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Feature: Prescription Drug "Fatal Medical Errors" Rising Dramatically -- What Does It Mean?

A study released this week charted a startling increase in deaths from "fatal medical errors," particularly those associated with people mixing street drugs and alcohol with prescription medications at home. In this context, "fatal medical error" refers to people dying from taking prescribed medications, usually opioids, but also including other drugs, such as benzodiazepines (Valium, for example).

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the pain reliever Oxycontin
But while the numbers have some in the medical community calling for tighter restrictions on prescribing, they have some in the pain relief community worrying about just that possibility. And they're leaving other interested observers wondering just how accurate they are, what they mean, and just who is dying.

According to the study by University of California at San Diego sociologist David Phillips, which examined all US death certificates from the beginning of 1983 to the end of 2004, the overall death rate from fatal medical errors increased more than three-fold over that period, but the death rate from fatal medical errors when the drugs are taken at home and combined with alcohol and/or street drugs has increased a whopping 30-fold.

That means that accidental overdoses at home with alcohol or street drugs involved accounted for 17% of fatal medical error deaths in 2004. That's a seven-fold increase over the 2.3% reported in 1983.

In real numbers, the study found 22,770 fatalities from medication errors in 2004, with 3,792 of them attributed to mixing meds with alcohol or other drugs. In 1983, by contrast, only 92 people died from mixing drugs.

The increase in fatal medical errors involving prescription drugs is larger than the increase in the use of prescription drugs themselves, which has increased about 70% in the last decade.

Fatal medical errors involving prescription drugs dispensed in a hospital or doctor's office setting increased only 5%, while such errors involving home use but no street drug or alcohol use and such errors involving medical settings and alcohol and/or street drug use both increased five-fold.

Phillips and his coauthors pointed their finger at the ongoing migration of prescription drug dispensing from medical professionals at hospitals and doctors' office to patients at home. The decades-long shift in the location of medication consumption from clinical to domestic settings, they said, "is linked to a dramatic increase in fatal medication errors."

It is not just people swallowing prescription pills at home, but the involvement of other drugs in the overdoses that is disturbing, they said. "Domestic fatal medication errors, combined with alcohol and/or street drugs, have become an increasingly important health problem."

The study recommended increased screening for patient abuse of prescription drugs, alcohol, or street drugs, as well as increased vigilance toward prescribing medicines with known dangerous interactions with alcohol or street drugs.

But others in the medical profession are taking the study's findings and running with them. One medical blogger looking to restrict access to pain meds put it like this: "What is going on here is a direct result of politicizing medicine by the pain rights movement and the organizations that have mandated liberal pain management into guidelines and enforcement standards. More recently the push to promote patient satisfaction in healthcare organizations has resulted in liberalizing of prescribing opioid medications to make patients happy. Whatever happened to do no harm? Medicine has lost its way. These numbers should serve as a wake up call and re-examination of pain management practices."

And that is, unsurprisingly, raising hackles in the embattled pain relief movement. Pain relief advocates have long argued that access to effective opioid pain medications is too restricted, pointing to numerous cases of doctors prosecuted and imprisoned for their prescribing practices -- and the patients being left in the lurch.

"The pain relief movement had made only modest gains when it was faced with a government-wide crackdown, led by the Justice Department," said Siobhan Reynolds of the Pain Relief Network. "Now, those who know that they could find help in the form of opioids, find themselves shut out of care and stigmatized by the entire system. I don't think I have ever seen a more destructive phenomenon sweep this country... all in the name of a drug free America, an America which could never exist."

It's not pain patients who are dying of opioid overdoses, said California pain management physician Dr. Frank Fisher. "I've analyzed dozens of these deaths now, and the field of forensic pathology is in such disarray that any time they find an opioid post-mortem, they label the death an overdose," he said. "But pain patients almost never overdose because of the phenomenon of tolerance -- unless it's a massive deliberate overdose, and then they have to take the benzos, barbiturates, or alcohol."

"It's true that it's very hard for an opioid tolerant person to overdose -- if they know what they're doing," said Dr. Matt Das Gupta, an epidemiologist working with North Carolina's Project Lazarus, a program that distributes the opioid antagonist naloxone (Narcan) to drug users to prevent overdoses. But mixing opioids with other drugs or alcohol can fell even the hardiest opioid tolerant patient, he warned.

Most pain patients are dying of cardiac disease, said Fisher. "Heart disease kills pain patients because they're sedentary because of their conditions and they're under stress from chronic pain. What I'm seeing is an epidemic of cardiac disease brought on or exacerbated by chronic pain. Medical examiners are calling them overdoses because they have opioids in their systems, but the medical examiners are wrong when it comes to chronic pain patients."

Suicides among pain patients are no surprise, said Fisher, but they tend to be undercounted. "Unless they leave a note, the medical examiner never calls it suicide, they will call it undetermined or accidental overdose. The medical examiners are giving us terrible data," he complained.

"Medical examiners not coding properly is a perennial problem," said Das Gupta. But that could go both ways. "There are people who died who probably should be included, but were not coded as ODs. For example, one code is chronic use of opioids. If you include that, the numbers go up by 10% or 15%."

(For more on the controversies surrounding drug-related deaths, cause of death coding issues, and associated topics, check out this page at Brian C. Bennett's web site, Truth: The Anti-Drug War.)

While pain relief advocates such as Reynolds and Fisher are concerned primarily with protecting patients' access to effective opioid pain relievers, harm reductionists such as Das Gupta are concerned primarily with preventing overdoses and other deaths related to drug use. While the harm reduction movement has traditionally focused on the use of street drugs, like cocaine and heroin, the rapid increase in prescription drug deaths may be a sign that it needs to broaden its focus.

"When you look at deaths at the state level and start to pull actual medical examiner case files, you find that the people dying are really a mix of pain patients, non-medical opioid users, and heroin users," said Das Gupta. "Here in North Carolina, we found that 80% of prescription overdose deaths were people with prescriptions. That doesn't mean they were chronic pain patients, though; they could have been people scamming docs. What we have is a really heterogenous mix, and the way things are coded doesn't offer enough nuance."

Project Lazarus is trying to adjust, he said. "We've been tweaking traditional programs to a different setting. Instead of using needle exchange programs, we're doing it through doctors' offices," explained Das Gupta. "Anyone who prescribes opioids for pain in North Carolina should be considering naloxone for specific populations," he said. "There is an ethical responsibility for physicians not to endanger their patients' lives."

"We're working on overdose prevention here in New York, but the people we have had access to are the heroin users," said Dr. Sharon Stancliff, medical director for the Harm Reduction Coalition, for whom she oversees drug overdose prevention projects in New York and San Francisco. "But the bigger problem is people misusing or abusing opioids. We need to be getting information out to the general practitioners who are prescribing these drugs. They need to be prescribing Narcan with all those meds," she suggested.

"We need to change the national agenda about overdose prevention," said Stancliff. "Naloxone is an answer, but it's not the only answer. We need naloxone, we need education, we need more research."

And, Stancliff added, the federal government needs to quit being an obstacle and start helping to solve the problem. "We don't have an early alert system, we have really bad surveillance, we're not getting the research done," Stancliff complained. "We don't know who is dying -- is it the people being prescribed the drugs? Is it people they're giving them to? Is it illicit drug users? We don't know enough. The Centers for Disease Control don't quite cover this, and it should be a Substance Abuse and Mental Health Services Administration (SAMHSA) issue, too. Maybe in the next administration, when harm reduction isn't a dirty word."

Medical Marijuana: DEA Seizes Medical Marijuana Seized By Seattle Police

Washington state has a medical marijuana law, and the city of Seattle has an ordinance making marijuana offenses the lowest law enforcement priority, but that didn't stop Seattle police from raiding the Lifevine medical marijuana co-op two weeks ago, seizing hundreds of patient files, as well as 12 ounces of dried buds and several pounds of leaf.

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California medical marijuana bags (courtesy Daniel Argo via Wikimedia)
In the wake of pointed criticism, King County Prosecutor Dan Satterberg declined to press charges against co-op operator Martin Martinez and ordered the return of the patient files. But police did not return the co-op's stolen property -- the medical marijuana.

Now, it has become clear the medical marijuana will never be returned. The Seattle Police announced Wednesday that the DEA, acting at the request of US Attorney Jeff Sullivan, took the medicine last Friday.

The DEA tersely confirmed it had seized the medicine. "Accordingly, the DEA has seized and processed the marijuana for destruction; that concludes this matter," agency spokesperson Jodie Underwood said in a statement reported by the Associated Press.

Probable Cause: Washington Supreme Court Rules Marijuana Smell in Vehicle Not Enough to Arrest All Occupants

The Washington Supreme Court ruled July 17 that police cannot arrest passengers simply for being in a car that smells of marijuana. The unanimous decision overturned a 29-year-old precedent allowing police to search or arrest passengers if they smelled pot near a car.

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The case, State v. Grande, began with a 2006 traffic stop in Skagit County. Driver Lacee Hurley and passenger Jeremy Grande were arrested by a state trooper during a traffic stop after he smelled pot coming from their car. The trooper searched the pair, finding a pipe and a small amount of pot on Grande. Both were charged with drug offenses. At a pretrial hearing, Grande's judge ruled there was no specific probable cause for his arrest and suppressed the evidence. But the Skagit County Superior Court overturned that ruling, citing a 1979 appellate court ruling saying the smell of pot smoke coming from a car was probable cause to arrest all the occupants.

But the state Supreme Court said federal case law since 1979 has eroded the legal footing of that decision. Officers need additional evidence that each passenger broke the law, the court held.

"Our cases have strongly and rightfully protected our constitution's protection of individual privacy. The protections... do not fade away or disappear within the confines of an automobile," Justice Charles Johnson wrote for the court.

"We hold that the smell of marijuana in the general area where an individual is located is insufficient, without more, to support probable cause for arrest. Where no other evidence exists linking the passenger to any criminal activity, an arrest of the passenger on the suspicion of possession of illegal substances, and any subsequent searches, is invalid and an unconstitutional invasion of that individual's right to privacy," the opinion concluded.

The ruling won quick praise from drug reformers and civil libertarians. "As a general statement, it's a step back from the direction that our government has been going as we're veering into a sort of surveillance society," Alison Holcomb of the American Civil Liberties Union's Washington chapter told the Seattle Post-Intelligencer. "It strikes me as refreshing that the court has reaffirmed the values that our constitution calls for."

Seattle Hempfest organizer Vivian McPeak told the newspaper it was not uncommon for people to be arrested, jailed, stigmatized, and have their property seized simply for being in a vehicle with someone carrying or smoking pot. "A lot of people have gone down because of these vehicle offenses," he said. "Being in a car used to be one of those wrong-place, wrong-time kind of situations."

Grande's attorney, David Zuckerman, cheered the ruling, but added it was "unfortunate" it took so long to overturn previous state case law on drug-smell arrests. "I think it's led to an awful lot of innocent people getting handcuffed by the side of the road just because they happened to be in a car that smells of marijuana," Zuckerman said.

Medical Marijuana: Whole Plant Better Than Isolated Components in Pain Relief, Italian Study Finds

Scientists at the University of Milan have published a study finding that whole-plant marijuana extracts provide better relief for neuropathic pain than isolated components of the plant, like THC alone. The research is an intervention in the ongoing debate between medical marijuana supporters and herbal and alternative medicine advocates on one side and the US government, some politicians, and the pharmaceuticalized medicine industry on the other.

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Marinol advertisement on Google
"The use of a standardized extract of Cannabis sativa... evoked a total relief of thermal hyperalgesia, in an experimental model of neuropathic pain,... ameliorating the effect of single cannabinoids," the investigators reported. "Collectively, these findings strongly support the idea that the combination of cannabinoid and non-cannabinoid compounds, as present in extracts, provide significant advantages... compared with pure cannabinoids alone."

Congressional drug warriors like Rep. Mark Souder (R-IN) have long argued that marijuana is not a medicine and that any medicinal compounds in the plant should be isolated or synthesized, as is the case with Marinol, which contains one of the hundreds of cannabinoids found in the plant. The DEA takes a similar approach.

But this latest research only adds to the evidence that that position is mistaken.

A Revealing Remark From the Deputy Drug Czar

Deputy Drug Czar Scott Burns visited Arcata, CA last week to see "America’s grow house capitol" firsthand. After meeting with local authorities and accompanying police on a few marijuana raids, he said this:

…regarding enforcement, Burns seemed to offer a mixed message. While unyielding in asserting that federal law holds marijuana illegal under all circumstances and trumps all state and local medical cannabis laws, Burns nonetheless advised Arcatans to “defer 100 percent good judgment of the people who have been elected and appointed” while motioning to those present in the APD conference room. But most of them are working on guidelines under which medical marijuana may be safely cultivated and dispensed. [Arcata Eye]

I just cannot possibly point out often enough that the conflict between state and federal drug laws doesn't marginalize the value of state-level reforms. The deputy drug czar doesn’t arrive in California with a convoy of DEA super-narcs to slash and burn everything in sight. He can't do that and he knows it, as his remark clearly illustrates.

The federal war on medical marijuana is a political strategy designed to create the appearance of chaos in order to deter other states from implementing medical marijuana laws. Medical marijuana is more available than ever before, notwithstanding sporadic DEA activity in California. Yet we still hear folks suggesting that "the DEA will just swoop in and ruin everything" if we pass new marijuana reforms at the state-level. To be clear, the DEA has ruined many lives, but it has not ruined California's medical marijuana law. That should be obvious to all of us.

The DEA cannot overcome the will of voters and I'm tired of seeing the press and even some reformers helping them pretend they can.

Europe: Austrian Parliament Okays Medical Marijuana, But Only State Agency Can Grow It

The Austrian parliament approved a bill July 9 that allows for the cultivation of marijuana for medical and scientific purposes, Agence France-Presse reported. But the bill gives the exclusive right to grow marijuana to a health and food safety agency under the control of the Health Ministry.

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Maria-Theresien-Platz with Kunsthistorisches Museum and Hofburg Palace in background, downtown Vienna
Still, it is progress, said Michael Bach, president of the Austrian pain studies association OeSG. "Any initiative that makes it possible to develop and provide new drugs for pain therapy is welcome," he said. "Substances drawn from cannabis have been used for medical purposes more and more in the last few years," he added.

It is unclear whether or how quickly this move will result in the provision of medical marijuana to patients or whether it signals a softening of official attitudes toward medical marijuana users. Currently, possession or sales of marijuana will get you six months in prison in Austria.

Chronicle Book Review: "Dying to Get High: Marijuana as Medicine," by Wendy Chapkis and Richard J. Webb (2008, NYU Press, 244 pp., $22.00 PB)

Click here to order this book today!

Phillip S. Smith, Writer/Editor

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In "Dying to Get High," sociologists Wendy Chapkis and Richard Webb have written a sympathetic yet academically rigorous account of the contemporary controversies surrounding medical marijuana. They trace the use of marijuana as medicine in the US, its decline as a medicine in the early 20th Century, its removal from the pharmacopeia in 1941 (just four years after it was banned by federal law), the continuing blockage of research into its medical benefits by ideologically-driven federal authorities, and the renaissance of medical marijuana knowledge today, much of it derived from -- gasp! -- patients, not doctors or researchers.

As sociologists, Chapkis and Webb have a keen eye for the broader social, cultural, and political forces surrounding the issue of medical marijuana, from the rise of the pharmaceutical and medical establishments to the "culture war" contempt for marijuana and users among many Americans. But as much as middle America may disdain pot-smoking hippies, it seems that it is marijuana's location on the wrong side of the modern scientific and pharmaceutical discourse that most hinders its acceptance as a medicine.

Pot is a plant, not a pill. It is an herbal medication, not a chemical compound. It is a "crude plant material," not a "pure drug." All of this, Chapkis and Webb suggest, make it difficult indeed for the medical and scientific establishment to wrap its head around medical marijuana. And when scientific bias is coupled with cultural disdain and fear of widespread "abuse," that the federal government remains resistant to medical marijuana is hardly a surprise.

Chapkis and Webb deliver a resounding, well-reasoned indictment of the political and (pseudo) scientific opposition to medical marijuana, and their succinct discussion of the issues surrounding the controversy is worth the price of admission.

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But "Dying to Get High" is also an in-depth portrait of one of the country's most well-known medical marijuana collectives, the Wo/Men's Access to Medical Marijuana (WAMM) collective in Santa Cruz, California, and it is here that the authors are really breaking new ground. They go from the big-picture sociology of medical marijuana in the past century to narrowly focus on ethnography of a patient collective, describing in loving detail the inner workings, dynamics, and tensions of a group with charismatic leadership -- Mike and Valerie Corral -- more than 200 seriously ill patients, and the specter of the DEA always looming.

Their account of the emergence and permanence of WAMM is both moving and enlightening. Rooted in the fertile soil of Santa Cruz, already well-tilled by previous social movements such as feminism, gay rights, and AIDS activism, WAMM may only have been possible in a place that friendly to radical movements and that familiar with activism around issues of medical care and social justice. Chapkis and Webb chart its formation, its growth, its conflicts and problems, and the humanity of its suffering members.

They also tell the story of the 2002 DEA raid on the WAMM garden and its devastating impact on members. But that raid and its aftermath were not just a blow to the sick and dying, they were a call to arms, impelling WAMM into ever more overtly political action to protect itself and the broader movement.

More broadly, Chapkis and Webb do a great service by dissecting WAMM, looking at how it works, how it handles dysfunction, and how it provides a service far beyond mere medical marijuana to its members. WAMM is perhaps the model medical marijuana collective, and it has many lessons to offer the interested reader.

Would a WAMM-style collective work elsewhere? Chapkis and Webb emphasize the importance of the cultural and political backdrop in Santa Cruz in making WAMM possible, but I think the very emergence of WAMM as a successful collective makes the possibility of similar collectives coming into being elsewhere all the more likely. After all, even California as a whole is not as radicalized as Santa Cruz or San Francisco, but similar collectives are popping up in Santa Rosa and the San Fernando Valley, among other places.

In any case, Chapkis and Webb provide plenty to chew on, for those who want to pick up some historical knowledge and debating points, for those interested in the genesis of the contemporary marijuana movement, and for those who are pondering the viability of similarly radical approaches to health and self-organizing.

Click here to order this book today!

Medical Marijuana: Seattle Police Seize Hundreds of Patient Files in Raid on Co-op

Seattle police who acted after a bicycle officer smelled marijuana seized files on nearly 600 medical marijuana patients Tuesday, the Associated Press reported. After consulting with prosecutors, police raided the Lifevine cooperative and seized 12 ounces of marijuana and a computer, as well as the patient files.

According to Martin Martinez, who heads the co-op as well as Cascadia NORML, no marijuana was being grown at the scene and no one was arrested. The patient files were on hand because Cascadia NORML was preparing ID cards and needed proof the patients were legitimate, he said.

Under Washington's medical marijuana law, patients can have a 60-day supply of marijuana. The law does not define that quantity, but the state Health Department this month proposed that it be defined as 24 ounces of usable marijuana, and six mature and 18 immature plants. Seattle voters in 2003 passed an initiative making adult marijuana possession offenses the lowest law enforcement priority.

Apparently somebody in the city's law enforcement establishment didn't get the message. A spokesman for the King County prosecutor's office told the AP that police consulted a deputy prosecutor before raiding the co-op. The Seattle police have so far not commented.

Martinez and Seattle medical marijuana attorney Douglas Hiatt said they tried to persuade police and the deputy prosecutor not to raid the premises since the state's medical marijuana law was not being violated. But that didn't work.

The police "have a heck of a lot of patient records I don't think they should have," said Hiatt. "For one thing, those records are protected under federal privacy laws. If you're a medical marijuana patient, you don't want the police to know who you are or where you live, and this is why -- because you don't get treated very well."

Washington ACLU attorney Alison Chinn Holcomb told the AP there was no evidence the co-op was growing or providing marijuana and no information so far revealed that would justify seizing patient records. "These are very sick people with very serious conditions, and we're sure none of them want the nature of those conditions made available to the public or to anyone who doesn't have a valid need for it," she said.

Medical marijuana on Retirement Living TV

Debate rages nationwide over the use of marijuana for pain relief: http://www.rl.tv/VIEWPOINT/.

Hope Unlimited San Diego Cannabis Support Group Meeting

Hope Unlimited San Diego Cannabis Support Group is proud to welcome Jeff W. Jones, Executive Director of the Patient ID Center (PIDC) -- formerly known as Oakland Cannabis Buyers Cooperative (OCBC) -- to our July 24th meeting! Free food - come meet other patients, growers, caregivers, friends, family of the San Diego medical cannabis community! This is a relaxed, chill place to make new friends, learn about San Diego cannabis politics, how to get involved, MEETING A CAREGIVER, GROWER...some of many possibilities at a Hope meeting! The goal of PIDC is to provide seriously ill patients with a safe and reliable source of medical cannabis information and patient support. Our cooperative is open to all patients with a verifiable letter of recommendation for medical cannabis used to alleviate or terminate the effects of their illnesses. The PIDC is currently unable to dispense medical cannabis due to federal court order -- this ruling is currently under appeal and we will post updates as they become available. Federal statutes currently prohibit the use of cannabis as medicine. However, scientific evidence, including anecdotal evidence, documents the relief that cannabis provides to many seriously ill patients. The cooperative is dedicated to reducing the harm these patients encounter due to the prohibition of cannabis. PIDC's offices are multi-faceted facilities, accessible to people with disabilities. We provide a professional atmosphere for patients to obtain photo ID cards qualifing them under the Health and Safety Code section 11362.5, with trained member advocates on hand to offer advice and assistance. We also offer self-help services such as cultivation meetings and massage therapy by appointment. In addition, PIDC provides information on a variety of topics, including AIDS prevention and treatment, safe sex, and cannabis reform in general. (See our calendar.) The Patient ID Center currently operates under the auspices of California Proposition 215 and Oakland City Council Resolution No. 72516. Resolution 72516, and pursurant to Oakland Municpal Ordinance 8.42. Furthermore, the city has appointed a working group to oversee PIDC functions and to determine the most effective means to protect and assist seriously ill patients. For more information, see: www.hopeisunlimited.blogspot.com & www.hopeforfree.blogspot.com, or contact cannabiscaregiver@yahoo.com or 414.418.0140.
Date: 
Thu, 07/24/2008 - 8:00pm
Location: 
3949 North Ohio Street (in the North Park neighborhood)
San Diego, CA 92104
United States

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