Medication Overload: Breaking the Pill-Popping Cycle

 

The current medical paradigm in America and Europe is centered around keeping people hooked on medication, rather than helping them kick the habit. It is as if doctors are incentivized to continuously write prescriptions, rather than focusing on preventative care or holistic wellness.

 

It seems like some patients are carrying a whole pharmacy in their pockets these days. Just take into account the following scenario: Dr. Juanita Williams (her name has been changed to protect her anonymity), worked as a pharmacist in a large hospital in Adelaide, and she frequently witnessed patients feeling overwhelmed by the quantity of medications they used on a daily basis. She made the observation that such patients frequently report to her that they take so many medications that their bones basically rattle as they walk is one of the side effects. In addition, she was concerned that some of the medications that these patients were taking did not appear to be doing any good and may perhaps be doing  damages on their bodies.

Patients, like Dr. Williams' patients, don't stand out, at least not among those living in wealthy countries. It is estimated that approximately 15% of the population in England takes five or more prescription medications on a daily basis. As do 20% of those aged 40 to 79 in both the United States and Canada. The quantity of medicines that a person takes typically increases with age due to the fact that older people tend to be sicker. Two thirds of elderly people in the United States take at least five different medications on a daily basis. A quarter of people over the age of 65 in Canada take ten or more.

Not all of those medications are in the patients' best interest. The majority of older Canadians, or 50%, take at least one that is improper in some way. After conducting an investigation into the practice of overprescribing in England in 2021, researchers came to the conclusion that at least 10% of prescriptions that were filled by general practitioners, pharmacists, and other medical professionals probably should not have been filled. And even medicines that are prescribed correctly can have unwanted side effects. The more medicine a person consumes, the greater side effects they will feel from those medicines.

The use of many medications at the same time by a patient to treat their illnesses is referred to as polypharmacy, and it can have a significant negative impact on a person's overall health. According to the findings of a recent study conducted at a hospital in Liverpool, adverse medication reactions are responsible for approximately one in every five hospital admissions. According to the evidence that has been released, the excessive use of medications in the United States could result in about 150,000 premature deaths and 4.5 million admissions to hospitals between the years 2020 and 2030.

Getting people to stop using  medicines or drugs is an uncharted territory for today's medical systems, which are primarily designed to prescribe medication to their patients. On the other hand, that is starting to change. De-prescribing networks are being organized by medical professionals such as physicians, pharmacists, and nurses in an effort to disseminate the necessary information in that regard. (Dr. Williams, who is currently teaching at Monash University in Melbourne, is in charge of the one that is administered in Australia.) In 2021, the National Health Service of England unveiled a proposal to cut down on inappropriately prescribed medications. The previous year saw the first ever international conference on the subject, which took place in Denmark.

Patients are burdened in multiple ways by taking an excessive amount of medication. One is the sheer amount of work that goes into the logistics.  People get the impression that their entire life are determined by the prescriptions they take. The more drugs a someone consumes, the greater the likelihood that some of those drugs may be consumed in an improper manner. Other issues can be explained more simply by medical conditions. Certain individuals wind up having to take multiple medications, each of which affects the same biological route. Anticholinergics are a good illustration of this type of drug because they inhibit the function of the neurotransmitter acetylcholine. This mechanism of action is shared by a number of medications, such as some anti-allergy medicines, anti-incontinence meds, and tricyclic antidepressants. However, according to Dr. Williams, physicians are not always aware of that fact.

 

Breaking the Cycle

 

That might lead to overdose. Anticholinergic drug abuse can severely inhibit acetylcholine, rendering patients unconscious or confused. Such effects are frequently mistakenly attributed to aging or disease. According to scholarly study, it will be able to correct the misdiagnosis of some diseases (such as dementia) by eliminating hazardous medicines.

From a medical perspective, excessive prescription may start to reinforce itself. Serotonin, another neurotransmitter, is blocked by a number of widely used medications. Overdosing can result in tremors, sleeplessness, and jerky arm and leg movements. These signs are frequently confused for Parkinson's symptoms. As a result, Parkinson's medications are added, creating a prescribing cascade. These can then lead to delirium and low blood pressure, both of which are naturally treated with further medications.

The issues can overlap in other ways. It is more likely that some medications will interact negatively the more pills a person consumes. Pharmacy technicians scan reference databases for harmful medication interactions. But since clinical studies typically only evaluate one medicine at a time, knowledge is constrained. When various medications are filled at separate pharmacies, pharmacists are unable to detect dangerous combinations. Additionally, anything purchased over the counter is entirely invisible.

The aged, whose bodies are less effective at metabolizing medicines, experience all these symptoms in even greater intensity. For instance, taking sleeping drugs the night before could leave a child feeling groggy the next day. They can produce brain fog in elderly people, which makes doing daily chores impossible. Finding the proper dose is challenging for the obvious reason that elderly individuals are typically not included in clinical trials for new medications.

For a variety of reasons, medication overload continues. One is overselling the advantages of drugs in advertising, especially in America. Another is the absence of standard personal health records. Therefore, it is feasible for a doctor to prescribe medication for a patient, let's say a cardiologist, without knowing what medication the doctor treating his lungs may have prescribed.

The most frequent cause may be that patients either forget or are not instructed when to cease taking a medication. One in five Americans who receive the powerful painkiller gabapentin after surgery continue to take it 90 days later (the recommended duration is four weeks). Other doctors frequently automatically renew prescriptions because they see them in a patient's notes and presume they ought to be kept.

Many medical professionals assume that patients are not particularly motivated to discontinue taking their medications. That is likely incorrect; according to research from various nations, eight out of ten patients are willing to stop taking a medication if their doctor recommends it. But those medical professionals have their own issues. There is little funding for de-prescribing investigations. Drug companies, who often sponsor clinical studies, have little interest in participating.

Nevertheless, evidence concerning the best course of action is beginning to accumulate. In Canada, brochures have been created to assist patients in weaning themselves off of a variety of popular medications. They detail various options, such as cognitive behavioral therapy in place of sleeping medications for insomnia, among other things. Trials show they are effective.

In recent years, automated de-prescribing tools and recommendations for various medications have also been created. Medsafer, one of these electronic tools, boosted the proportion of hospital patients for whom medications were deprescribed from 30% to 55%, according to numerous studies. Another technique is the Drug Burden Index, which totals the cumulative dosages of medications with sedative or anticholinergic effects.

In other words, a medical movement is only getting started. It might have a significant influence. In 2021, Keith Ridge, England's top pharmaceutical official, made an amusing yet poignant contrast. If the health authorities can only get this right, he claims, millions of people's health may be improved—equal to a new "blockbuster" drug—due to the fact that well over a billion products are dispensed annually.

Overprescribing medicines is like throwing pills at a problem in hopes that one of them will stick. The problem is that this method could cause patients to take too many medicines, which could lead them to take even more medicines to treat side effects from other medicines. Because of this, it is important for doctors to find a new way to treat patients that puts an emphasis on lowering the number of  medicines drugs they take.

 

 

 

 

Notes

 

Bortolotti, J. (2023). One in Four Canadian Seniors on 10 or More Prescription Drugs. Retrieved from Hospital News: https://hospitalnews.com/one-in-four-canadian-seniors-on-10-or-more-prescription-drugs/

Department of Health and Social Care. (2021, September 22). Government Pledges to Reduce Overprescribing of Medicines. Retrieved from UK Government Press Release: https://www.gov.uk/government/news/government-pledges-to-reduce-overprescribing-of-medicines

Gregory, A. (2021, September 21). Government Review Finds 10% of Drugs Dispensed in England Are Pointless. Retrieved from The Guardian: https://www.theguardian.com/society/2021/sep/22/government-review-finds-10-of-drugs-dispensed-in-england-are-pointless

Hales, C. M., Servais, J., Martin, C. B., & Kohen, D. (2019). Prescription Drug Use Among Adults Aged 40–79 in the United States and Canada. Data Brief , Center for Disease Control and Prevention, National Center for Health Statistics . Retrieved April 28, 2023, from Center for Disease Control and Prevention: https://www.cdc.gov/nchs/data/databriefs/db347-h.pdf

Hayward, E. (2021, September 21). Doctors Are Urged to Issue Fewer Prescriptions as it Emerges 15% of Adults Take Five or More Medications Every Day. Retrieved from Daily Mail: https://www.dailymail.co.uk/news/article-10014917/Doctors-urged-issue-fewer-prescriptions.html

Health Policy Institute. (2023). Prescription Drugs. Retrieved from George Town University's Health Policy Institute: https://hpi.georgetown.edu/rxdrugs/

Masnoon, N., Shakib, S., Kalisch-Ellett, L., & Caughey , G. E. (2017). What is Polypharmacy? A Systematic Review of Definitions. BMC Geriatrics, 17(230). doi:https://doi.org/10.1186/s12877-017-0621-2

McPherson, M., Ji, H., Hunt , J., Ranger , R., & Gula, C. (2012). Medication Use among Canadian Seniors. Healthcare Quarterly, 15(4), 15-18.

O'Connell, J., Burke, E., Mulryan, N., O'Dwyer, C., Donegan, C., McCallion, P., . . . O'Dwyer , M. (2018). Drug Burden Index to Define the Burden of Medicines in Older Adults With Intellectual Disabilities: An Observational Cross‐Sectional Study. British Journal of Clinical Pharmacology, 84(3), 553–567.

Odense Deprescribing Initiative . (2022, September 5-7). 1st International Conference on Deprescribing. Retrieved from https://www.conferencemanager.dk/icod2022

Perri, G., Bortolussi-Courval, E., Brinton, C. D., Berall, A., Santiago, A. T., Morcos, M., . . . McDonald, E. G. (2022). MedSafer to Support Deprescribing for Residents of Long-Term Care: a Mixed-Methods Study. Canadian Geriatrics Journal, 25(2), 175-182.

The Economics. (2023, April 26). Overprescribing Drugs: Too Many People Take Too Many Pills. Retrieved from https://www.economist.com/science-and-technology/2023/04/26/too-many-people-take-too-many-pills