Wednesday, November 29, 2017

Wisdom Wednesday: Taking Four or More Prescription Meds? Consider Scaling Back

More than half of Americans regularly take about four prescription medications, increasing the likelihood that mistakes could occur, according to Consumer Reports.

People taking multiple prescription medications should visit their doctor for a “medication checkup.”

By showing their doctor or pharmacist a comprehensive list of every drug they are taking, including vitamins and other dietary supplements, patients can be warned about potentially harmful interactions. They can also find out if any of these medications are no longer necessary, which would save them money.

Consumer Reports encourages patients to have this type of medication review at least once a year.

“Much medication use is lifesaving, without a doubt. But some drugs can potentially do more harm than good,” said Lisa Gill, deputy editor of Consumer Reports. “Our concern is that inappropriate prescribing can lead to unnecessary risk, including trips to the emergency room,” she said in a news release from the organization. “We hope to encourage consumers to talk with their health care providers about the meds and supplements they take, so they can ultimately lower their risk,” Gill said.

Use of prescription drugs has surged over the past 20 years. The U.S. population has increased just 21%, but the total number of prescriptions filled by Americans has surged 85% - from 2.4 billion prescriptions in 1997 to 4.5 billion in 2016, Consumer Report said.

“There are many root causes, including a ‘culture of prescribing.’ Perhaps most worrisome is prescribing for pre-disease stages of a condition, such as pre-osteoporosis or pre-diabetes, where the medications offer limited benefit for people,” Gill said. “And we’ve seen a push to treat common problems like back pain, heartburn and insomnia with medication before trying effective, non-drug measures first,” she said.

People who are on multiple medications also need to be extra careful about possible interactions.

The harmful effect of inappropriate prescription drugs sent 1.3 million people to emergency rooms across the United States in 2014. Of these patients, roughly 124,000 died, according to the U.S. Centers for Disease Control and Prevention and the U.S. Food and Drug Administration. Many of these medication events were preventable.

My Take:
Medication checkup should be the responsibility of your primary care physician (PCP). Unfortunately, there are no medical standards for removing patients from medication, so the job falls to the patient. As I have said many times, you must be your own health advocate.

As a holistic physician, I keep a comprehensive list of every drug my patients are taking even though I did not prescribe them. Obviously, that includes vitamins and other dietary supplements, again, even if I did not recommend them. I frequently visit to review medication I am not familiar with. Most commonly prescribed medications have several hundred potentially severe drug interactions with other medications. As you reach polypharmacy (5 or more prescription drugs), negative drug interactions are inevitable.

The Bottom Line:
I applaud Consumer Reports for publicizing this information. However, I think they undersell the risk-benefit ratio. I think 124,000 deaths per year from inappropriate prescribing of drugs is more than “unnecessary risk”, I think it is criminal malpractice.

Source: October 31, 2017 National Institutes of Health

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