Over the past two decades the number of Americans who died at home after combining street drugs and alcohol with prescription medications has seen a dramatic increase according to University of California, San Diego study published in the July 29 issue of the Archives of Internal Medicine.

Lead author David P. Phillips of the University of California and his colleagues analyzed nearly 50 million US death certificates from 1983 to 2004 of which more than 224,000 involved fatal medication errors, including overdoses and mixing prescription drugs with alcohol or street drugs.

Overall, the number of fatal medication errors rose from 3,954 in 1983 to 22,770 in 2004, while the number of deaths resulting from combining medications with alcohol or street drugs or both rose to 3,792 in the home in 2004 from 92 in 1983, meaning an increase of nearly 3,200 percent

“More and more often the patient is put in charge of quality control rather than medical staff, and some patients aren’t up to it. We haven’t been sufficiently aware that some patients cannot follow directions as scrupulously as nurses or physicians,” Dr. Phillips said.

The study is the first to quantify medication error deaths that occur at home where people are not supervised by a physician. The study was also an effort to understand the impact of combining prescription medications with other intoxicants.

Medication deaths occurred between 1983 and 2004 were divided in four categories as follows: 1. deaths occurred at home and involved street drugs and/or alcohol; 2. deaths occurred at home and involved only medications; 3. deaths occurred away from home and involved prescription drugs, street drugs and alcohol; 4. deaths occurred away from home and involved only medication.

Overall, the researchers found a 564 percent spike in deaths from prescription drugs alone at home and a 555 percent rise in deaths away from home from the combination of prescription medications, street drugs and/or alcohol. The highest increase in deaths from fatal medication errors was among people aged 40 to 59, meaning 890.5 percent. There was only a 5 percent jump in deaths from medication errors that occurred away from home and did not involve street drugs or alcohol.

This increase in fatalities might be due to the fact that more medications that once were available only by prescription are now bought over-the-counter and more people are taking more than one medication.

Also, people use to share prescription at an alarming rate, Dr. J. Lyle Bootman, the University of Arizona's pharmacy dean, who was not involved in the research, said.

A previous study found 23 percent of people saying they have loaned their prescription medicine to someone else and 27 percent saying they have borrowed someone else’s prescription drugs.

Moreover, many patients ignore the danger lying beyond combining alcohol with prescriptions thinking that one drink won’t hurt them, Cynthia Kuhn of Duke University Medical Center, who was not involved in the study, said. The bad part is that “they have three or four,” she added.

Following these worrisome results, Dr. Phillip calls for better screening of patients for possible drug and alcohol use. He also said patients should be informed on the potential dangers of mixing medications and other substances. Finally yet importantly, he said doctors should be more careful when prescribing medications that have known interactions with street drugs and alcohol.

“Patients have to realize how much more careful they have to be and how much more educated they have to be,” he said.