's correct. Announcer: We're your daily dose of science, conversation, medicine. This is The Scope, University of Utah Health Sciences Radio. |