A growing number of Canadian medical professionals are urging people to take a closer look at their medication, warning that some prescriptions might be doing more harm than good.
“If you’ve ever walked into an older person’s house and opened the medicine cabinet, it can be pretty scary,” said Dr. Cara Tannenbaum, director of the Canadian Deprescribing Network.
Two-thirds of people over the age of 65 take five or more medications per day, said the geriatrician and professor at the Université de Montreal. One-quarter take 10 or more every day.
And increasing the number of pills you take increases the possibility that something might go wrong, she said. “Sometimes you need to take 15 medications. But there’s no question that as the number of medications increases, so too do drug interactions, drug side effects, drug-related hospitalizations.”
Johanna Trimble saw the effects of drug interactions in her elderly mother-in-law, Fervid Trimble. “My mother in law, she basically had the flu, she had gotten dehydrated, she was feeling very weak,” she said.
Fervid went to the emergency room, where she was rehydrated and sent back to her retirement complex. However, as she was still too weak to leave her independent living apartment to go down to the dining room, the complex suggested she spend a few days in their medical facility to recuperate.
“To make a long story short, what really surprised the family is that instead of getting better and recuperating in a few days, she got a lot worse,” said Johanna Trimble.
“When I say a lot worse, a lot of it was cognitive. She became confused, delusional. She was at some points having hallucinations. She got to the point where she wasn’t recognizing family members. She was having physical symptoms as well.”
The family was baffled. The only thing they were able to find out was that Fervid had been prescribed two new medications that seemed to be causing a drug interaction and severe side effects.
It took two or three months before they were able to meet with the medical staff and get them to agree to a “drug holiday” – pulling Fervid off these medications to see what happened. “And basically, she just completely recovered cognitively.”
The experience caused Trimble to become a patient advocate: pushing for more awareness of overprescribing, and educating people about “deprescribing.”
What is deprescribing?
“Deprescribing is defined as the planned process of gradually stopping or reducing the dose of medications that may no longer be necessary or may be causing harm,” said Tannenbaum.
The idea is to improve the quality of patients’ lives by reducing possible side effects and drug interactions, she said.
Why are health professionals concerned about people’s medication?
Cathy Balsom, a clinical pharmacist at Memorial University’s Medication Therapy Services Clinic, said that she first became concerned about how many medications people were taking when she managed a pharmacy.
“I was thinking, I can’t imagine having 15 or 20 medications that I had to have every single day. Are these absolutely necessary? And what are really the risks and benefits?”
Many people have trouble managing their medications, and it can become a significant burden on the patient, she said. “Their life often revolves around taking medication when you get to that point that you’re on 10 medications or more.”
“I’ve had patients who have left events like their son or daughter’s wedding in order to get home to be able to take their pills in time.”
Drug interactions can be serious, said Tannenbaum. One pill might stop another from being absorbed. Depending on the drugs, they could increase the risk of falls or cause problems for someone who’s driving, for example, or many other issues.
And sometimes, people get prescribed a new drug just to deal with the side effects of another. “All of a sudden, they have 12 plus medications and they only have one or two medical conditions,” said Balsom.
For all these reasons, Balsom and Tannenbaum think it’s worth periodically reviewing your prescriptions with your doctor or pharmacist.
Does that mean you should just stop taking some of your prescriptions?
Absolutely not. “One of the key messages here is always talk to a health-care provider before stopping something,” said Balsom. Some drugs carry serious risks, including death, if you stop them cold-turkey. And of course, some medications are life-saving, or help prevent conditions like high blood pressure.
But – if you have concerns, you should ask about them. “Just walk into your doctor, nurse or pharmacist’s office, and say, ‘Do you think I could stop one of my pills?’” said Tannenbaum.
The health-care provider should then take the time to review your medication, including why it was prescribed in the first place, if you’ve been on it long enough, and if the benefits still outweigh the risks or side effects. They may also decide whether there are non-drug therapies that you could try instead that might be just as beneficial, she said.
Changing the culture
Tannenbaum thinks that the pendulum has swung too far in favour of treating conditions with drugs.
“It’s a bit of a culture that’s instilled itself where you walk into the doctor or nurse’s office and hope to get a pill that cures all your symptoms,” she said. The Canadian Deprescribing Network is trying to educate patients and physicians about the benefits of deprescribing, when doctors have mostly been trained to prescribe.
“In medical school and in pharmacy school, we’re all trained on how to determine if a patient needs a medication, but we’re never really taught about when to recognize that a patient needs to stop a medication,” said Balsom.
She often hears from people with stories like her family’s, and she hopes that changes. “You want it not to be happening to other people.”