Death Diaries for Patients by Dr. Roneet Lev

Step 12 Magazine Death Diaries

Judy Garland, Marilyn Monroe, Elvis Presley, Prince, Michael Jackson, Heath Ledger, all world famous entertainers from different eras and backgrounds who share one distressing distinction; each died of an accidental prescription drug overdose. While these deaths are well known, thousands of men, woman and children—who are not rich or famous—die without ever being noticed. Despite that, chances are you know someone who died of an accidental prescription overdose. Sadly, none of the people who die intend to overdose.

In 2015, the San Diego’s Medical Examiner’s office worked with the California Controlled Substance Utilization and Review and Evaluation System, CURES, to look at the prescriptions people took in the year before they died. We called this study the San Diego Death Diaries because they tell the story of a person’s life through prescription drug use and abuse. Every day in the United States, over one hundred people die from accidental medication overdoses. The majority, seventy-eight a day, die as a result of prescription painkillers.

In 2013, in San Diego County, 254 people died from prescriptions; 186 had data on CURES. This group received 4,366 prescriptions for thirty-three different types of medications, from 713 different physicians, and 275 pharmacies. Eighty percent died from a cocktail of several medications. Methadone was the cause of death in forty-six people; in twelve others, methadone was most responsible for deaths related to a single medication.

Do people die if they take their medications exactly as they are told? The answer is, yes, but in significantly lower numbers. Of the 254 people who died, forty-two (16.5%) died using the medication in the doses and intervals they were prescribed, and not combining their medication with drugs or alcohol. There are risks even when taking medication as prescribed—let alone taking too many or mixing medication with alcohol or over-the-counter medication.

As much as we wish for everyone to be pain and anxiety free, it is not always possible. Patients—especially those in recovery—need to ask themselves: do I really need this? Ask the same question of your doctor.

Here are some tips cultivated from studying the Death Diaries. Please remember that these recommendations do not replace talking with your doctor about your medications.

Take medications only as prescribed. There is a fine line between a medication being helpful and being a poison. No extras. More is not better.

Do not share your medication. While your intentions may be good, you may be hurting, not helping.

Use only one doctor and one pharmacy for coordinating your medications. Many patients have different doctors: primary care, psychiatrist, and surgeon, but there must be one who is coordinating the medication to avoid drug interactions.

Beware of sleeping pills and Benadryl. Sleep aids depress your central nervous system and have an additive effect on painkillers and anxiety medications. Sleep aids stop being effective after continued use. It is best to use non-medication methods of getting sleep when necessary.

Avoid being on pain and anxiety medications at the same time. More than half of the Death Diaries showed this combination. Many people are anxious and in pain, but that does not take away from the risk this combination causes.

Do not assume that, because you have been taking your medication for years, they are safe. Sometimes your family and friends are able to see changes in you that you cannot see, ask them about it.

With pain medications one must beware of time lapses between dosages. Your pain receptors adjust over time and many people die assuming they can handle the dosage because they did before.

Realize there are many alternatives to pain medication. You need to understand your pain, have realistic expectations of pain management, and use alternative methods of care, including ice, heat, massage, acupuncture, acetaminophen, and ibuprofen.

Prescription medications can be lifesavers, but when they are misused, unintentionally or otherwise, they can become prescriptions for death. Use this information to reduce your chances of becoming a prescription drug casualty.