title: A steep increase in domestic fatal medication errors with use of alcohol and/or street drugs.
abstract: BACKGROUND
  Increasingly, medications are consumed outside of clinical settings, with relatively little professional oversight. Despite this trend, previous studies of medication errors have focused on clinical settings.
  
  
  METHODS
  We examined all US death certificates from January 1, 1983, to December 31, 2004 (N = 49,586,156), particularly those with fatal medication errors (FMEs) (n = 224,355). We examined trends in 4 types of FMEs that vary according to the relative importance of alcohol/street drugs and the relative likelihood of professional oversight in the consumption of medications.
  
  
  RESULTS
  The overall FME death rate increased by 360.5% (1983-2004). This increase far exceeds the increase in death rates from adverse effects of medications (33.2%) or from alcohol and/or street drugs (40.9%). The increase in FMEs varies markedly by type. Type 1 (domestic FMEs combined with alcohol and/or street drugs) shows the largest increase (3196%). In contrast, type 4 (nondomestic FMEs not involving alcohol and/or street drugs) shows the smallest increase (5%). Types 2 and 3 show intermediate increases. Type 2 (domestic FMEs not involving alcohol and/or street drugs) increased by 564%. Type 3 (nondomestic FMEs combined with alcohol and/or street drugs) increased by 555%. Thus, domestic FMEs combined with alcohol and/or street drugs have become an increasingly important health problem compared with other FMEs.
  
  
  CONCLUSIONS
  These findings suggest that a shift in the location of medication consumption from clinical to domestic settings is linked to a steep increase in FMEs. It may now be possible to reduce FMEs by focusing not only on clinical settings but also on domestic settings.
authors.affiliation: Department of Sociology 0533, University of California at San Diego, 9500 Gilman Dr, La Jolla, CA 92093-0533, USA. dphillips@ucsd.edu
authors.forename: David P
authors.initials: DP
authors.lastname: Phillips
authors.forename: Gwendolyn E C
authors.initials: GE
authors.lastname: Barker
authors.forename: Megan M
authors.initials: MM
authors.lastname: Eguchi
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000437:Alcoholism / Q000150:complications / Q000401:mortality*; D002423:Cause of Death / Q000639:trends*; D002648:Child; D002675:Child, Preschool; D003644:Death Certificates; D005260:Female; D006801:Humans; D013287:Illicit Drugs / Q000009:adverse effects*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008508:Medication Errors / Q000639:trends*; D008875:Middle Aged; D012189:Retrospective Studies; D017678:Sex Distribution; D019966:Substance-Related Disorders / Q000150:complications / Q000401:mortality*; D014481:United States / Q000453:epidemiology
chemical_list: D013287:Illicit Drugs