Helping Patients Deprescribe

Unnecessary drug prescriptions are at an epidemic level in the Unites States, as are adverse drug events (ADEs). The most recent statistics (from 2019 or before) paint a frightening picture:

Prescription Drug Use by Age^1-2

• 38% of 18-29-year-olds take at least one prescription drug.
• 51% of 30-49-year-olds take at least one prescription drug.
• 75% of 50-64-year-olds take at least one prescription drug.
• 89% of older adults (65 and older) take at least one prescription drug.
• 42% of older adults take five or more prescription drugs.
• Almost 20% of older adults take 10 or more prescription drugs.

Hospitalization, Death & Cost of ADEs^2-4

• 750 daily ADE hospitalizations of older adults
• 2 million ADE hospitalizations over the past 10 years
• 5 million older adults sought medical care for ADEs in 2018 alone
• Over 106,000 ADE deaths annually
• $30 billion in ADE annual costs

An article late last year reviewed the challenges associated with polypharmacy and the barriers to deprescribing drugs that are no longer useful and may even be harmful.

“Over time, a drug’s benefit may decline while its harms increase, Johns Hopkins geriatrician Cynthia Boyd, MD, MPH, told JAMA. ‘There are a pretty limited number of drugs for which the benefit-harm balance never changes.’”⁵

There are a number of reasons why medical doctors are reluctant to deprescribe. They may be afraid to change the course of care, assuming that the drugs are working even though they may not be. They may not want to deprescribe a drug prescribed by another doctor. Ultimately, it may be the lazy path of least resistance.

“‘We’re all taught how to prescribe these medications. We’re not taught how to stop these medications,’ Eric Lee, MD, a Kaiser Permanente geriatrician in Los Angeles, explained in an interview with JAMA. So ‘prescribing inertia’ – the tendency to keep prescribing a drug even if the indication it originally treated no longer exists – sets in.”⁵

Talking Deprescription

An effective deprescription conversation in many cases relies on what matters most to the patient. Patients looking to reduce their drug dependency and seeking nonpharmacological alternatives are more likely to receive a change in their care.

As a large portion of your patients are currently taking at least one prescription drug, it’s well-worth a conversation suggesting that they review their prescriptions with their MD to see if any can be eliminated, reduced or replaced with nondrug solutions. If you don’t have this conversation with them, who will?

References

1. Kirzinger A, et al. Data Note: Prescription Drugs and Older Adults. KFF.org, Aug 9, 2019.
2. Medication Overload and Older Americans. Lown Institute, Jan. 28, 2020.
3. Preventable Adverse Drug Reactions: A Focus on Drug Interactions. U.S. Food and Drug Administration, March 6, 2018.
4. Sultana J, et al. Clinical and economic burden of adverse drug reactions. J Pharmacol Pharmacother, 2013 Dec;4(Suppl 1):S73-7.
5. Rubin R. Deciding When it’s better to deprescribe medicines than to continue them. JAMA, 2023;330(24):2328-2330.