Drug overuse: the silent pandemic

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Health Sciences

Health professionals concerned about the high number of prescription drugs some patients are taking are “deprescribing” and seeing the number of pills they take dramatically drop, writes Justin Turner of the University of Montreal

Modern drugs have had a significant and positive impact on human health. Over the past 100 years, they have reduced symptoms, managed chronic disease, improved quality of life, and reduced mortality.

But when used longer than necessary, or in certain combinations, they can be dangerous.

The problem is so widespread that doctors and pharmacists have coined the term “potentially inappropriate drug” to describe drugs for which the potential for harm outweighs the potential for benefit.

Overuse of these drugs, especially in older people who are more sensitive to their effects, has been associated with an increase in falls, fractures, hospitalizations and deaths. It seems crazy that we are using these drugs, however, data shows that 50 percent of seniors in Canada are prescribed potentially inappropriate drugs each year.

Seniors are also on the front lines of what is called “polypharmacy”, commonly defined as when a person takes five or more medications. The reason is simple – as people age and develop more and more health problems, they are more and more likely to be prescribed more and more drugs – but it can quickly get out of hand.

In Canada, for example, two in three seniors take five or more prescription drugs and a quarter of them take 10 or more prescription drugs every day.

Medicines prescribed for individual conditions, when taken together, may increase the risk of drug interactions and harmful effects. The Lown Institute in America calls this “over-medication”. They call it America’s “other drug problem”, leading to 750 elderly people in the United States being hospitalized every day because of the side effects of the drugs.

It’s a similar story in the UK. England’s chief pharmacist recently explained how overprescribing has increased dramatically over the past 25 years and is now causing serious problems for the healthcare system.

In an effort to address these issues, in 2019, the Australian Federal Government announced that “Quality Use of Medicines and Safety of Medicines” would be the 10th national health priority area. Likewise, in Canada, there is increasing pressure to “create and implement a national strategy on appropriate prescribing”.

What is deprescribing?
Deprescribing – the process by which a patient and their healthcare provider both assess the potential benefits and harms of each drug and reassess whether the drug is still meeting the patient’s goals of care – might be the solution.

Just because a drug was good for you when it started 10 years ago doesn’t mean it’s still good for you now. Things can change over time: how our body interacts with drugs; our state of health or our vulnerability to side effects of drugs, for example. New evidence may emerge and new treatments are available.

For all of these reasons, it is very important to have patients’ medications reviewed to ensure that they are still appropriate for them.

Many health care providers assume that patients are reluctant to stop their medications. But research around the world consistently shows that most patients are willing to stop any of their medications if their doctor deems it necessary. Likewise, many patients are reluctant to question their healthcare providers, assuming that all is well with their medications.

Canada shows how deprescribing can be done and how it can save lives.

Educate patients and prescribers

In one trial, called “EMPOWER,” patients received an educational brochure in the mail on the pros and cons of their medications and alternative treatments they might consider. Patients were encouraged to strike up a conversation with their doctor or pharmacist and ask if the drug was still needed for their care.

This simple approach reduced the use of sleeping pills by 27 percent. In some cases, doctors and pharmacists have told patients that since they had not had a problem with the drug until then, deprescribing was not necessary. Therefore, a follow-up study asked pharmacists to educate both patients and prescribers about deprescribing. This approach increased the reduction in the number of drugs to 43 percent.

Fight opioids
Inspired by the results of direct public engagement, the Canadian government in Manitoba adapted the EMPOWER trial of sleeping pills to opioid drugs.

The TAPERING trial randomized the entire Manitoba population to take opioids for chronic non-cancer pain relief. Over the next six months, opioid use decreased and there was a significant reduction in mortality after three months.

There was a similar story in the province of Newfoundland and Labrador, Canada, which in 2018 had one of the highest uses of sleeping pills and proton pump inhibitors (PPIs). for reflux in Canada.

Health officials in the region worked with the Canadian Deprescribing Network, the University of Montreal and Memorial University of Newfoundland to create SaferMedsNL. He allocated new funds to pharmacists to talk to patients about deprescribing.

Although final results are not available, an interim analysis shows that 20 percent of patients pharmacists spoke to continued to deprescribe their medications.

The pharmacist program was strengthened by a public awareness campaign aimed at educating people about the pros and cons of their medications. Awareness of overuse of PPIs has increased significantly across the province, which may increase patient-led conversations about deprescribing.

One in six people said their doctor or pharmacist told them about deprescribing. Governments now have a research-based roadmap to successfully reduce harmful drugs.

Originally published under Creative Commons by 360info ™.

Dr Justin Turner is Assistant Professor at the Faculty of Pharmacy at the University of Montreal and Co-Director of the Canadian Deprescribing Network. Justin Turner has received funding for his research from the Canadian Institutes of Health Research, MITACS and the Fonds de Recherche du Québec Santé.


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