Combined drug intoxication

Combined Drug Intoxication or CDI, also known as Multiple Drug Intake (MDI), is an unnatural cause of human death. While it is sometimes reported as a simple "overdose", it is distinct in that it is due to the simultaneous use of multiple drugs, whether the drugs are prescription, over-the-counter, recreational, or some combination. The reasons for toxicity vary depending on the mixture of drugs.

CDI can occur with numerous drug combinations, including mixtures of over-the-counter (OTC) drugs, illegally obtained prescription drugs, herbal mixtures, and home remedies. Ingestion of alcoholic beverages, in combination with other drugs, increases the risk of CDI. Drugs which may fatally interact with one another need not be pharmacologically similar.

The CDI/MDI phenomenon seems to be becoming more common in recent years. In December 2007, according to Dr. John Mendelson, a pharmacologist at the California Pacific Medical Center Research Institute, deaths by Combined Drug Intoxication were relatively "rare" ("one in several million") though they appeared then to be "on the rise". In July 2008, the Associated Press and CNN reported on a medical study showing that over two decades from 1983 to 2004, such deaths have soared. It has also become a prevalent risk for older patients.

Physicians whose patients die from CDI may face malpractice lawsuits and consequences from state licensing boards.

Risk factors
People who engage in polypharmacy and other hypochondriac behaviors are at an elevated risk of death from CDI. Elderly people are at the highest risk of CDI, due to having many age related health problems requiring many medications and due to impaired judgment leading to confusion in taking their medications. Wealthy and or professional people and their families, especially their children, are at high risk, simply due to their ability to buy expensive drugs. Entertainers seem to have the highest risk of dying from CDI/MDI. Physicians are pressured by their celebrity patients, who claim they cannot perform their livelihood, without prescription narcotic painkillers or claim that their life is so stressful, that they need sedatives to sleep at night or tranquilizers to cope with their fast paced hectic lifestyle.

Lately, Veterans who come back from war suffering from Post Traumatic Stress Disorder (PTSD) in combat seem to have a higher risk of dying from CDI/MDI. Nine Veteran PTSD patients died from CDI/MDI in America in 2007. They appear to be dying from combinations of Antidepressants and Antipsychotics and Minor Tranquilizers with OTC medicines like Benadryl. When still a U.S. Senator from Illinois, United States President elect Barack Obama asked the U.S. Congress to inquire about the safety of these drugs, and there is an ongoing investigation of the matter. {weasel words}

Prevention
In general, the simultaneous use of multiple drugs should be carefully monitored by a qualified individual. Close association between prescribing physicians and pharmacies, along with the computerization of prescriptions and patients' medical histories, aim to avoid the occurrence of dangerous drug interactions. Lists of contraindications for a drug are usually provided with it, either in monographs or package inserts (accompanying prescribed medications) or in warning labels (for over-the-counter (OTC) drugs). CDI/MDI might also be avoided by physicians requiring their patients to return any unused prescriptions. Patients should ask their doctors and pharmacists if there are any interactions between the drugs they are taking.

Direct causes of death
Combined Drug Intoxication can be caused by interactions between many different drugs.

CDI/MDI deaths often involve multiple CNS depressants, such as benzodiazepines and narcotic analgesics. Interactions between depressants may lead to severely depressed breathing or slowed heartbeat (bradycardia), causing the victim to become unconscious or comatose. While unconscious, the victim may regurgitate and die from asphyxia, in effect, drowning in vomit.

Certain drugs potentiate or amplify the effects of another drug and can lead to much- stronger effects than either drug taken alone would produce; for example, Alcohol, a depressant, will potentiate the effects of other depressants and can cause respiratory depression and bradycardia; yet, because it is legal, easy to obtain, and commonly used, it may figure in about half of all MDI/CDI cases.

A CDI victim may have a drug-induced heart attack or heart failure. Multiple drug usage may weaken the human heart, which may fail during bowel movements. Many victims are found dead in their toilets. Some drugs may weaken the human immune system, making the patient susceptible to infections. It has been speculated that Howard Hughes may have died in such a manner.

The combination of OTC and prescription analgesics like NSAIDs and acetaminophen can (potentially fatally) damage organs including the kidney, liver, and pancreas. Certain drug combinations can cause a mechanical interaction with blood, leading to excessive clotting. Clots may then travel into the heart, brain, or lungs and block blood flow, depriving tissue of oxygen and causing unconsciousness and then death (thrombosis).