Are You Taking Too Many Medications?
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Medications treat, cure, and diminish what can often be painful and debilitating diseases. In a time of need, whether for acute or chronic conditions, they offer hope and relief. But when a person takes too many or misuses them, the miracle of drugs becomes a double-edged sword, causing unexpected side effects — or worse.
Polypharmacy, defined as the regular intake of five or more drugs, is a growing problem in the U.S. Polypharmacy includes not only prescription medicines, but also dietary supplements, herbs and other natural remedies.
However, Marcio R. Soares, M.D., chief of geriatric and palliative medicine at the University of Miami Health System, interprets polypharmacy through a broader lens.
“It’s not so much a specific number of drugs as the inappropriate use,” Dr. Soares says.
If you’re taking one medication when you no longer need it or never did, that, too, can be a problem.Dr. Marcio Soares
Polypharmacy is “extremely common” among older adults, Dr. Soares adds. Physicians’ observations and studies confirm this unfortunate fact. A report by the Lown Institute, a nonpartisan think tank that advocates for more equity within our healthcare system, underscores the troubling issue.
The Lown study found that 42% of all older adults in the U.S. take five or more prescription medications a day. Almost 20% take 10 drugs or more.
More worrisome: in the past two decades, polypharmacy incidences have tripled. The institute predicts that if this trend continues, overmedication or the inappropriate use of otherwise helpful drugs could result in about 150,000 premature deaths in the next 10 years. These incidences will cost $62 billion and lead to 4.6 million hospitalizations in the U.S. alone.
Other studies confirm this dire warning.
One 2016 survey, for example, found that more than half of the 100 older patients admitted to a hospital were taking between five and nine drugs. Potentially dangerous interactions between these drugs were observed in 52% of the cases.
It’s not only a U.S. problem, of course. The World Health Organization has declared polypharmacy a significant public health issue, blaming it for millions of preventable hospitalizations due to adverse reactions to drugs.
And it’s not just the elderly taking too many pills, either.
For instance, well-meaning parents may also be overmedicating young children with certain conditions. In 2016, the Centers for Disease Control and Prevention issued a statement urging parents of preschoolers with attention-deficit/hyperactivity disorder (ADHD) to first try behavior therapy before using drugs.
Overmedication, however, remains primarily a problem for the 65-and-older set. It’s actually a byproduct of modern medicine.
“As we live longer, we also live with more chronic conditions,” Dr. Soares says. “What used to be a potentially terminal illness, such as diabetes or HIV/AIDS, can now be treated effectively.”
Taking too many medications, even when needed, can be tricky.
That’s because our reaction to drugs changes as we grow older and our metabolism slows.
“As we age, our organs begin to slow down,” Dr. Soares adds. “When you look at the liver and kidneys, they become less efficient in breaking down and eliminating the drugs.”
What’s more, a 2020 analysis published in the Review of Pharmacology and Toxicology found that as many as half of patients taking four or more drugs didn’t always use them as prescribed. And the more medications taken, the greater the risk of harmful interactions.
Tackling the problem of overmedication can prove challenging — but not insurmountable.
Here are some of Dr. Soares recommendations:
Put all your medicine bottles in a bag and bring them to every visit with your primary care physician or another medical professional. Dr. Soares calls this strategy “brown paper bag medicine,” but it’s an excellent way to remember every prescription (and supplement) along with its dosage.
Discuss your medications with your doctor. “This should lead to a conversation that addresses why each medication is needed, what is the proper dosage, and which medications can be eliminated.”
Inform a new physician or specialist about your current medications list. Keep it current by adding any new medicine or over-the-counter supplement.
Make sure you understand “what these medications are for and what their benefits and risks are,” Dr. Soares adds. “You always want to make sure the benefits outweigh the potential side effects.”
Be alert to the proper use (both dose amount and length of time) for each drug. Too often, people continue to take sleep aids and anti-anxiety medications long after they shouldn’t. They may also increase the amount. That’s because these medications tend to become less effective over time. Your physician should be able to offer alternatives.
Look out for what Dr. Soares calls “the cascade effect.” That’s when the side effects of one medication require using a second medication to treat those side effects. Depending on the situation — and a physician should always be consulted — it may be better to remove or replace the first drug.
Know that certain meds can be especially risky for seniors. These include opioids, antipsychotics, diabetes medications, blood thinners, sedative-hypnotics, and blood pressure medications. Also, benzodiazepines, non-benzodiazepine prescription sedatives, anticholinergics, antipsychotics, mood stabilizers, and opiate pain medications are among the most commonly used drugs that negatively affect cognitive function.
“The goal is not to remove a medication for the sake of removing it,” Dr. Soares explains. “It’s not about, ‘I want to go from eight pills to one.’ What we want to do is identify the medications you may no longer need or those that essentially work the same way.
The question should always be: “Am I taking the right medication in the right way [for my condition] at this time?”
Ana Veciana-Suarez, Guest Columnist
Ana is a regular contributor to the University of Miami Health System. She is a renowned journalist and author, who has worked at The Miami Herald, The Miami News, and The Palm Beach Post. Visit her website at anavecianasuarez.com or follow @AnaVeciana on Twitter.