W. Gifford-Jones, MD and Diana Gifford-Jones
Common Sense Health
Many diseases can be effectively managed thanks to therapeutic treatments involving pharmaceutical drugs. But have we gone too far in popping pills for every ache? Or even for serious health conditions, has your doctor put as much thought into how to get you off prescription medications as has gone into putting you on them?
The statistics are alarming. A study of drug use among seniors in Canada in 2016 found that 2 out of 3 Canadians over the age of 65 were taking at least 5 different prescription medications and over a quarter took at least 10 different prescription medications! In the U.S., a 2018 national survey found that 48.6% of the entire population used at least one prescription drug in the month prior to the survey. Some of these statistics are certainly made up by people who are taking medications they no longer need.
Among adults aged 60–79, the most commonly used drug types in the United States were lipid-lowering drugs, antidiabetic agents, and beta blockers; in Canada, they were lipid-lowering drugs, analgesics, and proton pump inhibitors.
How should you proceed if you want to reduce the numbers of medications you take? First, take all your medications to your doctor and have a discussion. But don’t expect miraculous answers, as doctors are known for writing more, not fewer, prescriptions – and sometimes, for good reasons.
About 50% of those prescribed medications for chronic conditions stop taking them within the first year of starting therapy. This non-adherence can further deteriorate health. More hospitalizations result, costing an estimated $300 million in avoidable expenditures per year
About 1 in 5 individuals prescribed antidepressants who stop medication can suffer a host of problems, collectively called discontinuation syndrome.
But there are many situations where less medication is not such tricky business. Sleeping pills, for example, should only be for short-term use. Allergy medication should only be used when allergens cause symptoms.
Stopping blood pressure medication needs your doctor’s endorsement. But one way to manage hypertension and get blood pressure into the normal range is to lose extra weight. Finding natural alternatives to strong, addictive painkillers is another smart move.
It’s also highly advisable to have a strategy for reducing cholesterol medicines, known as statins, which can have devastating side effects, including liver damage and memory problems. Has your doctor made you aware of all your choices? If you’ve read this column for years, you’ll know that high-dose vitamin C could be a life-saving option for reducing the rick of heart attack or stroke.
A special note about those who are very elderly or frail. These individuals can be more susceptible to medications, particularly when considering the extent of inappropriate polypharmacy (i.e., too many drugs, unnecessary drugs, and/or doses that are too high) that they are often taking without adequate oversight. If you are, or know someone, at risk, then be careful to ensure that the doctor has full information about all medications and that the patient understands benefits and harms of medication and gives consent.
Socioeconomic factors are also noteworthy. Seniors living in long-term care facilities, low-income neighbourhoods and rural/remote neighbourhoods used more drugs, with one study showing 21.4% of seniors living in the lowest-income neighbourhoods were prescribed 10 or more drug classes, compared with 14.3% of seniors living in the highest-income neighbourhoods.
Finally, if you have been able to make reductions, how should you dispose of all the unused or expired medications? Most jurisdictions have drug take back sites. The U.S. Food and Drug Administration has a “Flush List” of those medications that can be disposed of in the toilet. Whatever your means of disposal, remember that drugs pose a huge hazard to unsuspecting children or pets. Dispose of them safely.
The weekly column by W. Gifford-Jones, MD has been published without interruption for 45 years. The same no-nonsense tradition now continues in a father-daughter collaboration. Sign-up at www.docgiff.com to receive our weekly e-newsletter. For comments, firstname.lastname@example.org.