October 24, 2012
Nonprescription Drugs as Likely to Poison Patients
as Prescriptions

Rochester, NY—In terms of poisoning potential, products found on drug stores’ open shelves can sometimes be as dangerous as those behind the pharmacy counter.

That’s according to a new study that notes nonprescription medications are just as likely a cause of poisoning from misuse as prescription drugs. The study, from Timothy Wiegand, MD, of the University of Rochester, New York, Medical Center and colleagues, analyzes the data from the second annual report of the Toxicology Investigators Consortium (ToxIC) and was published online recently by the Journal of Medical Toxicology.

A case registry established by the American College of Medical Toxicology in 2010, ToxIC, acts as a real-time surveillance system to identify current poisoning trends. The researchers analyzed the 2011 data, including all cases involving medical toxicologists at 28 participating centers during that time period.

Of the 10,392 cases in the registry, 53% involved patients in emergency departments. Pharmaceutical overdoses occurred in 48% of patients—a combination of intentional overdoses in 37% of patients and unintentional in 11% of patients.

The most common classes of medications accounting for toxicology consultations were sedative–hypnotics (23% of cases), nonopioid analgesics (21%), opioids (17%), antidepressants (16%), stimulants/sympathomimetics (12%), and ethanol (8%).

Of the 35 deaths from medication overdoses in the database in 2011, 10 were attributed to opioids and eight to nonopioid pain relievers, primarily acetaminophen but also aspirin and NSAIDS. Of the opioid-related deaths, six involved oxycodone and three involved heroin.

From 2010 to 2011, a substantial increase in consultations was observed for designer drugs, such as psychoactive “bath salts” and synthetic cannabinoids, the researchers note, with overall numbers doubling from 6% of all registry entries in 2010 to 12% in 2011.

“Entries involving psychoactive drugs of abuse also increased twofold from 2010 to 2011 jumping 3 to 6%, primarily due to increasing frequency of synthetic cannabinoid (“K2”) related intoxications as 2011 progressed,” they add.

While an intensive focus on opioids is certainly warranted, according to the authors, more of a spotlight should be put on other drugs, such as sedative-hypnotics.

“Much of the current concerns about prescription medication abuse have centered on opioids, and while opioids are certainly of greater concern in regard to morbidity and mortality related to overdose, the data reported here suggest that emphasis should also be placed on sleeping pills,” Weigand said. “Our data also suggest that while medication abuse is a major problem, restricting our concerns to prescription drug abuse fails to acknowledge the major contribution of nonprescription agents to healthcare resource utilization."

U.S. Pharmacist Social Connect