A 'dangerous duo': Opioids, anticoagulants involved in 40% of medication-related liability claims

Be careful out there.
http://www.fiercehealthcare.com/hospitals/opioids-anticoagulants-coverys-medication-liability-claims?

by Paige Minemyer |

Oct 19, 2017 1:05pm

Coverys found that antibiotic stewardship and barcoding are two areas where healthcare has found success in improving medication safety. (Getty/Gti337)Opioids are involved in more medication-related liability claims than any other type of drug, according to a new analysis. 

Twenty-four percent of liability claims related to medication involved opioids, according to a report (PDF) from Boston-based medical liability insurer Coverys. Nearly half of those claims (46%) involved primary care providers, while 22% of claims were related to emergency departments or operating rooms.
Coverys analyzed more than 10,000 closed medical liability claims filed against its clients between 2012 and 2016 for the report. Medication-related claims are listed as the fourth leading cause for liability claims overall, behind diagnostic-related claims, surgery-related claims and medical management-related claims.
RELATED: Surgical residents not immune to medical malpractice claims; average payout $900K 
Though opioids were the leading drug associated with medication-related claims, Coverys said such medications were part of a "dangerous duo" with anticoagulants, which account for 16% of claims.
"When it comes to making patients safer, conversations between provider and patient and the routine activities surrounding medication are paramount," the report concluded. "It’s these 'everyday' or 'routine' decisions, interactions, and processes surrounding the medication episode of care that can and must be handled better."

In addition, in 15% of cases, opioid claims involved allegations that physicians "behaved in an inappropriate way" toward a patient who was seeking the medication.
RELATED: Nearly 1 in 4 Medicaid patients prescribed opioids in 2015 
The analysis offers five takeaways that providers can refer to in order to better manage risk and avoid medication-related claims:

1. The first and last points (ordering and medication monitoring and management) in a medication episode of care are most vulnerable to mistakes. These include prescribing errors and medication reconciliation issues, Coverys found.
2. Medication error risk is greatest when it involves the youngest, oldest, smallest and heaviest patients. These patients may have specific dosing needs.
3. Interventions must be supported and implemented. Top-down support for interventions to prevent medication errors is key to their success, according to Coverys.
4. Different care settings pose different challenges to medication safety.
5. Opioids and anticoagulants specifically require special care. As use of these medications becomes more common, so do complications, according to the report. 

Coverys also noted several areas where the healthcare industry has made progress in reducing medication errors that can lead to claims, including antibiotic stewardship, self-assessments and barcoding.

'Home-brew' morphine/opiods from brewer's yeast now possible - study

This is just for informational purposes only. Do not do this.
There is one study suggesting that opiods are useful. But that was 30 years ago and I'm sure we have made zero progress in further study. And this was only in cats.

Treatment of stroke with opiate antagonists — Effects of exogenous antagonists and dynorphin 1–13

 'Home-brew' morphine/opiods from brewer's yeast now possible - study

Opioid-induced hibernation protects against stroke

This will never be studied fully here, you can't study any kind of recreational drug even if it could save thousands of lives. One major problem is that the rats were put into opiod hibernation prior to giving them a stroke. I can't ever see that occurring in real life, 'I'm going to have a stroke in the next hour so get me my opium so I can hibernate through it.' But maybe put into hibernation in the ambulance, someone can compare the efficacy of that to hypothermia.
http://www.alphagalileo.org/ViewItem.aspx?ItemId=58600&CultureCode=en
Using an opioid drug to induce a hibernatory state in rats reduces the damage caused by an artificial stroke. Researchers writing in the open access journal BMC Biology have shown that those animals put into the chemical slumber suffered less behavioral dysfunctions after a period of cerebral artery blockage than control rats.
Cesar Borlongan, a neuroscientist at the University of South Florida Center for Aging and Brain Repair, in Tampa, FL, worked with a team of researchers from the National Institutes of Health, USA, to investigate the role of the opioid system in brain injury and protection. He said, “Studies in hibernating and active squirrels have shown that ‘natural hibernation’ has anti-ischemic effects. We’ve shown that a drug that induces hibernation can achieve similar results”.
Borlongan and his colleagues dosed the rats with [D-ala2,D-leU5]enkephalin (DADLE), a drug from the same pharmaceutical family as morphine and heroin. They found that, after an experimental stroke, the pretreated animals performed better than control rats in a series of behavioral tests. The researchers write, “DADLE prevented cell death processes and behavioral abnormalities. The observation that this substance, previously shown to induce hibernation, attenuated deficits inherent in cerebral ischemia provides a new pharmacological target for stroke therapy”.

Treatment of stroke with opiate antagonists — Effects of exogenous antagonists and dynorphin 1–13

Originally published
Neuropeptides
Volume 5, Issues 4-6, February 1985
So 27 years later have we learned anything new about this or are we still afraid of using these types of drugs for medical use?
http://www.sciencedirect.com/science/article/pii/0143417985900149

Abstract

We studied the effects of acute and long-term, continuous administration of six opioid compounds—naloxone, naltrexone, diprenorphine, leucine enkephalin, dynorphin 1–13, and dynorphin 3–13—on neurologic function, survival, and infarct size in a feline model of acute focal cerebral ischemia. Acutely, aaloxone, naltrexone, and diprenorphine significantly improved motor function over baseline scores; the other drugs and saline (control) had no effect. In the long-term condition, no substance administered significantly affected level of consciousness, sensory function, or pupillary reactions. Naloxone, naltrexone, and dynorphin 1–13 significantly prolonged survival (p<0.1); the other substances had no effect. Evaluations of cat brains postmortem showed that the infarcts involved the sensory and motor cortex, internal capsule, and caudate nucleus. Infarct size was unaltered by any treatment administered; results among groups were remarkably similar. In evaluations of opiate receptor binding characteristics, high-affinity binding of ekylketocyclozocine was significantly reduced in the right (occluded) side of the cortex. Dynorphin 1–13 given 8 h postocclusion but before sacrifice increased this binding affinity to the previous level in non-occluded cortex. The observed protective effect of dynorphin 1–13 warrants further investigation. Our results support the involvement of endogenous opioid peptides in the pathophysiology of cerebral ischemia and suggest that, administered appropriately, opiate antagonists may be useful in the treatment of focal ischemic neurologic deficits.

So start carrying them in your ER daypack to give to your ER doctors.