Pharmaceuticals Cause One in Nine ER Visits

by Heidi Stevenson

9 August 2009

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 longer.

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 them.

Study Design

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 problems:

• 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.)

Study Results

The most significant types of drugs that sent people to the ER are as follows:

• Antimicrobial agents (mostly antibiotics), 11.2%
• Opiods, 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 nonpermanent injury.
• Severe, 12 cases (9.8%), life threatening or resulting in permanent disability.

• Adverse drug reactions, 39.3%
• Nonadherence 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.

The Irony

We can confidently state that pharmaceutical drugs account for 12% of emergency room visits—and it's 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.

The effects of pharmaceuticals are rarely benign. Their use usually exacts a steep price—occasionally, a trip to 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.

As this study documents, it is clear that about 12% of hospital emergency visits are the result of pharmaceuticals. The true holocaust, though, can only be guessed.

Ironically, the power of this system is so great that people return to it—the cause of their illnesses and injuries—in their attempts to be healed. Almost invariably, the treatments received are more of the same.