Drug-Related ED Report

Almost one hundred years ago, prescription drugs like morphine were available at almost any general store. Women carried bottles of very addictive potent opiate based pain killers in their purse. Many individuals like Edgar Allen Poe died from such addictions. Since that time through various federal, state and local laws, drugs like morphine are now prescription drugs; however, this has not stopped the addiction to opiate based pain killers. Today’s society combats an ever increasing number of very deadly addictive drugs from designer drugs to narcotics to the less potent but equally destructive alcohol and marijuana. With all of these new and old drugs going in and out of vogue with addicts, it appears that the increase of misuse and

In 2017, up to November 11th, 580 emergency calls were placed regarding opioid-related overdoses in the Waterloo Region (1). Thus, the running total of calls in 2017 as of November 11th is already one-hundred and fifteen percent of the total calls for the 2016 year (1). From the year 2012, opiate-related overdose calls have raised three-hundred percent (1). Consequently, the issue of opiate overdose is clearly an important one.

B’s tolerance to opiates not considered, Mr. B.’s clinical situation not considered (i.e., Mr. B’s age and renal function), and knowledge deficit of opiates. Drilling down the data to identify the root cause of Mr. B’s death is the fifth step in conducting a RCA on Mr. B’s sentinel event. Upon analyzing the data, causative factors, and events leading to Mr. B’s sentinel event, the RCA team determined that the root cause of Mr. B’s death is a medication error. Mr. B was given an overdose of hydromorphone. The final step in a root cause analysis is to implement changes that will mitigate the root cause. Changes include educating the nursing staff about hydromorphone, such as side effects and adverse reactions,

To help combat the opioid crisis, there are some existing policies that have been set in place by the government and various agencies. For instance, the U.S. Centers for Disease Control and Prevention (CDC) have implemented the use of Prescription Drug Monitoring Programs (PDMPs). These state-run programs are electronic databases that track down the prescriptions of controlled substances, including opioids. Physicians and other medical personnel can utilize this database to look at specific information such as the type of drug prescribed, the quantity, and so on. In addition, they can look at a patient’s history with controlled substances, which in turn helps them to avoid the prescription of controlled substances to a person with possible

Opiates have been commonly used in the United States for several decades. During the late 19th century opium and morphine became regular ingredients in a lot of widespread patent medicines (Spohn & Belenko, 2015, p. 25). Since then, the use and abuse of opiates has been a serious epidemic that has been growing at a fast pace in the United States for many years now. Every day roughly forty-one people die from overdoses which are related to prescription painkilling drugs in the United States (Clark, 2014, p. 1).

“Substance use disorders” or “substance-related disorders” are intended synonymously and are used interchangeably when referring to the broad category of addiction to psychoactive substances. Additionally, the word “drug” should be considered in the context in which it appears and can refer to alcohol specifically and/or other psychoactive substances such as cocaine or heroin etc. Again, this is because of the large overlap within the broader category of substance use and the high prevalence of polysubstance use. For the sake of clarity, “drug” as used in North America to generally refer to any illicit or controlled substance has been avoided. Instead, “medication” will be used to denote a prescribed substance used to treat physical symptoms. However, many legally prescribed medications (such as morphine) can and are abused and have addictive quality, making them just as devastating as “street drugs” or alcohol (Compton & Volkow, 2006).

Prescription drug abuse is an increasingly rampant public health issue. The Centers for Disease Control and Prevention (CDC) has affirmed that the United States is in the midst of an epidemic of prescription drug overdose deaths (2010a). Drug overdose, especially related to the non-sanctioned consumption of prescription opioid analgesic (painkiller) drugs, is the second leading cause of deaths from unintentional injuries in the United States, surpassed only by motor vehicle mortalities (Girion, Glover, & Smith, 2011). In 2005, President Bush signed the National All Schedule Prescription Electronic Reporting Act (NASPER), which amends section 390O of the Public Health

Until recently, there was a dramatic disconnect between this research and drug court operations. The consequences of this disconnect included relapse, overdose, and death. While drug courts were designed to accommodate those in need of medical care, most operated under the misguided and dangerous practice of requiring defendants, as part of their successful program completion, to stop taking life-saving addiction medication prescribed by their physicians. This practice, which is at odds with decades of scientific and medical research, put individuals with opioid addictions in the precarious position of either having to stop taking their effective medication and risk relapse or use their medication and face incarceration. To compound matters

These efforts are focusing little attention on the source of the medications themselves, the access point -- the medical practitioner with a pen. In the current environment, a doctor, dentist, or nurse practitioner can write a prescription to anyone without accountability for the aftermath. In March the CDC convened to put forth guidelines for prescribing opioid medications in cases of chronic pain (Dowell, Haegerich, & Chou, 2016, pp. 1633-1641). The published guideline is a passive 12 point recommendation for prescribing practices without accountability, solutions, or intention to enforce better practice. To date, the national response to the crisis can be described as impotent at best, and the body count rises. “Drug overdose is the leading cause of accidental death in the U.S., with 52,404 lethal drug overdoses in 2015. Opioid addiction is driving this epidemic, with 20,101 overdose deaths related to prescription pain relievers, and 12,990 overdose deaths related to heroin in 2015.” (ASAM,

The present regulations are not as effective in reducing opioid use. New programs and uniformity among them will lead to a reduction in opioids. In the years 1999 to 2015, 180,000 people died from opioid related overdoses (CDC, 2017). Drug overdoses still present an ongoing threat in the United States. The medication that is healing the patient does not have proper monitoring and restrictions, thus allowing for an overdose problem to occur. A temporary fix tries to lower the number of overdoses, but with proper guidelines and stricter regulation on dosage, usage, and physician prescribing, the chances of overdosing and death due to overdose will be reduced over time. The programs in place now are not correctly

Opioid use in the US has increased over the years, and this has led to an increase in substance abuse. Substance abuse is not only associated with use of illicit drugs but also prescription drugs. In 2015, of the 20.5 million reported cases of substance abuse, 2 million had an abuse disorder related to prescription pain relievers and 591,000 associated with heroin.1 The increase in substance abuse disorder has led to an increase in opioid related death. In 2015 drug overdose was the leading cause of accidental death in the US with 52, 404 lethal drug overdoses.2

Prescription opioid misuse has emerged as a significant public health issue in the United States. Since the late 1990s, nationwide sales of prescription opioids have risen 4-fold, and with this, the rate of admissions for substance use treatment and the rate of death from opioid overdose have grown proportionately.1

The United States currently faces an unprecedented epidemic of opioid addiction. This includes painkillers, heroin, and other drugs made from the same base chemical. In the couple of years, approximately one out of twenty Americans reported misuse or abuse of prescriptions painkillers. Heroin abuse and overdoses are on the rise and are the leading cause of injury deaths, surpassing car accidents and gun shots. The current problem differs from the opioid addiction outbreaks of the past in that it is also predominant in the middle and affluent classes. Ultimately, anyone can be fighting a battle with addiction and it is important for family members and loved ones to know the signs. The cause for this epidemic is that the current spike of opioid abuse can be traced to two decades of increased prescription rates for painkillers by well-meaning physicians.

Drug Abuse Warning Network (DAWN) is a health surveillance program targeting patients from medical examiners, those in hospitals. The program also utilizes samples obtained from the victims who have died and taken to the mortuaries (Maxfield & Babbie, 2017). The information, in form of data, is gathered from individuals who report to the hospitals due to drug ingestions or those who have been injured or killed, in which drug intoxication was a contributor. The study population was 380,000 episodes of drug abuse that was gathered from sampling frame of patients from 242 hospitals which were sampled from 66 metropolitan areas. Collectively, the participating hospitals surrender information to the Drug Abuse Warning Network for analysis.

The problem with prescription drugs is that many people deny they are addicted to them, but the case is that many of these side effects from the drugs are leading to trips to the Emergency Room (ER). In 2013, the State of the County Health Report released a publication that explained the rates of acute poisoning by prescription drugs. According to the report released by the 2013 State of the County Health Report, “nearly forty percent of the visits of the Emergency Room visits for acute poisonings