Hospital admissions for adverse reactions from medications and illegal drugs doubled in between 1997 and 2008, according to a new government report.
The report, released by the Department of Health and Human Services' (HHS) Agency for Healthcare Research and Quality (AHRQ) found that there was a major increase in hospital discharges from effects of both prescription and over-the-counter medications, as well as illegal drugs, among adults ages 45 and older.
"This report reveals a disturbing trend, and we need to find out more about why these admissions are increasing," said AHRQ director Carolyn M. Clancy, MD, in a press release.
Hospital admissions for drug-related conditions grew from about 30,000 per year to more than 65,000 per year -- a 117% increase -- between 1997 and 2008 for people ages 45 to 64, according to the report.
The increase was largely driven by hospitalizations from conditions related to three types of medications and drug-related conditions: drug-induced delirium; "poisoning" or overdose by codeine, meperidine and other opiate-based pain medicines; and withdrawal from narcotic or non-narcotic drugs, according to the press release. "Poisoning" by pain medicines can be caused by accidental overdose or failing to recognize the drug's active ingredient and taking too many pills.
"Substance abuse is rising, and drug abuse of all kinds is exploding as a major public health concern for our country," said Pamela S. Hyde, JD, administrator of HHS' Substance Abuse and Mental Health Services Administration. "The challenge for our healthcare practitioners is to see that patients receive medications when there is medical need but also to help prevent the adverse health consequences from drug use."
Given the explosion in the prescribing of narcotics over the past decade, the trend is not at all a surprise, John Dombrowski, MD, an anesthesiologist at the Washington Pain Center, told MedPage Today.
Dombrowksi, who is a board member of the American Society of Anesthesiologists, explained that in the mid-1990s, there was a push for physicians to measure a new vital sign during office visits -- pain. Dombrowski said the increase in asking patients about their daily pain levels had both positive and negative effects.
On the one hand, many patients divulged malignant pain only after being asked to rate their daily pain on a scale. On the other hand, doctors asking patients about pain led to a huge increase in prescriptions for opioids, oftentimes to treat pain that could be managed better without drugs, according to Dombrowski.
"Unfortunately, Americans are a pill-taking society," Dombrowski said. " 'Sure -- give me a couple percocets and I'll feel better.' But that's not the right way to take care of nonmalignant pain. When you drown the patient in narcotics, they don't do too well."
The AHRQ report detected a similar trend among elderly people. Hospital admissions for drugs grew by 87% among people ages 85 and older.
However, among adults ages 18 to 44, hospitalization for medications and illegal drugs declined by 11% over the study period.
The cost of treating patients with medication and drug-related conditions was $1.1 billion in 2008. Medicare and Medicaid paid 57% of that cost; private insurance covered 24%, and 14% of the costs came from uninsured patients; the remaining 5% were covered by other payers, such as TRICARE.
Dombrowski said he predicts the number of prescriptions for opioid painkillers will decrease as awareness of opioid abuse and misuse grows, and as the Department of Justice continues to focus on the issue.
The FDA recently proposed a plan to prevent inappropriate prescribing, misuse, and abuse of extended-release opioid painkillers. However, an FDA advisory committee voted 25-10 in July to reject the proposal, saying it lacked the teeth to stem the "public health crisis" of opioid addiction, overdose, and death.
The agency's plan to put a risk evaluation and mitigation strategy (REMS) in place would have required drug companies that make extended-release opioids to develop educational programs to guide physicians in patient selection, dosing, and patient monitoring. Prescribers were also to have been trained to counsel their patients on how to safely store and dispose of opioids.
HHS' Substance Abuse and Mental Health Services Administration helped support the analysis of the data in the report on hospital care for mental health and substance abuse disorders.
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Skip to main page content HOME CURRENT ISSUE PAST ISSUES CME SUBSCRIBE ONLINE HELP SUBMIT TO A&A ACTIVATE MY ACCOUNT Search GO Advanced Search ? User Name Password Sign In Postoperative Mortality in Children After 101,885 Anesthetics at a Tertiary Pediatric Hospital Benjamin F. van der Griend, MBBS, BMedSc, FANZCA*, Nichole A. Lister, BA, BSc(Hons), PhD?, Ian M. McKenzie, MBBS, DipRACOG, FANZCA?, Nick Martin, MBBS, FRCA, FANZCA?, Philip G. Ragg, MBBS, FFARACS, FANZCA?, Suzette J. Sheppard, BSc(Hons)? and Andrew J. Davidson, MBBS, MD, FANZCA? From *Christchurch Hospital, Christchurch, New Zealand and ? Royal Children's Hospital, University of Melbourne, Melbourne, Victoria, Australia. Address correspondence to Benjamin F. van der Griend, MBBS, BMedSc, FANZCA, Christchurch Hospital, Riccarton Avenue, Private Bag 4710, New Zealand. Address e-mail to ben{at}vandergriend.com. Abstract BACKGROUND: Mortality is a basic measure for quality and safety in anesthesia. There are few anesthesia-related mortality data available for pediatric practice. Our objective for this study was to determine the incidence of 24-hour and 30-day mortality after anesthesia and to determine the incidence and nature of anesthesia-related mortality in pediatric practice at a large tertiary institution. METHODS: Children ?18 years old who had an anesthetic between January 1, 2003, and August 30, 2008, at the Royal Children's Hospital, Melbourne, Australia, were included for this study. Data were analyzed by merging a database for every anesthetic performed with an accurate electronic record of mortality of children who had ever been a Royal Children's Hospital patient. Cases of children dying within 30 days and 24 hours of an anesthetic were identified and the patient history and anesthetic record examined. Anesthesia-related death was defined as those cases whereby a panel of 3 senior anesthesiologists all agreed that anesthesia or factors under the control of the anesthesiologist more likely than not influenced the timing of death. RESULTS: During this 68-month period, 101,885 anesthetics were administered to 56,263 children. The overall 24-hour mortality from any cause after anesthesia was 13.4 per 10,000 anesthetics delivered and 30-day mortality was 34.5 per 10,000 anesthetics delivered. The incidence of death was highest in children ?30 days old. Patients undergoing cardiac surgery had a higher incidence of 24-hour and 30-day mortality than did those undergoing noncardiac surgery. From 101,885 anesthetics there were 10 anesthesia-related deaths. The incidence of anesthesia-related death was 1 in 10,188 or 0.98 cases per 10,000 anesthetics performed (95%confidence interval, 0.5 to 1.8). In all 10 cases, preexisting medical conditions were identified as being a significant factor in the patient's death. Five of these cases (50%) involved children with pulmonary hypertension. CONCLUSIONS: Anesthesia-related mortality is higher in children with heart disease and in particular those with pulmonary hypertension. The lack of anesthetic-related deaths in children who did not have major comorbidities reinforces the safety of pediatric anesthesia in healthy children. Footnotes Funding: Hospital funded. The authors declare no conflicts of interest. Reprints will not be available from the authors. Accepted January 21, 2011. Copyright ? 2011 International Anesthesia Research Society ? Previous | Next Article ?Table of Contents This Article Published online before print May 4, 2011, doi: 10.1213/?ANE.0b013e318213be52 A & A June 2011 vol. 112 no. 6 1440-1447 ? Abstract Full Text Full Text (PDF) CME Classifications Pediatric Anesthesiology Services Email this article to a colleague Alert me when this article is cited Alert me if a correction is posted Similar articles in this journal Similar articles in PubMed Download to citation manager Request Permissions Citing Articles Load citing article information Google Scholar Articles by van der Griend, B. F. Articles by Davidson, A. J. PubMed PubMed citation Articles by van der Griend, B. F. Articles by Davidson, A. J. Related Content Outcomes Patient Safety Pediatrics Load related web page information Current Issue August 2011, 113 (2) 
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