Deaths sound an Rx alert

Two patients die after receiving naturopathic injection for back pain

By peter korn

The Portland Tribune, Apr 20, 2007, Updated Oct 30, 2009 (4 Reader comments)

Nearly identical deaths of patients at hospitals in Portland and Washington state recently have health officials suspecting a highly toxic medication used primarily by naturopaths.

While state authorities are investigating the deaths, which occurred within days of each other, the Oregon Poison Center has issued an alert about the drug to the state licensing board that oversees naturopaths.

The medication is called colchicine, and, according to pharmaceutical experts, some medical practitioners are using it in ways that might be inappropriate and dangerous.

The deaths of the two patients, whose names have not been released, occurred after they received intravenous injections of colchicine as treatment for back pain, according to what the patients told medical doctors who treated them at hospitals.

Public health officials are considering the possibilities that the deaths are due to either overdosing or a batch of the medication that was more potent than labeled.

Details of the two cases, including the names of the people who may have prescribed the colchicine, have not been made public pending investigation. But Zane Horowitz, medical director of the Oregon Poison Center, said that on April 3 he was notified by a physician at a local hospital, later identified as Legacy Emanuel Hospital and Health Center, that he was treating a patient for what appeared to be colchicine poisoning.

According to the treating physician, Horowitz said, the patient related receiving daily injections of colchicine from a naturopath as treatment for back pain.

The patient eventually died. Though the cause of death has not been released, colchicine poisoning often leads to heart failure.

Notice posted to naturopaths

A few days before Horowitz learned of the Portland patient, he said he had taken part in a teleconference call between state poison center administrators.

An administrator from Washington said that the state’s poison center had just days before handled a report of a death from colchicine poisoning in someone who had been given IV injections for back pain, according to Horowitz.

Horowitz said he has seen only four or five cases of colchicine toxicity in his 10 years as medical director of the poison center.

He called the timing of the two deaths so close together “alarming,” and immediately started a process for alerting the state’s naturopaths about the deaths by having a notice posted on the licensing board’s Web site.

“Colchicine is highly toxic,” the alert reads, “and doses used in one of the cases were reported to us as being above safe amounts.”

Colchicine is approved as a treatment for gout. But Horowitz and others say the drug is rarely used anymore by physicians.

“It wouldn’t be my choice of drug to be used for anything,” said John Horn, a professor of pharmacy at the University of Washington in Seattle who has studied colchicine. “It’s a nasty drug. People die from this stuff. If you’re going to use it, you use it with a lot of caution and not for frivolous indications.”

Narrow safety margin noted

The federal Agency for Health Care Policy and Research issued treatment guidelines in 1994 for back pain that specifically warned against colchicine, citing “the potential for serious side effects.”

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