OxyContin formula change has many abusers switching to heroin

Researchers at the Washington University in St. Louis have found that the frequently abused prescription medication, OxyContin, is now leading drug abusers to switch from OxyContin to heroin as a result of a recent change in the drug's formulation.  An abuse-deterrent formulation was introduced in August 2010.  The researchers at Washington University examined the effect of the change in formulation with regard to the abuse of OxyContin and other opioids.

The painkiller's new formula makes inhaling or injecting the drug more difficult. This has led to a switch to heroin.  So while the abuse of OxyContin has decreased, which is good, the problem is that there is now a surge in the use of heroin.  This may lead to an increase in heroin related overdoses and other public health and safety issues associated with the street drug.

The Washington University scientists published their findings in the New England Journal of Medicine:

Cicero TJ, Ellis MS, Surrat HL. Effect of abuse-deterrent formulation of OxyContin.  The New England Journal of Medicine, July 12, 2012.

Medical errors cause up to 98,000 deaths and more than 1 million injuries each year in the United States

Dr. Christopher Landrigan

In 1999 a report from the Institute of Medicine stated that medical errors cause up to 98,000 deaths and more than 1 million injuries each year in the United States.  There was a major response from a number of concerned groups to improve patient safety.  Some initiatives have been demonstrated to have a positive effect.  Others have not been evaluated rigorously or have not been implemented on a wide scale.


A "Special Article" in the New England Journal of Medicine by Christopher Landrigan, et al. eloquently notes that not much improvement has actually occurred.  The article, "Temporal Trends in Rates of Patient Harm Resulting from Medical Care" is a must read for those concerned about patient safety.  Soon after it's publication, Denise Grady of the New York Times wrote an article based on the study by Dr. Landrigan.


In the decade that passed since the report from the Institute of Medicine, only 17% of hospitals have computerized systems for ordering prescriptions, which is a source of medication errors.

Incidence of adverse events and negligence in hospitalized patients: results of the Harvard Medical Practice Study I*

Here's an abstract of an interesting article, which first appeared in the New England Journal of Medicine and was subsequently republished:

Background: 

As part of an interdisciplinary study of medical injury and malpractice litigation, we estimated the incidence of adverse events, defined as injuries caused by medical management, and of the subgroup of such injuries that resulted from negligent or substandard care.

Methods: We reviewed 30 121 randomly selected records from 51 randomly selected acute care, nonpsychiatric hospitals in New York State in 1984. We then developed population estimates of injuries and computed rates according to the age and sex of the patients as well as the specialties of the physicians.

Results:  

Adverse events occurred in 3.7% of the hospitalizations (95% confidence interval 3.2 to 4.2), and 27.6% of the adverse events were due to negligence (95% confidence interval 22.5 to 32.6). Although 70.5% of the adverse events gave rise to disability lasting less than 6 months, 2.6% caused permanently disabling injuries and 13.6% led to death. The percentage of adverse events attributable to negligence increased in the categories of more severe injuries (Wald test x2 = 21.04, p,0.0001). Using weighted totals we estimated that among the 2 671 863 patients discharged from New York hospitals in 1984 there

were 98 609 adverse events and 27 179 adverse events involving negligence. Rates of adverse events rose with age (p,0.0001). The percentage of adverse events due to negligence was markedly higher among the elderly (p,0.01). There were significant differences in rates of adverse events among categories of clinical specialties (p,0.0001), but no differences in the percentage due to negligence.

Conclusions: There is a substantial amount of injury to patients from medical management, and many injuries are the result of substandard care.