Does taking non-prescribed medications constitute as poisoning?

jadeed@unionhospital.org

I know what the typical questions we pose concerning what is considered an overdose/poisoning, error in dosage or administration, intentional, accidental, etc.  A patient came in w/ lethargy, confusion; questionable metabolic encephalopathy, toxic encephalopathy. I believe the "medication" they were considering causing her symptoms included marijuana, which was not prescribed. The ingestion of the drug was purposeful and it wasn't not taken to inflict any kind of harm. They did not say in the medical record that the pt had an overdose of marijuana. My question is, are non-prescribed medications also considered, in the coding world, a poisoning?

I have attached a decision tree from our encoder that addresses adverse effect/poisoning. From the bottom part of the decision tree, it looks like a non-prescribed/street drug could be considered a poisoning, but I wasn't sure if the lower part of the decision tree addresses some kind of potentiation/combination of prescribed drug only. I've gone back and forth over this issue and sometimes I think it's a poisoning, sometimes I don't think it is.

Does anyone have any insight?

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jadeed@unionhospital.org

Yes, thank you, that is what I was wondering.

amy.feltman@stvhs.com

Cocaine does code out as poisoning as it can be used therapeutically by a MD (e.g. ENT).

lostwater

I would consider the untoward effects of a combination of a properly prescribed and taken drug *along* with an illicit, illegal, or other drug *not* prescribed, or *not* taken according to instructions, as a poisoning. Especially an adverse event for an otherwise therapeutic drug NOT prescribed or taken outside of the prescribed instructions, would be considered a poisoning. (be careful, we do have "undersdosing as opposed to poisoning as an appropriate alternative if truly an underdose situation occurs)