“We all know that medicines save lives, but they can also harm in cases where they are inappropriately prescribed, taken the wrong way, without proper monitoring, or are not of an adequate quality,” said World Health Organization (WHO) Deputy Director-General Dr Zsuzsanna Jakab as she opened the floor on World Patient Safety Day 2022. 

The WHO chose the theme for this year’s day, which falls on Saturday, as “Medication Without Harm”, in light of the heavy burden of preventable errors in the prescription, administration, and surveillance of medicines.

“Nobody should be harmed while seeking care,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.

Yet every year, nearly three million preventable deaths occur around the world because of medication errors, and WHO estimates the cost to healthcare systems to be up to $42 billion annually.  

“Evidence suggests that medication-related harm accounts for 50% of overall avoidable harm in medical care,” said Dr Neelam Dhingra, unit head of the Patient Safety Flagship at WHO responsible for coordinating the event.

The abundant availability of information related to medication incident reports means researchers have a deeper understanding of the reasons that medications and their use can cause harm than in many other areas of patient safety. 

This, Dhingra says, is a very good reason to believe that much more can be done: “There is a huge opportunity here for us to work on medical errors because all medication errors are avoidable.”

Progress has faltered

Since the time the Patient Safety Alliance was launched in 2004, progress in reducing medical errors has faltered.

“Of all the categories of avoidable harm and death that occur in health care, medication-related harm is the biggest single category,” said Sir Liam Donaldson, former UK Chief Medical Officer and current WHO Patient Safety Envoy.

“But over the last few decades, the trajectory of progress has been slow and faltering. There is a need to drive progress further and faster,” said Donaldson. “We have built very strong foundations, but what we now need is a major push forward on medication safety,” 

“There are five preventable deaths every single minute of every single day”, said Jeremy Hunt, former British health secretary and co-chair of the World Patient Safety Day steering committee alongside Jakab. “If we removed medication error and dealt with the patient safety issues before us today, we would be tackling one of the top 10 killers in the world.”

Hunt emphasized that the technology and medical expertise to change patients’ lives are already out there.

“This is one of the great causes of our time in medicine”, he said. “And the great thing is that lives can be saved today, just by the spreading of good practise. This is not about inventing a new cure for cancer or scientific advances – wonderful as they are – these are things that we can improve today.”

Africa carries heaviest burden

Patients in low- and middle-income countries are twice more likely to experience preventable medication harm than in high-income countries, according to the WHO. 

COVID-19, and the strain it has placed on health care systems, has made things worse.

“More than two years of the COVID-19 pandemic have caused a high-risk emergency which has exacerbated many of the circumstances that drive medication errors,” said WHO Africa Regional Director Dr Matshidiso Moeti.

 Africa also faces a uniquely acute challenge in the area of substandard and falsified medicines.

 WHO estimates that between 72,000 and 169,000 children under five-years-old die as a result of inadequate pneumonia antibiotics every year, while bad antimalarials are estimated to lead to anywhere from 31,000 to 116,000 deaths in Sub-Saharan Africa annually.

“While the extent of unsafe medical practices in the African region is unknown, the region accounts for the highest prevalence of substandard and falsified medicines in the world, with about 1 in 5 of all medicines being either substandard or falsified,” said Moeti. “Inefficient regulatory systems present among the biggest barriers to access to safe, effective, high-quality medical products.”

But the region has made heartening progress on this front in recent years. Ghana, Nigeria, and Tanzania have already achieved the level of efficiency in their national regulatory agencies strived for under WHO guidelines, and, Moeti says, many others are following close behind.

Opioids responsible for 70% of global drug deaths

The global opioid overdose crisis is perhaps the starkest example of what impact bad medical practise can have on the lives of patients around the world. 

“The opioid crisis will not be news to any of you, I am sure”, said Ewan Maule, Director of Medicines and Pharmacy for the Integrated Care Board of the UK’s North-East and North Cumbria region. “But perhaps the scale will be.” 

Worldwide, there are about half a million deaths every year attributable to drug use, both prescribed and illicit, and more than 70% of that is caused by opioids.

“Opioid addiction touches every family unit, every demographic, and every single one of us in some way,” Maule said. “This is something that will be an issue regardless of where you are in the world.”

In North Cumbria, thanks to a campaign directed by Maule and his agency, the last few years have seen a 30% drop in overall opioid use, and a 50% reduction in high-dose opioid use.

The foundational pillar to this success, he says, has been patient education. 

“One of the things we heard from our clinicians was that one of the biggest barriers to reducing the risk of high, long-term opioid use was the percentage of patients that did not have an understanding of the relative benefits of opioid use for pain management”, Maule said.

While clinical best practice no longer supports the use of opioids for chronic pain, the UK Royal College of Anesthetists found “little evidence that they are helpful for long term pain” and can present “substantial risk of harm”, patient education has not yet caught up. 

The normalisation of this use of opioids over the previous decades, Maule explained, has meant many patients are not in a position to make informed decisions about their care. 

“They vastly underestimate the size of the risk they are exposing themselves to.”

Addressing opioid overdose is “a difficult thing to do”, Maule said. “But not only can we do it, but we should also do it. And I believe that for the patients, we must do it.”