Polypharmacy and Accidental Death From Prescription Medication

Allen Frances the former head of the American Psychiatric Association and chair of the DSM IV task force, has gained noteriety over his criticisms of the new DSM process has recently written a response in the Psychiatric Times to the issue of military veterans dying because of over-prescribing of psychiatric drugs.

As I’ve pointed out before and Frances does in this article too this gross over-medication is not done only in the military. I was on EVERY SINGLE psychiatric class of drug at once, for a total of 6 drugs at very high doses when I began my withdrawal. I’ve known and corresponded with hundreds of people on similar cocktails that are not in the military.

These cocktails are DEADLY. Lets stop it from happening everywhere.

I’ve excerpted the first part of this article that lays out the problem. Frances ends with a paragraph that proposes solutions. He doesn’t go nearly far enough.

Polypharmacy, PTSD, and Accidental Death From Prescription Medication

The New York Times of February 14 carries the disturbing news of an alarming increase in deaths from accidental overdose among our active duty military personnel and our war veterans. The usual scenario is a diagnosis of PTSD (often accompanied by a pain syndrome) unsuccessfully treated with a wide array of psychotropic drugs, which in their aggregate wind up killing the patient– often at a very young age. Autopsy reveals significant blood levels of prescribed medication reflecting the heavy drug cocktail and no other apparent cause of death.

PTSD/pain patients are often prescribed a combination of psychotropics that may include–one antidepressant, one antipsychotic, one antianxiety, one sleep, and one pain medicine. Sometimes, the enormous medication burden is worsened even further–either by the simultaneous prescription of more than one drug from a given class or the additional self medication effected by the sharing of pills among patients.

Individual psychotropic drugs can have serious side effects–in excessive combination they sometimes threaten respiratory and cardiac function in a potentially lethal way. And the whole is even more dangerous than the sum of its parts since the medications can interact to increase each other’s blood levels. Prescription drugs are overtaking illegal drugs as the primary cause of accidental overdose and death.

To its credit, the military is catching on and beginning to initiate procedures to restrict and review heedless and excessive polypharmacy. But this is a tough problem with no ready solutions. Some of the factors involved are:

  1. The over prescription of multiple drugs that is also rampant in civilian life. There is no research literature to guide and restrain polypharmacy–so it becomes subject to individual physician whim, often under patient pressure for relief.
  2. PTSD has no effective medication treatment, encouraging the potentially dangerous scatter shot approach of treating the individual symptoms each individually with its own medication.
  3. The recent ubiquity and carelessness of prescription of dangerous pain medications that resulted as an over-compensation by the military after it was previously criticized for being too sparing in their use.
  4. Because they are legal, accessible, and cheap, pain medications are now an attractive alternative to illegal recreational drug use–but with dangerous consequences given their interaction with other psychotropic drugs.
  5. The tendency to always add and never sunset medications leads to the continued use of drugs that have not been effective, but will add on to the cumulative and interacting side effects.
  6. Chasing the side effects of one drug by adding another to deal with them–eg if an antidepressant causes anxiety or insomnia it is usually a mistake to add yet another potentially harmful pill to deal with these side effects rather than reducing the dose or trying another antidepressant.
  7. A shortage of mental health personnel that results in pill pushing rather than the easy access to the one treatment with clear efficacy for PTSD- cognitive behavior therapy.
  8. Forgetting,the Hippocratic injunction of “FIRST DO NO HARM.” This evolved in ancient Greece specifically to discourage practitioners from being overly aggressive in using dangerous treatments for conditions that are not responding (and may not respond well) to existing interventions. It is important to recognize that sometimes the treatment becomes worse than the disease. This is exactly our modern dilemma with some cases of PTSD where restraint is safer and saner than unreasonable treatment perfectionism and optimism– which can be costly and sometimes even lethal.

read the rest here

His solutions as noted if you click to read the rest all deal with accepting that these drugs will be widely used. While some the suggestions are fine for the status quo, we need to create a different system.

We need to start thinking about avoiding the use of these drugs altogether except in the case of critical and acute crisis. Maintenance long-term use is what make them deadly ALONE or in combination.

Pursuing treatment programs that support people for the long run without medications being the first line of treatment with the choice of a vast array of alternatives is what is needed.

Right now there are no virtually no resources nor even enough people trained in such methods to do such a thing societally wide. THAT is what needs to be addressed.

For now it is only the privileged and the well-educated that tend to have access to such alternatives.

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