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US Emergency Department Visits Attributed to Medication Harms

Budnitz DS, Shehab N, Lovegrove MC, Geller AI, Lind JN, Pollock DA. US Emergency Department Visits Attributed to Medication Harms, 2017-2019. JAMA. 2021;326(13):1299–1309. doi:10.1001/jama.2021.13844


Medication risk assessment should account for both therapeutic use as well as nontherapeutic use. Therapeutic use refers to medications taken as prescribed, while nontherapeutic use refers to unsupervised medication use, medication misuse and abuse, and self-harm. To account for both types of use, Dr. Daniel Budnitz and CDC colleagues set out to describe the nature of emergency department (ED) visits for medication harms in the US between 2017-2019. The authors investigated both medication type and intent of use associated with ED visits, as well as differences by patient age group.


Budnitz and colleagues used cross-sectional, nationally representative public health surveillance data to identify adverse events attributed to one or more medications. The rate of ED visits for medication harms was highest among patients aged 65 and older. Anticoagulants and diabetes agents taken as prescribed were most frequently implicated. In fact, authors found that 95.8% of older adults’ medication-related ED visits were attributed to medications taken as prescribed.

In their article, authors begin to discuss the especially high risk of adverse events among older adults, even when medications are taken properly. 

Dr. Daniel Budnitz, lead study author and Director of the CDC’s Office of Medication Safety, explained the issue further: 

“The rate of emergency visits for harms due to adverse reactions to medications increases significantly with age, peaking among those 75 years of age or older (16 emergency visits per 1,000 population per year, or 1 out of 62 individuals 75 years of age or older each year). The leading causes of these emergency visits are bleeding from anticoagulants (blood thinners) and hypoglycemia (low blood sugar) from diabetes medications, so optimizing the selection, dosing, and monitoring of these types of drugs should be a priority for older adults.”

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