A steep increase in domestic fatal medication errors with use of alcohol and/or street drugs

Arch Intern Med. 2008 Jul 28;168(14):1561-6. doi: 10.1001/archinte.168.14.1561.


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.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Distribution
  • Alcoholism / complications
  • Alcoholism / mortality*
  • Cause of Death / trends*
  • Child
  • Child, Preschool
  • Death Certificates
  • Female
  • Humans
  • Illicit Drugs / adverse effects*
  • Infant
  • Infant, Newborn
  • Male
  • Medication Errors / trends*
  • Middle Aged
  • Retrospective Studies
  • Sex Distribution
  • Substance-Related Disorders / complications
  • Substance-Related Disorders / mortality*
  • United States / epidemiology


  • Illicit Drugs