The Effects Of Combining Prescription Medication

December 19, 2018

BEWARE. Fatal accidental overdoses of drugs prescribed by doctors to make us healthier and prolong our lives have “constantly increased” over the past 15 years, warns a leader in public health and drug safety.

“You don’t need a drug problem to overdose,” said John Ryn, Chief Executive of the Penington Institute, Australia’s leading independent drug, research, policy and education organisation.

The Institute’s Annual Overdose report released earlier this year said deaths involving the use of sleeping and anxiety medication had doubled since 2006.

Stars like actor Heath Ledger and entertainers Michael Jackson and Prince, all died from accidental overdoses of prescription drugs.

Mr Ryan said with opioid-associated deaths in Australia growing from 55 to 746 in four years he was concerned “we are at risk of following a similar path to the United States.”

“Almost 30,000 people died in 2017 after taking fentanyl or similar compounds,” said Mr Ryan.

In 2015, 82% of the 384 overdose deaths in Victoria involved prescription drugs.

Victorian Coroner Audrey Jamieson said that Benzodiazepines were most commonly implicated in toxic deaths.

“I hardly ever investigate a matter where the cause of death is mixed drug use, where a benzodiazepine isn’t seen,” she said.

Accidental overdoses occur from drug interaction.

The National Prescribing Service, which provides expert advice on drugs to professionals and the public, describes it as a medicine mixing badly with another in a person’s body. Mixing with some foods and drinks can also add to the problem.

Combining any of the following can have a potentially lethal effect:

  • Opiate (morphine, codeine) and non-opiate (paracetamol) medicines
  • Sleeping tablets
  • Anxiolytics (anti-anxiety medication)
  • Antipsychotic drugs
  • Antiemetic (drugs that are effective against vomiting e.g. motion sickness medication)
  • Hayfever medication
  • Alcohol

CASE STUDIES (Breakout)

Daniel Bogart, on a Christmas trip with friends, went to bed after accidently taking a lethal combination of his prescribed medication and never woke up. Daniel had been prescribed Valium for anxiety and oxycodone to treat pain.

While Daniel was not constantly taking the Valium he had never been warned of the danger when taken together.

Both medications are considered downers and act as sedatives to decrease mental and physical activity.

Dr Meredith Craigie, Dean of the Faculty of Pain Medicine of the Australian and NZ College of Anaesthetists said “if you’re heavily sedated with another drug, it may be that the brain simply doesn’t wake you up to start breathing again.”

After a fall that left Jon Raggam fighting for his life, he overdosed on a toxic cocktail of prescription medication shortly after his release from hospital.

In 2012, Jon became a paraplegic after falling four meters and breaking his back. He spent the next two years in hospital. When released Jon took his medication as prescribed by his GP only to die of an accidental overdose three days later from mixed drug toxicity.

“He was on Valium, he was on Edone, which is in the oxycodone family, he was also given an antidepressant for the nerve pain,” explains his sister Jasmin.

With opioid related deaths on the rise Dr Jennifer Stevens from Sydney’s St Vincent’s Private Hospital explains that the problem with these drugs is we are finding more and more reasons to use them.

“30 or 40 years ago they used to be used primarily for cancer pain and it turns out that was the right thing. We’ve moved to using them for all sorts of things we wouldn’t have dreamt of using them for before – so headaches and back pain.”

In American, teens are playing Russian roulette with their lives by mixing prescription drugs and alcohol.

In 2012, Emily Jackson, 18, staying with family after her uncle’s funeral, took a single OxyContin prescription pill from her uncle’s cancer prescription while drinking. She never woke up.

Alcohol and painkillers are both respiratory depressants. Combining them overwhelms the brains, which stops giving the heart and lungs signals to keep functioning.

“Adolescents and young adults are at risk because they think they are invincible,” said Kathleen Meyers, a senior researcher for the Treatment Research Institute, a non-profit research organisation for substance abuse.

“You have no idea the (respiratory) consequences of any one group of substances, and then you put all that together and the risks go up exponentially,” she said.

In 2015, Becky Savage lost two of her sons in one night to an accidental overdose.

After consuming hydrocodone (a type of opioid) and alcohol at a graduation party, Savage found her oldest sons, Nick and Jack, unresponsive the next morning.

“We’ve talked to our kids about drinking, but we had never talked to them about prescription drugs, because it wasn’t even on our radar,” said Savage.

Kathleen Meyers said better communication is needed. “Maybe if we did a better job with how we communicate the effects of prescription medications when mixed with other substances with them, maybe we wouldn’t have the number of people who are in crisis.”

Alcohol can prove lethal when mixed with prescription drugs, especially when mixing multiple drugs or antidepressant drugs like benzodiazepine.

Some of the effects of mixing alcohol and prescription drugs include:

  • Heart problems
  • Stroke
  • Liver damage
  • Internal bleeding
  • Brain damage
  • Death

Professor Paul Wallace, Chief Medical Advisor at Drinkaware, an independent UK based charity working to reduce alcohol misuse and harm, describes the effects of mixing alcohol and prescription drugs.

“Alcohol is a depressant; it affects the way your brain works, numbing your senses so they don’t operate properly,” he said.

“Some types of medication can also affect the way your brain works, and if you’re drinking alcohol there will be a conflict.”

Professor Wallace said people taking long-term medications should be careful with alcohol as it can make the drugs less effective and can actually make long-term conditions worse.

“People taking sedative drugs or antidepressants should avoid alcohol altogether,” he said.

Of the 2,177 drug-related deaths in Australia in 2016, 1,704 were accidental, having doubled since 2006.

Accidental drug deaths have overtaken the road death toll.

To combat a patient’s ability to receive multiple supplies of dangerous drugs, the Federal Government committed $16 million to the rollout of real-time monitoring of prescriptions in July, last year.

The system is focused on identifying those at risk of harm due to dependency, misuse or abuse of prescription medicine.

Professor Nicholas Lintzeris, a leading addition specialist at The University Sydney spoke about his concerns of real-time prescription monitoring.  “There is a huge grey area of prescribed opiate patients who do not identify as drug users but are nevertheless at risk of overdose.”

Real-time monitoring could create a demand for black-market drugs. “We may inadvertently be creating some drivers that encourage patients to hoard medicines and on-sell them.”

“Simply introducing the system doesn’t mean you’re going to fix the problems,” Professor Lintzeris said.

Besides accidental overdoses there is also a rise in accidental poisoning in children. Young children often learn about new things by putting them in their mouths. Unfortunately, this can lead to roughly 40 children per week being hospitalised for accidental poisoning.

With fatal combinations of drugs, Better Health Channel, a website aimed at providing the public with easy to understand information about health and medical conditions describes how to protect your children.

“Medicines are some of the most common causes of poisoning in children. Keep all medicines out of reach and out of sight of children.”

“Put medicines away immediately after purchase and use,” they said.

Many Australian households will have a large collection of medication and while it may seem wasteful to dispose of unwanted medicines keeping them can be dangerous.

The National Prescribing Service said many medicines deteriorate over time leading to changes in their chemical composition.

“The medicines become less effective or, in some cases, potentially harmful if they are used after their expiry date.”

It’s best not to keep unnecessary drugs in the house however, disposing of old medicines can also be potentially harmful.

According to the Pharmacy Guild of Australia, the national peak body representing community pharmacy, throwing unwanted medicines in the garbage or flushing down the toilet is dangerous to the environment.

“More than 500 tonnes of medicines find their way into waterways and landfill every year.”

“Medicines disposed of in landfills have leached back into the food chain via water or fertilisers made from landfill,” they said.

DISPOSING OF UNWANTED DRUGS

The safest way to dispose of unwanted medicines is through the Return Unwanted Medicines (RUM) scheme run by a government funded organisation called The National Return & Disposal of Unwanted Medicines Limited.

This organisation collects unwanted medicines and disposes of them via special high-temperature sealed incinerators

To dispose of unwanted medicines:

  • Collect all expired and unwanted medications
  • Place medications in a bag or container
  • Return the medications to a local pharmacy, where the pharmacist will put them in a secure bin for collection and safe disposal

All medications can be disposed through the RUM scheme and is free to use.

Besides removing unnecessary medications from your home, it’s also important to store them in the right place.

According to Return Unwanted Medicines, a not-for-profit government funded company that addresses the Quality Use of Medicines (QUM) in Australia; this is how to store medications:

  • Store medicines in cool, dry places away from light and ideally in an airtight container
  • Store medication up high and out of reach of children and pets
  • The bathroom medicine is not the ideal storage place due to heat and humidity
  • Avoid storing medication above the cooktop or refrigerator

Many accidental overdoses are from people who abuse prescription drugs, however, there are some that result from a lack awareness of the dangers of mixing prescription drugs and other substances.

To lower the risk of an accidental overdose, be aware of the different medications you are taking and talk to your doctor or pharmacist about managing your prescriptions safely.  

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