A Vancouver, Canada study has documented
that 12% of emergency room (ER) visits were the direct
result of problems with a pharmaceutical drug. The length
of stay for those admitted to the hospital was significantly
When a study is well-designed, it's quite remarkable
how often the result documents the high risks associated
with conventional medical care. Once again, it's clear
that pharmaceutical drugs carry great risks. However,
as discussed at the end of this article, this study
documents only a very small proportion of harm done
by pharmaceutical drugs.
The study, reported by the Canadian Medical Association
Journal, was carefully designed by a panel of eleven
pharmacists and doctors. The hospital was Vancouver
General Hospital, which is large (955 beds) and offers
a wide range of services, including emergency care.
About 69,000 patients are treated every year.
The study team practiced the data collection process
on real patients during a four week trial period. Three
pharmacy research assistants who had been through pharmacy
residency collected the data. The attending physician
was asked his or her opinion of the reason for admission.
If there was a discrepancy between the physician's and
pharmacist's opinions, a panel consisting of one emergency
doctor and one pharmacist adjudicated. To be included
in the study, both panel members had to agree, with
a high degree of certainty, that the cause was pharmaceutical.
Patients were randomly selected through use of a computer
random number generating program. Any patient who had
been transferred from another hospital or was returning
for a scheduled visit was not included.
During the course of the study, 14,911 emergency patients
were seen by the hospital. Of those, 1,194 were randomly
selected and considered for the study. The number of
study patients was 1,017. Of these, 122 -- 12% -- were
seen for prescription drug-related problems. Of those,
the study determined that 83 -- 68% -- were preventable.
Characteristics of patients who were in ER for pharmaceutical
* Average age was 51.9.
* 62 (50.8%) were female.
* Number of comorbidities (other conditions) was 2.5
* Only 8 (6.8%) of the 117 used any complementary or
alternative medications. The authors never stated whether
they were the cause of any of the ER visits. However,
of the people in ER for non-drug related reasons, 11.1%
had used complementary/alternatives. That is, the alternative
medicine users were 61.2% less likely to require ER
services for complications with pharmaceuticals. (This
point was not made by the authors, but the data clearly
supports the statement.)
The most significant types of drugs that sent people
to the ER are as follows:
* Antimicrobial agents (mostly antibiotics), 11.2%
* Opioids, 11.2%
* Antipsychotics, 9.5%
* Benzodiazepines, 6.1%
The authors defined 68.0% of the pharmaceutical-caused
ER visits as preventable.
Severity of the incidents were classed as:
* Mild, 19 cases (15.6%), not requiring treatment.
* Moderate, 91 cases (74.6%), requiring treatment or
hospital admission, or resulting in non-permanent injury.
*Severe, 12 cases (9.8%), life threatening or resulted
in permanent disability.
Causes of drug-induced ER visits were defined as
* Adverse drug reactions, 393%
* Non-adherence to instructions, 27.9%
* Wrong or suboptimal drug, 11.5%
36.9% of those who went to the ER because of pharmaceutical
problems were hospitalized, while 21.0% who went for
other reasons ended up hospitalized. The median length
of stay for the drug-related cases was significantly
longer: 8 days, 2 days longer than the non-drug cases.
What This Study Shows Us
It's certainly interesting that we can confidently state
that pharmaceutical drugs account for 12% of emergency
room visits. This, though, is probably a very small
percentage of the true pharmaceutical holocaust. Most
drug-induced illnesses are never officially acknowledged.
When a person develops Cushing's syndrome, the fact
that it was likely caused by prescribed steroids is
not generally noted and would not have been picked up
by this study. In fact, the host of serious illnesses
caused by steroids would not have shown up. The multitude
of people who have become diabetic or developed heart
disease is not figured in here. Other drugs, such as
beta blockers, cause a huge amount of illness, though
the connection between the drug and the illness is rarely
The effects of pharmaceutical drugs are rarely benign.
There is usually a price to be paid for using them.
Occasionally, the price is a trip to the ER, or even
death directly induced by the drug. In far more cases,
though, the effects are seen months, often years, later,
and the connection to the drug is never made.