Combined drug intoxication

Combined drug intoxication (CDI), or multiple drug intake (MDI), is a cause of death by drug overdose from poly drug use, often implicated in polysubstance dependence.

Risk factors

People who engage in polypharmacy are at an elevated risk of death from CDI. Other dangers of combining drugs such as "brain damage, heart problems, seizures, stomach bleeding, liver damage/ liver failure, heatstroke, coma, suppressed breathing, and respiratory failure", along with many other complications. Disorders like depression and anxiety can also stem from polydrug use.^[1] Elderly people are at the highest risk of CDI, because of having many age-related and health problems requiring many medications combined with age-impaired judgment, leading to confusion in taking medications.^[2]^[3] Elderly patients are often prescribed more than one drug within the same drug class, and doctors may treat the side effects of prescribed drugs with even more drugs, which can overwhelm the patient.^[4]

Prevention

In general, the simultaneous use of multiple drugs should be carefully monitored by a qualified individual such as board certified and licensed medical doctor, either an MD or DO. Close association between prescribing physicians and pharmacies, along with the computerization of prescriptions and patients' medical histories, aim to avoid the occurrence of dangerous drug interactions. Lists of contraindications for a drug are usually provided with it, either in monographs, package inserts (accompanying prescribed medications), or in warning labels (for OTC drugs). CDI/MDI might also be avoided by physicians requiring their patients to return any unused prescriptions. Patients should ask their doctors and pharmacists if there are any interactions between the drugs they are taking.

Prevalence

In 2004, there were 3,800 deaths in the US resulting from a fatal medication error involving alcohol, while in 1983 there were fewer than 100 such deaths.^[5] It is more of a risk for older patients.^[3]^{[medical citation needed]}

Common combinations

Alcohol

Alcohol can exacerbate the symptoms and may directly contribute to increased severity of symptoms. The reasons for toxicity vary depending on the mixture of drugs. Usually, most victims die after using two or more drugs in combination that suppress breathing, and the low blood oxygen level causes brain death.^[6]

References

^ "Polydrug Abuse - Dangerous Drug Combinations". AddictionCenter. Retrieved March 28, 2019.
^ "Home deaths from Drug Errors Soar". CNN. cnn.com (Associated Press). July 28, 2008. Archived from the original on March 22, 2014. Retrieved 2008-08-04. Deaths from medication mistakes at home, such as actor Heath Ledger's accidental overdose, rose dramatically during the past two decades, an analysis of U.S. death certificates finds. ... Prescription drug abuse plays a role in the rise in fatalities, but it's unclear how much, researchers said. ... The authors blame soaring home use of prescription painkillers and other potent drugs, which 25 years ago were given mainly inside hospitals. ... 'The amount of medical supervision is going down and the amount of responsibility put on the patient's shoulders is going up,' said lead author David P. Phillips of the University of California, San Diego. ... The findings, based on nearly 50 million U.S. death certificates, are published in Monday's Archives of Internal Medicine. Of those, more than 224,000 involved fatal medication errors, including overdoses and mixing prescription drugs with alcohol or street drugs. ... Deaths from medication mistakes at home increased from 1,132 deaths in 1983 to 12,426 in 2004. Adjusted for population growth, that amounts to an increase of more than 700 percent during that time.
^ ^a ^b Rubin, Rita (December 23, 2008). "Mixing Drugs Puts More Older Patients at Risk" (Web). USA Today. Gannett Corporation. Retrieved December 24, 2008.
^ Gujjarlamudi, Hima (2016). "Polytherapy and drug interactions in elderly". Journal of Mid-Life Health. 7 (3): 105–107. doi:10.4103/0976-7800.191021. PMC 5051228. PMID 27721636.
^ Phillips, David P. (July 28, 2008). "A Steep Increase in Domestic Fatal Medication Errors With Use of Alcohol and/or Street Drugs". Archives of Internal Medicine. 168 (14): 1561–1566. doi:10.1001/archinte.168.14.1561. ISSN 0003-9926. PMID 18663169. S2CID 8371574.
^ "Combined Drug Intoxication". American Outreach. (March 22, 2010).

External links

Drug Interactions Checker at Drugs.com: Drug Information Online
Drug Interaction Checker at Medscape (registration required)

[1] "Polydrug Abuse - Dangerous Drug Combinations". AddictionCenter. Retrieved March 28, 2019.

[CNN-2] "Home deaths from Drug Errors Soar". CNN. cnn.com (Associated Press). July 28, 2008. Archived from the original on March 22, 2014. Retrieved 2008-08-04. Deaths from medication mistakes at home, such as actor Heath Ledger's accidental overdose, rose dramatically during the past two decades, an analysis of U.S. death certificates finds. ... Prescription drug abuse plays a role in the rise in fatalities, but it's unclear how much, researchers said. ... The authors blame soaring home use of prescription painkillers and other potent drugs, which 25 years ago were given mainly inside hospitals. ... 'The amount of medical supervision is going down and the amount of responsibility put on the patient's shoulders is going up,' said lead author David P. Phillips of the University of California, San Diego. ... The findings, based on nearly 50 million U.S. death certificates, are published in Monday's Archives of Internal Medicine. Of those, more than 224,000 involved fatal medication errors, including overdoses and mixing prescription drugs with alcohol or street drugs. ... Deaths from medication mistakes at home increased from 1,132 deaths in 1983 to 12,426 in 2004. Adjusted for population growth, that amounts to an increase of more than 700 percent during that time.

[Rubin-3] Rubin, Rita (December 23, 2008). "Mixing Drugs Puts More Older Patients at Risk" (Web). USA Today. Gannett Corporation. Retrieved December 24, 2008.

[4] Gujjarlamudi, Hima (2016). "Polytherapy and drug interactions in elderly". Journal of Mid-Life Health. 7 (3): 105–107. doi:10.4103/0976-7800.191021. PMC 5051228. PMID 27721636.

[5] Phillips, David P. (July 28, 2008). "A Steep Increase in Domestic Fatal Medication Errors With Use of Alcohol and/or Street Drugs". Archives of Internal Medicine. 168 (14): 1561–1566. doi:10.1001/archinte.168.14.1561. ISSN 0003-9926. PMID 18663169. S2CID 8371574.

[6] "Combined Drug Intoxication". American Outreach. (March 22, 2010).

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v t e Combined substance use and adulteration
Combined substance use	Active metabolite Codrug Combination drug Combined drug intoxication Drug interaction Polysubstance use List of polysubstance combinations Polypharmacy Polypill Polysubstance dependence Prodrug Synergy
Adulteration	Drug fraud Illegal drugs Counterfeit illegal drug selling Clandestine chemistry Lacing Medicines Counterfeit medications List of medicine contamination incidents Impurity
Harm reduction	Drug checking Reagent testing (List of reagent testing color charts)