The accidental discovery of penicillin in 1928 has saved millions of lives over the last 80 years, and prescription drugs become increasingly more sophisticated as time marches on. With all of the lifesaving benefits that these medications can provide, there are also risks. Risks that can cause permanent damage or death to a patient.
To add fuel to the fire, it has become increasingly common for prescription medications to be used off label, or incorrectly alongside other medications—especially when it comes to treating a patient who may have multiple illnesses or injuries. Medications can also have severe adverse effects, dangerous drug interactions, and cause severe allergic reactions if not monitored properly.
When not monitored properly, even relatively safe prescription medications can become dangerous, let alone the ones already known to have potentially severe adverse effects. Severe adverse effects occur when a treatment causes a problem because it does more than treat the target issue, resulting in an unintended or harmful side effect.
Along with many benefits, come many dangers to taking prescription medications as well. Weighing the risk-reward, understanding the dangers of drug interactions, and keeping yourself informed of the prescription medications you are taking can mean the difference between a good outcome, and a life-threatening one.
What are Drug Allergies and Adverse Reactions?
A drug allergy is the abnormal reaction of your immune system to a medication. Any medication—over-the-counter, prescription or herbal—is capable of inducing a drug allergy. However, these allergic reactions are more likely with certain medications. The most common signs and symptoms of a drug allergy are hives, rash, or fever, but they can cause more serious reactions, including a life-threatening condition that affects multiple body systems called anaphylaxis.
A drug allergy is not the same as an adverse drug reaction, a known possible reaction listed on a label. A drug allergy is also different from drug toxicity caused by an overdose of medication.
An adverse drug reaction, also called a side effect, is any undesirable experience associated with the use of a medicine in a patient. Adverse events can range from mild to severe. Serious adverse events are those that can cause disability, are life threatening, result in hospitalization, death, or birth defects.
This type of warning is also commonly referred to as a “black box warning.” It appears on a prescription drug’s label and is designed to call attention to serious or life-threatening risks.
The FDA requires a black box warning if:
- The medication can cause serious undesirable effects, such as a fatal, life-threatening or permanently disabling adverse reaction, compared with the potential benefit from the drug. Depending on the health condition of the patient, the physician would need to decide with the patient whether the potential benefit of taking the drug is worth the risk.
- A serious adverse reaction can be prevented, reduced in frequency, or reduced in severity by proper use of the drug. For example, a medication may be safe to use in adults, but not in children. Or, the drug may be safe to use in adult women who are not pregnant.
What are Drug Interactions?
Drug interactions occur when a medication combines and interacts with other substances in the body, this can alter the effect of the medication. Additionally, this can cause the medication to be more or less potent than intended, or result in unexpected side effects.
A physician should be aware of whether or not a patient uses multiple medications, has pre-existing health conditions, or sees more than one physician at a time. All medications, herbs, supplements, and vitamins should be disclosed to the physician, recorded in the patient’s medical records, and taken into consideration when prescribing new medications.
Medical Malpractice and Incorrect Drug Dosing
Medications that can bring relief to suffering patients become dangerous if prescribed incorrectly. Recently, a man being treated for a painful scapula injury was given a fentanyl patch as a means to relieve his pain. The patch was prescribed and administered after the man had already received other painkillers in the ER, at the time of his injury. It was not made clear to him or his family how dangerous this particular type of medication and its delivery method could be.
The man later died of an opioid overdose sleeping in his recliner chair during the night Had his family known the risks, they could have accounted for them, instead he was negligently given more pain medication than his body could reasonably tolerate.
The issue the emergency room physician failed to consider was that his patient was opioid naïve. A term reserved for patients who do not take opioid pain relievers on a regular basis, or ever at all. These patients are unable to metabolize opioids at the same rate as regular opioid users considering tolerance levels.
What is Informed Consent in Regard to Medications?
Informed consent supports the patient’s ability to decide their course of treatment. It is the process in which the physician explains to the patient all of the risks of a procedure or treatment recommended. A physician must also explain what it would look like for the patient if they decided to forgo the recommended procedure or treatment, including any medications. The patient must be competent to make a voluntary decision.
The Joint Commission requires documentation of all the elements of informed consent “in a form, progress notes, or elsewhere in the medical record.”
The following are the required elements for documentation of an informed consent discussion:
- Nature of the procedure
- Risks and benefits and the procedure
- Reasonable alternatives
- Risks and benefits of alternatives
- Assessment of the patient’s understanding of elements 1 through 4.
It is the duty of the provider to make it clear that the patient is participating in the decision-making process and the patient is not obligated to agree with the physician’s recommendations, but rather clearly understands what they are.
What are the Five Most Dangerous Prescription Drugs?
Many things can cause prescription drugs to be dangerous in addition to points above, including a patient’s past addictions to other substances, family history of substance abuse, pre-existing conditions, exposure to peer pressure around drug use, and lack of knowledge about prescription medications and their potential harm.
While some prescription medications are certainly more harmful than others, always ensuring all the information has been provided and considered is critical.
What are the five most dangerous drugs currently being prescribed by physicians?
Opioids
Opioid overdose rates began to increase. In 2017, more than 47,000 Americans died as a result of an opioid overdose, including prescription opioids, heroin, and illicitly manufactured fentanyl, which is 100 times more powerful than heroin. Also within 2017, an estimated 1.7 million people in the United States suffered from substance use disorders related to prescription opioid pain relievers, and 652,000 suffered from a heroin use disorder (not mutually exclusive).
To add to the wild discrepancies already in place, as overprescriptions soar for white Americans, Black Americans are being consistently under prescribed pain medications. So while addiction rates are on the rise, the other side of the coin is continued systematic racism.
Methadone
Methadone, though technically used for pain relief, is often used as a heroine substitute for those battling the disease of addiction. Because it is considered to be less dangerous than heroin, it can be used to wean a patient off of the street drug, slowly. It is, however, still possible to overdose on methadone, and the risk increases when it is used in combination with other drugs, or when the dosage is changed significantly in a short period of time
Benzodiazepines
Unlike opioid painkillers, benzodiazepines are in a different class of tranquilizer drugs. These drugs are commonly prescribed for conditions such as anxiety and insomnia, and include commonly known medications such as alprazolam (Xanax), chlordiazepoxide (Librium), diazepam (Valium), and lorazepam (Ativan), as well as clonazepam (Klonopin), oxazepam (Serax), and temazepam (Restoril).
Issues tend to arise for those who take any of these medications for other than a very short period of time, as addiction can happen quickly. The side effects of withdrawal range from insomnia to grand mal seizures and delirium, if the medications are stopped too suddenly or if the dose is changed abruptly.
Stimulants for Attention Deficit Disorder
Attention Deficit Disorder is present in 4% of the adult population, and in up to 9% of the school age population. Most people diagnosed with ADD are treated successfully with medications such as Ritalin, which contain stimulants.
These medications become dangerous when they are overused or used off label as a recreational drug.
Anabolic steroids
Anabolic androgenic steroids are, strictly speaking, a prescription medication, although they are typically taken for non-medical reasons, particularly by people who want to increase their muscle mass. Bodybuilders and athletes, who are vulnerable to exercise addiction, are among those most likely to use these medications in a way that becomes dangerous.
In fact, several studies over the years have made it clear that the misuse of steroids is very dangerous to the user, as one 2015 study revealed that men who test positive for steroids had twice the rates of cardiovascular disease and death as those with negative tests. There is also an association between elevated aggression and violence in steroid users, and higher rates of violent causes of death, such as homicide and suicide.
The Safety of Prescription Drugs
Millions of people take prescription medications annually, and many of them do so safely, finding relief in the treatment they need. But at the end of the day, taking prescription medication is not without risk.
From the possibility of allergies, adverse reactions, addiction, and drug interactions, taking medications has the potential to extend or improve quality of life, and the potential to limit or end it. If your physician was negligent in prescribing a medication that caused harm, you may be able to hold that physician liable through a medical malpractice lawsuit.
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