A Denver doctor recently pled guilty to prescribing patients an illegal combination of drugs known as the Holy Trinity.
As reported by the Denver Post, Dr. Andrew Mark Ho agreed to 15 years of supervised release and gave up his ability to prescribe pharmaceuticals as a result of his guilty plea. Health regulators reported that Ho’s medical license is currently still active with restrictions.
The Holy Trinity is a combination of muscle relaxers and opioids. It’s a dangerous blend of pharmaceuticals that depress the body’s central nervous system and can potentially affect a user’s ability to breathe.
According to prosecutors, Ho prescribed pharmaceuticals considered “outside the scope of accepted medical practices,” including the Holy Trinity, several times between 2014 and 2016.
Prescription Drug Combinations are Often Dangerous
It’s common in the medical industry for patients to experience negative side effects from prescription medications, especially when two or more drugs are taken at the same time. Often, patients suffer unnecessarily because drugs are prescribed without concern for interactions. Sometimes dangerous drugs are prescribed in combination by a single doctor, while other patients receive different prescriptions from different doctors who do not realize or do not bother checking how the various drugs a patient is taking will interact.
The Holy Trinity is one of the most popular drug combinations in use today and its popularity continues to rise, despite the risks. It’s a regimen that includes at least one opioid, a benzodiazepine, and carisoprodol, a muscle pain reliever. It’s a combination that’s frequently prescribed by so-called Pill Mills.
In the past, drugs included in the Holy Trinity were considered safer because they were taken as a single entity. That has changed in recent years and patients can receive immediate-release formulations of these drugs, increasing their risk when compared to their extended-release counterparts. The newer formulations have a more dangerous rapid onset, which is exactly what those abusing the drugs seek.
In the case of the Holy Trinity, the drugs involved all have overlapping side effects. For instance, all of the drugs have the potential to trigger drowsiness, confusion, tremors, and seizures. Opioids all share the risk of respiratory depression. This means the potential for side effects linked to the drugs is at least doubled when taking them together. In the case of respiratory distress, that risk can be fatal.
There are patients with a genuine need for the medications included in the Holy Trinity, either alone or in combination, but there is rarely any legitimate reason for taking all three simultaneously. Most agree the benefits don’t outweigh the risks of combining the three drugs in this manner, especially considering that safer alternatives are available.
More Accurate Information Needed to Reinforce the Risk of the Holy Trinity
Medical experts and those concerned about the risks associated with the Holy Trinity note their problem with resources that call the risk of mixing this combination of drugs moderate. Not only are people abusing the drugs and unethical doctors prescribing them without concern for abuse, but many who intend to prescribe or use the drugs properly are also doing so without access to information that accurately describes the risk.
One of the main concerns deals with combining carisoprodol with opioids and benzodiazepines. This combination results in tens of thousands of emergency room visits each year. According to the US Centers for Disease Control and Prevention, approximately 30 percent of all opioid poisonings involve benzodiazepines. The agency also notes that all of the drugs involved in the Holy Trinity include a risk for dependence.
Pharmacists Being Called to Assist in the Battle against the Holy Trinity and Other Opioid-Related Problems
Those on the front lines of the battle against the opioid crisis and concerned about the use of the Holy Trinity are calling on pharmacists to be proactive when filling prescriptions. They want pharmacists to use prescription drug monitoring programs that can be accessed from all pharmacy settings in most states. These programs provide useful information that pharmacists may not otherwise have access to but do not usually offer information about prescriptions filled in other states or by the Departments of Defense or Veterans Affairs. Despite the flaws, these programs can still act as a resource to reduce the risks associated with dangerous drug combinations.
Pharmacists are also encouraged to inquire about how frequently patients are taking benzodiazepines and to explore whether safer alternatives to drugs used in the Holy Trinity could be an option.