Prescription Pain Reliever Abuse in Schools

SAMHSA Report - United Stated Department of Health and Human Services

12.4 percent of young adults age 18 to 25 used prescription pain relievers nonmedically in the past year.

How did these young adults get these medications?
According to a recent report from SAMHSA's Office of Applied Studies, among young adults age 18 to 25 who used prescription pain relievers nonmedically in the past year, over half (53.0 percent) obtained their most recent pain reliever used nonmedically from a friend or relative for free.

Among young adults age 18 to 25 who used prescription pain relievers nonmedically in the past year and met the criteria for prescription pain reliever dependence or abuse, 37.5 percent obtained their most recent prescription pain relievers for nonmedical purposes for free from a friend or relative, 19.9 percent bought them from a friend or relative, and 13.6 percent obtained them from one doctor.

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Oral Fluid-based Drug Free Workplace Solutions

Workplace Drug Testing Primer

Drug tests in the USA can be divided into two general groups, federally and non-federally regulated testing.



Federally regulated drug testing started when Ronald Reagan enacted executive order 12564, requiring all federal employees refrain from using illegal substances in specified DOT regulated occupations. Drug testing guidelines and processes, in these areas exclusively, are established and regulated (by the Substance Abuse and Mental Health Services Administration or SAMHSA, formerly under the direction of the National Institute on Drug Abuse or NIDA) require that companies who use professional drivers, specified safety sensitive transportation and/or oil and gas related occupations, and certain federal employers, test them for the presence of certain drugs. These test classes were established decades ago, and include five specific drug groups. They do not account for current drug usage patterns. For example, SAMHSA / DOT tests exclude semi-synthetic opioids, such as oxycodone, oxymorphone, hydrocodone, hydromorphone, etc., and other prescription medications that are widely abused in the United States

Non-federally regulated or General workplace drug testing allows for far more effective drug testing procedures. While SAMHSA / NIDA guidelines only allow laboratories to report quantitative results for the " NIDA-5 " / " SAMHSA-5 " for their official SAMHSA-approve tests, many drug testing laboratories and on-site tests offer a wider, " more appropriate " set of drug screens to better detect current drug use patterns. As noted above, these tests include synthetic pain killers such as Oxycodone (Oxycontin, Percocet), Oxymorphone, Hydrocodone (Vicodin), Hydromorphone. Some also include benzodiazepines (Valium, Xanax, Klonopin, Restoril) and barbiturates in other drug panels (a "panel" is a predetermined subset of tests run). The confirmation test (usually GC/MS, or LC/MS/MS) can tell the difference between chemically similar drugs such as methamphetamine and methylenedioxymethamphetamine (MDMA or ecstasy). In the absence of detectable amounts of methamphetamine in the sample, the lab wold report the sample as negative, or report it as positive if present.

Union Against Drug Testing ?

Source: September 6, 2008, Charleston Gazzette

MSHA: Test coal miners for drugs and alcohol


The White House administration will propose a rule early next week to require drug testing of miners who work in "safety sensitive" jobs in the nation's coal and non-coal mines.

U.S. Mine Safety and Health Administration ( MSHA ) officials are pushing for speedy approval of the rule, offering the mining community and the public a tight 30-day comment period - less than half the time provided for two other rules proposed by MSHA this year.

"An alcohol- and drug-free mine program as proposed in this rule will contribute to the prevention of such incidents and provide all miners, regardless of what state they work in and the size of the mine they work for, equal safety protection from working alongside miners under the influence of alcohol and/or drugs on the job,"

MSHA said in a proposal scheduled to be published in Monday's Federal Register.

The proposed rule would replace existing standards for drugs and alcohol at metal and non-metal mines with an industry-wide rule that also covers coal operations.

It would designate certain substances - alcohol and a list of controlled substances - that could not be possessed on mine property or used while performing safety-sensitive job duties, unless they were being used according to a valid prescription.

Mine operators would be required to establish an alcohol- and drug-free program, including a written policy, employee education, supervisory training and drug testing for miners in safety-sensitive jobs and their supervisors. Safety-sensitive job duties are defined as "any type of work activity where a momentary lapse of critical concentration could result in an accident, injury or death."

Company policies also must include treatment referrals for miners who violate the policy. The proposed rule also would require those who violate the prohibitions to be removed from the performance of job-sensitive duties until they complete recommended treatment and their alcohol- and drug-free status is confirmed by testing.

"Mining under the best of circumstances can be dangerous," said MSHA chief Richard Stickler, "and the use of alcohol and illegal substances creates additional, unnecessary hazards in the workplace."

MSHA's Federal Register notice did not include any mention of a public hearing on the proposal.

Department of Labor spokesman David James said the agency anticipates receiving a request for a hearing and that MSHA "is preparing to do" such a hearing.

"There will likely be a notice for public hearing published sometime during the public comment period," James said.

Coal industry officials have long sought an MSHA rule to require drug testing of miners, but the United Mine Workers union has questioned the need for such testing and worried about the specifics of how companies would carry out such testing.

Kentucky adopted its own drug-testing program for miners in 2006, and Virginia passed similar rules in 2007. West Virginia has declined to adopt drug-testing requirements for coal miners.

In October 2005, MSHA announced that it was working on such a rule, but after a string of mine disasters in 2006 and 2007, the drug-testing proposal appeared to have been put on the back burner as the agency scrambled to enact numerous safety reforms mandated by Congress.

Then, in early June, MSHA officials submitted their proposed rule to the White House Office of Management and Budget for its review. The OMB approved the proposal late last week, records show.

In its proposed rule notice, MSHA said

"a preliminary review of fatal and non-fatal mine accident records revealed a number of instances in which alcohol and drugs or drug paraphernalia were found or reported, or where the post-accident toxicology screen revealed the presence of alcohol or drugs."

MSHA cited a study that showed

more than 13 percent of full-time miners were heavy alcohol users and 7 percent admitted that they had used illicit drugs within the past month.

"Using alcohol and/or drugs can affect a miner's coordination and judgment significantly at a time when he or she needs to be alert, aware and capable of performing tasks where there is a substantial risk of injury to oneself or others," the MSHA notice said.

"Even prescription medications may affect a miner's perception and reaction time. Mining is a complicated and hazardous occupation, and a clear focus on the work at hand is a crucial component of mine safety."

During a previous comment period, UMW officials questioned whether MSHA had shown the need for a nationwide drug-testing program.

MSHA responded, "Although a subsequent internal [Department of Labor] review of accident reports failed to reveal a significant number of cases where alcohol or drugs were determined to be causative factors, it did reveal a lack of consistency in whether and how alcohol and drug tests are performed and in the investigative process used to determine whether alcohol or drugs may have been factors.

"In fact, currently accident investigations do not routinely include an inquiry into the use of alcohol or drugs and this is a failure that the proposed rule intends to address," MSHA said.

MSHA estimated that the drug-testing rule would cost the mining industry $16 million during its first year and $13 million every year after that.

At Least One Union Group Sees the Light On Drug Testing

Source: 2008 - August - Casino City - Las Vegas Gaming Wire

(Note: Drug Testing, including Random Drug testing is legal in all 50 States, despite political attempts to distort this fact. Furthermore, oral fluid-based on-site drug screening is the only feasible, cost-effective, and accurate method to conduct random testing at construction site. Oral fluid sceening can be directly observed, preventing the prevalent practice of drug abuser adulterating or substituting urine-based testing, and corporate security staff can administer the tests vs. relying upon $8-$10/hr third party collection personnel and sites with transient workers. Furthermore, leading on-site oral fluid tests screen for drugs commony found today on construction sites such as oxcodone and hydrocodone - tranditional NIDA-5 and/or SAMHSA-5 tests do not. )

Union rep in favor of drug test
11 August 2008


LAS VEGAS, Nevada -- Building contractors should be given authority to conduct random drug and alcohol tests of construction workers, either through legislation or through negotiations with unions, a spokesman for a construction trades group said a day after three union members were fired for entering the CityCenter job site after drinking at nearby bars.

Steve Holloway, executive vice president of the Las Vegas chapter of the Associated General Contractors, said Friday that the number of construction workers who are drinking on the job represents a small fraction of the total work force on the site.

However, "it's a large enough minority that it needs to be dealt with, probably by legislation that would allow a construction contractor to perform random drug and alcohol testing," he said.

Holloway is a member of an eight-person task force that was set up in the wake of a series of 12 construction worker deaths at Strip sites in the past 18 months. The committee is looking at possible legislation to be considered by the 2009 Legislature.

Holloway said none of the union contracts now in effect locally allow for random testing of construction workers. (NOTE: UNIONS, OWNERS, INSURERS & CONTRACTORS NEED TO ACT NOW TO ALLOW AND IMPLEMENT RANDOM TESTING VIA ALL SPECIMEN TYPES)

"That needs to be changed by statute, or by negotiations with the union," he said. "It should probably be by statute because we have just as many nonunion workers as we do union."

Steve Redlinger, spokesman for the Nevada Building and Construction Trades Council, an affiliate for 17 labor unions, said lawmakers can't legislate personal responsibility without coming dangerously close to treading on civil liberties. (NOTE: THIS STATEMENT IS COMPLETELY FALSE - U.S. SUPREME COURT HAS MADE IT CLEAR THAT RANDOM DRUG TESTING IS LEGAL AND THAT COMPANIES CAN (AND DO) IMPLEMENT RANDOM TESTING FOR SAFETY PURPOSES - IT IS FIRST AND FORMOST A FEDERAL LEGAL OBLIGATION FOR COMPANIES TO ENSURE A SAFE WORKPLACE FOR ALL EMPLOYEES... THIS IS NOT POSSIBLE AT CONTRUCTION SITES WITHOUT RANDOM DRUG TESTING (VIA OBSERVED SPECIMEN COLLECTION) IN CONCERT WITH EDUATIONAL PROGRAMS AND SUPPORT.)

Another member of the committee, state Assemblyman John Oceguera, D-Las Vegas, said he would not support giving employers "unfettered abilities" to randomly drug test employees because that would infringe on the individuals' rights. (NOTE- A PERSONAL OPINION VS. FACT)

A company should need to show there is "some indication" a worker is impaired by drugs or alcohol before it could demand a test, the state Assembly's majority leader said. (NOTE-THIS IS REPRESENTATIVE OF THE LACK OF EDUCATION ON THE TOPIC OF SUBSTANCE MISUSE-VISUAL OBSERVATION FAILS OVER 90% OF THE TIME TO DETECT SUBSTANCE MISUSE-ONLY RANDOM DRUG TESTING PROVIDES THE REQUISITE LEVEL OF DETERENCE AND DECTECTION).

Committee member and state Sen. Maggie Carlton, D-Las Vegas, sided with Oceguera in expressing concern over individual rights.

Existing union contracts already say companies can request a drug or alcohol test if an employee displays erratic behavior or is slurring speech, a union official said. Most of the current agreements also let employers demand tests before someone is hired or if they are involved in an accident.

Other committee members, Clark County commissioners Chris Giunchigliani and Rory Reid, Las Vegas Mayor Oscar Goodman and state Senate Minority Leader Steven Horsford, D-Las Vegas, did not return calls for comment. Trades Council President Rick Johnson also is on the committee.

The committee will probably reconvene in late August or early September and begin drafting a bill for next year, Holloway said.

The committee members' comments come two days after the Review-Journal reported that it had photographed 10 construction workers drinking at Strip bars before they went on to the CityCenter work site, a violation of rules set by the general contract, its subcontractors and the unions.

Dozens of additional workers were seen drinking alcohol outside convenience stores and inside bars, but they were identified as being off for the day.

On Thursday, three ironworkers members who were photographed returning to the job site were identified and fired by general contractor Perini Corp.

Perini officials said they have not identified any other workers yet, but the company will continue its investigation next week, said Doug Mure, Perini's vice president of human resources and risk management.

Chuck Lenhart, business agent for Ironworkers Local 433, said he met Friday with one of the disciplined workers, who admitted his behavior was inappropriate.

"When I spoke to one of them this morning, he got it," said Lenhart, who declined to give the workers' names or to describe their jobs. "He understood and I believe he is going to get some help."

Lenhart said the fired workers will need to go through counseling, at the union's expense, before they can be cleared to work on other jobs -- in two or three months, at the earliest. The workers won't be reassigned to another job site until they are cleared by a counselor, he added. (NOTE: AN EXCELLENT APPROACH BY THE UNION - SUPPORT, YET MONITOR)

However, each case is different and, if the workers have any prior disciplinary action on their records, they could be removed from the union.

But that is not a step the union wants to take, he said.

"When there is somebody that may have a problem they're not out the door," said Lenhart, who noted the Ironworkers local also screens workers before they join the union.

"We try to get help for them. Some people accept it and some people don't."

However, the responsibility ultimately lies with the individual worker to do the right thing for themselves and the workers around them. (NOTE: TRUE-HOWEVER, IN VIRTUALLY ALL CASES ABUSERS WILL NOT SEEK ASSISTANCE ON THERE OWN UNLESS DETECTED, OR AN INCIDENT OCCURS)

"They have free will and they can make their choices," Lenhart said. "Sometimes, they make bad choices. That's what I'm concerned about in this industry: When you have people who make these types of choices to (drink alcohol before work), there's a possibility of them hurting someone else on the job site."

Perini plans to look at what the company can do to control alcohol problems on its job site, although Mure said: "Our focus right now is the immediate identification (of the workers in the photos)."

The Perini executive did dismiss one rumor that went around the job site Thursday suggesting the company planned to "close" the job site so workers could not leave during lunch.

Mure said trying to close the 77-acre construction site, which employs 7,700 workers, would be impractical.

"That's not even really feasible on a project like CityCenter or any of the major construction projects in Las Vegas," he said. "Rumors are rumors. You've seen the site, it isn't something that could even be considered."

New Oral Fluid Technology for Cancer Detection

Source: ZD Net

Sensors to detect oral cancer in saliva
Posted by Roland Piquepaille @ 10:10 am

Categories: Health & Medicine, Engineering & Innovation

Tags: University Of California At Los Angeles, Team, Researcher, Protein, Sensor, Molecule, Cancer, Protein Sensor, Dr Wong, Team Management

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According to the American Cancer Society (ACS), there will be about 35,000 new cases of oral cancer in the U.S. this year. The ACS also estimates that ‘when oral cancer is identified in its early stages, patient survival rate is almost 90 percent, compared with 50 percent when the disease is advanced.’ This is why a team of University of California at Los Angeles (UCLA) researchers supported by the National Institute of Health (NIH) has developed a very sensitive optical salivary sensor. Clinical tests should start soon. A simple and fast saliva test in your dentist office might one day replace blood tests and even biopsies. But read more…


You can see on the left “Leyla Sabet, a member of the UCLA research team that built the new optical protein sensor, sits in front of the device. Based on a confocal microscope, the ultrasensitive system is being used by the researchers to detect biomarkers in saliva samples that are linked to oral cancer.” (Credit: UCLA, via MIT’s Technology Review)

This sensor has been developed by Chih-Ming Ho, a professor of engineering at UCLA and several colleagues of the UCLA Micro Systems Laboratories, including researchers Leyla Sabet and Winny Tan. David Wong, professor of oral biology, and several members of his lab were also involved in this project.

According to the NIH news release, “the sensor can be integrated into a specially designed lab-on-a-chip, or microchip assay, and preprogrammed to bind a specific protein of interest, generating a sustained fluorescent signal as the molecules attach. A microscope then reads the intensity of the fluorescent light — a measure of the protein’s cumulative concentration in the saliva sample — and scientists gauge whether it corresponds with levels linked to developing disease.”

And is this optical sensor successful? “In their initial experiments, the scientists primed the optical protein sensor to detect the IL-8 protein, which at higher than normal concentration in saliva is linked to oral cancer. Using saliva samples from 20 people — half healthy, the others diagnosed with oral cancer — the sensor correctly distinguished in all cases between health and disease. Importantly, the sensor achieved a limit of detection for IL-8 that is roughly 100 times more sensitive than today’s blood-based Enzyme-Linked ImmunoSorbent Assay (ELISA) tests, the standard technique to measure protein in bodily fluid.”

Now, let’s turn to a Technology Review article, “Spit Sensor Spots Oral Cancer” (Brittany Sauser, August 6, 2008) to learn why it has been difficult to detect oral cancer biomarkers in saliva.”Protein markers are harder to spot in saliva than in blood. To create the ultrasensitive sensor, researchers started with a glass substrate coated with a protein called streptavidin that enables other biomolecules to bind to the substrate and to one another. The researchers then added a molecule that would catch and bind the cancer biomarker — a protein in saliva called IL-8 that previous research has proved to be related to oral cancer. They also added molecules designed to keep the glass surface free of other proteins that might muddy detection of the biomarker. To visualize the target molecules, Ho’s team then added a set of fluorescently tagged proteins designed to attach to the captured IL-8 markers.”

And what was Ho’s team next step? “Because saliva has a lower concentration of proteins than blood does, the team needed a highly sensitive method to detect the tagged proteins among the background noise, stray molecules in saliva that also fluoresce. So the researchers used a confocal microscope — an imaging system that employs a laser to collect the light generated from a sample — to analyze the saliva. Ho and his team found that focusing the laser light on a specific part of the sample resulted in a lower signal-to-noise ratio, allowing them to detect lower concentrations of the cancer biomarker. Indeed, Ho says, the device is 100 times more sensitive than the standard protein-detection technique, ELISA.”

This research work has been published in Biosensors and Bioelectronics under the title “Optical protein sensor for detecting cancer markers in saliva” (Volume 24, Issue 2, 15 October 2008, Pages 266-271). Here is a quote from the abstract. “The ultra sensitive optical protein sensor presented in this paper has a wide number of applications in disease diagnoses. Measurements for detecting biomarkers in clinical sample are much more challenging than the measurements in buffer, due to high background noise contributed by large collections of non-target molecules. We used clinical saliva samples to validate the functionality of the optical protein sensor. Clinical detection of disease-specific biomarkers in saliva offers a non-invasive, alternative approach to using blood or urine.”

If you’re interested by this subject, you also should read a very good article coming from an unusual source, “On the tip of your tongue” by Anne-Marie McQueen (The National, United Arab Emirates, July 26, 2008). This article is more focused on David Wong’s research. “He and his team have already developed a saliva test for oral cancer and Sjogren’s Syndrome, a systemic disease in which the body’s immune system attacks the glands that produce saliva and tears. Dr Wong says they have promising early evidence that it will be possible – perhaps even within five years – to use saliva to detect biomarkers for more systemic diseases, like breast, lung and pancreatic cancers, as well as diabetes.”

And even if you like needles — which I don’t — “the benefits of saliva testing versus blood sampling or more invasive diagnostic tests are many, says Dr Wong. Saliva testing is easier, safer and less intrusive. Since its testing does not require specially trained personnel, there is no risk of exposing anyone to blood-born diseases. Also, oral fluids do not clot like blood, so they not require the same level of manipulation.”

More Trouble with DOT Drug Testing

Problems with urine-base DOT drug testing continue.... 2008

GAO: Truck drivers taking illegal drugs get hired


WASHINGTON (AP) — Tractor-trailer and bus drivers who tested positive for illegal drugs have flouted federal regulations by returning to work without the required treatment, in some cases transporting hazardous materials for many months, congressional investigators say.

The study by the Government Accountability Office, obtained Tuesday by The Associated Press, is the latest to detail problems involving unfit commercial drivers who can operate vehicles weighing 40 tons or more.

The GAO found that 19 out of 37 commercial drivers who had a positive drug test in the last two years were hired elsewhere less than a month later — keeping quiet about their previous test result.

These tractor-trailer or bus drivers, who had tested positive for cocaine, amphetamines or marijuana, passed a new pre-employment drug test either by quickly going clean or using products such as synthetic urine to mask drug use. They subsequently operated commercial vehicles for periods ranging from one month to over a year, GAO said.

Transportation Department regulations require that prospective employers request drug-testing records — with the commercial driver's consent — from previous employers. But because some drivers testing positive do not go through treatment and do not disclose test results, the new company might not be aware of drug use if it does not vigorously investigate.

The House Transportation and Infrastructure Committee, led by Rep. James Oberstar, D-Minn., is currently looking at ways to help get unfit commercial drivers off the nation's highways. One proposal would create a clearinghouse for drug test results for commercial truck drivers to make it easier for employers to conduct checks.

Some cases cited by GAO:

_A Tennessee truck driver tested positive for cocaine in May 2007. He moved to a different employer and was rehired after passing a new test eight days later. Prior to his tests, the driver was charged with possession of a controlled substance. He worked for several months afterward, driving trucks containing cargo and hazardous material.

_An Oklahoma truck driver tested positive for marijuana in October 2007 and passed a subsequent test with another company nine days later. The driver told investigators he "took appropriate measures to clean his system before applying at the second employer." The new employer said it was unaware of the prior drug test during the hiring and let him drive for a couple of months, but that he was now no longer working for the company.

The latest review comes after a GAO safety study disclosed by the AP earlier this month found hundreds of thousands of drivers carry commercial licenses even though they also qualify for full federal disability payments

. According to that report, 563,000 commercial drivers were determined by the Veterans Affairs Department, Labor Department or Social Security Administration to be eligible for benefits over health issues, with alarming examples that raised doubts about the safety of the nation's highways.

Last week, lawmakers in the House scolded federal regulators for failing to implement recommendations made in 2001 that are aimed at keeping medically unfit commercial truck and bus drivers off the roads.

In the latest GAO study, investigators looked at data from a third-party administrator for commercial drivers who had tested positive for illegal drugs with one employer and then negative for another employer. The GAO then identified cases from the past two years where drivers had tested negative less than a month after a positive result.

On the Net:
Government Accountability Office: http://www.gao.gov
House Transportation and Infrastructure Committee: http://transportation.house.gov/

Prescription Pain Relievers - Deaths from Misuse Dramatically

Source: CNN 2008

Home deaths from drug errors soar
Deaths from medication errors at home are up dramatically in last 20 years

Increase steepest in death rates from mixing meds, alcohol, street drugs at home

Researchers cite dramatic rise in home use of prescription painkillers

CHICAGO, Illinois (AP) -- Deaths from medication mistakes at home, such as actor Heath Ledger's accidental overdose, rose dramatically during the past two decades, an analysis of U.S. death certificates finds.


Prescription drug abuse plays a role in the rise in fatalities, but it's unclear how much, researchers said.

The authors blame soaring home use of prescription painkillers and other potent drugs, which 25 years ago were given mainly inside hospitals.

"The amount of medical supervision is going down and the amount of responsibility put on the patient's shoulders is going up," said lead author David P. Phillips of the University of California, San Diego.

The findings, based on nearly 50 million U.S. death certificates, are published in Monday's Archives of Internal Medicine. Of those, more than 224,000 involved fatal medication errors, including overdoses and mixing prescription drugs with alcohol or street drugs.

Deaths from medication mistakes at home increased from 1,132 deaths in 1983 to 12,426in 2004. Adjusted for population growth, that amounts to an increase of more than 700percent during that time.

In contrast, there was only a 5 percent increase in fatal medication errors away from home, including hospitals, and not involving alcohol or street drugs.

Abuse of prescription drugs plays a role, but it's unclear how much. Valid prescriptions taken in error, especially narcotics such as methadone and oxycodone, account for a growing number of deaths, said experts who reviewed the study.

The increases coincided with changing attitudes about painkillers among doctors who now regard pain management as a key to healing. Multiple prescription drugs taken at once -- like the sleeping pills, painkillers and anxiety drugs that killed "Dark Knight" star Ledger -- also play a part, experts said.

"When we see overdoses, we're seeing many more mixed drug overdoses," said Dr. Jeffrey Jentzen, president of the National Association of Medical Examiners and director of autopsies at the University of Michigan in Ann Arbor. Jentzen said autopsies are much more likely to include toxicology tests today than 25 years ago, which would contribute to finding more fatal medication errors as cause of death.

But Phillips said there were no significant increases in other poisonings, such as suicidal overdoses or homicides, so more testing doesn't explain the huge increase. The analysis excluded suicides, homicides and deaths related to side effects.

The increase was steepest in death rates from mixing medicine with alcohol or street drugs at home; that death rate climbed from 0.04 per 100,000 people in 1983 to 1.29 per 100,000 people in 2004.

Many patients ignore the risk of mixing alcohol with prescriptions, said Cynthia Kuhn of Duke University Medical Center, who was not involved in the study.

"They think, 'Oh, one drink won't hurt.' Then they have three or four," Kuhn said.

The increase in deaths was highest among baby boomers, people in their 40s and 50s.

"We're sort of drug happy," said boomer Dr. J. Lyle Bootman, the University of Arizona's pharmacy dean, who was not involved in the research. "We have this general attitude that drugs can fix everything."


People share prescriptions at an alarming rate, Bootman said. One recent study found 23 percent of people say they have loaned their prescription medicine to someone else and 27 percent say they have borrowed someone else's prescription drugs.

Kenneth Kolosh, a statistics expert at the National Safety Council, praised the study but said improved attention to coding location on death certificates may account, in part, for the huge increases the researchers found.

Phillips countered that home deaths from any cause increased relatively little during the time period, so better coding doesn't explain the change.

Michael R. Cohen, president of the Institute for Safe Medication Practices, said more states should require pharmacists to teach patients about dangerous drugs and insurers should pay pharmacists to do so.