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The highly anticipated Batman film will premiere later this month, but unfortunately the Joker will be missing from the red carpet. It’s been almost six months since toxicology reports revealed that the death of actor Heath Ledger resulted from an accidental overdose—a fatal interaction of prescription drugs including pain, sleeping, and anti-anxiety medications. The Oscar nominee was taking six different legitimately prescribed drugs including Xanax, Valium, and Restoril—all considered, for the most part, to be safe. However, the medical community has done little to address this problem, and it’s certainly nothing to joke about.
The Centers for Disease Control & Prevention reported in 2004 that 14 million patients misuse their medications and more than 20,000 cases a year result in an unintentional death. In the U.S., painkillers such as OxyContin and Vicodin, the ones prescribed to Ledger, are more likely to cause a fatal overdose than heroin or cocaine. These accidents can be prevented, and the burden should fall on the medical community. Taking care of patients does not mean prescribing a quick, easy refill.
And refilling they are. In 2005, Medicaid spent $5.4 billion on antipsychotic drugs including Seroquel because of its prevalent misuse to treat Alzheimer’s. The Centers for Medicare & Medicaid Services reported that 30% of the nursing home population is receiving an antipsychotic, yet 21% of those cases do not suffer from psychosis. And the trend extends to all age groups, not just the elderly. In 2007 doctors filled more than 45 million prescriptions for an antipsychotic, according to IMS Health. Yet there are only 2.4 million schizophrenic patients (for whom the drugs were originally intended), according to the National Institute of Mental Health.
That’s just the overprescription of one pill. The heightened risk of patients’ mixing medication is also carelessly assessed by the medical establishment. Doctors and pharmacists don’t share medical records, and they assume patients are drug-free when they step into the office, meaning they can prescribe a drug that proves deadly when combined with a previous Rx from another doctor.
Furthermore, the 2008 shooting at Northern Illinois University that claimed the lives of six students has been linked to the gunman’s abrupt discontinuation of prescription pills Ambien, Prozac, and Xanax. This tragedy should remind doctors of the need to monitor their patients closely, not only when they start their prescriptions but also right after they stop.
New prescription drugs are allowing people to live longer and healthier lives than ever before. These pharmaceuticals help patients with conditions from depression and anxiety to high blood pressure and cholesterol, problems that were often inadequately treated.
For example, cholesterol-lowering Lipitor, introduced in 1997, quickly became the best-selling drug in pharmaceutical history, helping 26 million Americans contend with heart disease, the top health problem in the U.S.
Indeed, the use of newer drugs ranks as the most important contributor to increases in U.S. longevity, according to a 2007 study by the Manhattan Institute, a conservative think tank.
There’s no question that prescriptions are being written at a record rate. Prescription purchases increased 71%, to 3.6 billion, from 1994 to 2005, while the U.S. population grew just 9%, according to the Henry J. Kaiser Family Foundation.
In addition to new drugs driving demand, the nation’s swelling senior and overweight populations are among several factors contributing to the sharp rise.
As more medicines become available, more are also abused or used incorrectly. As the deaths of Heath Ledger and Anna Nicole Smith tragically illustrated, misuse can turn deadly.
Yes, drugmakers woo doctors to prescribe more of their products, but the percentage of medical professionals who recklessly sign Rx forms is tiny. The vast majority do what they think is best for the patient, and carefully track use.
More scrutiny is needed to ensure proper prescription and use of medications, but doctors alone cannot be blamed for incorrect usage. Instead, the medical establishment, the government, and patients themselves must share the responsibility.
Today, doctors have less time with each patient, and patients frequently switch health-care providers. It means that doctors aren’t able to track patients as they once could.
Ideally, doctors would know exactly what a patient is taking. But without shared records, health-care providers often have incomplete information. This allows the unwitting use of dangerous drug combinations, or "doctor shopping," when patients get more drugs than needed from various sources by lying about what they are already taking.
One response: government-run, Internet-based, drug-tracking systems that keep tabs on who is getting what. Twenty-six states had prescription monitoring programs as of December 2007; nine more are planned, according to the Drug Enforcement Administration. These programs are imperfect—they only track prescriptions statewide, for example—but they help. Patients must also do their part by taking responsibility for their own drug use.
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