Melbourne: Millions of medicines handed to patients each year may be unnecessary and even potentially harmful. Deprescribing is one way forward.

Millions of medicines handed to patients each year may be unnecessary and even potentially harmful and it’s a problem happening in both developed and developing economies.

The term polypharmacy originally meant the prescription of five or more medications but has come also to refer to the prescription of medications with no specific current indication, that duplicate other medications, or that are known to be ineffective for the condition being treated.

The problem is highly prevalent, especially among older adults.

A recent survey published by Keith Ridge, chief pharmaceutical officer for England, concludes that up to 110 million medicines handed to patients each year may be unnecessary and even potentially harmful.

In England, 15 percent of people now take five or more medicines a day, while 7 percent are on eight drugs or more. A 2018 University of Sydney report recommended a strategy to reduce inappropriate polypharmacy.

Its recommendations included the provision of incentives for health care professionals to encourage quality use of medicines by older patients.

But the problem is also a major public health issue in India.

Factors contributing to the misuse of medication there include health system and regulatory failures, poor prescribing practices on the part of physicians, ease of access to medications from pharmacists without requiring a prescription as well as a lack of education among patients about their medications.

Increasingly, health care providers around the world are seeing deprescribing as a solution. This process, led by pharmacists and doctors, involves systematically discontinuing medicines that are inappropriate, duplicative or unnecessary.

Other solutions include so-called social prescribing , which takes into account a range of social, economic and environmental factors such as housing, economic resources, pollution, health behaviours and diet when prescribing.

In the UK studies suggest this can improve people’s health and wellbeing and reduce workload for healthcare professionals and demand for secondary care services. In England social prescribing is part of the NHS Long Term Plan.

REALITY CHECK An estimated 36.1 per cent of older Australians were affected by continuous polypharmacy.

In India, it has been estimated that at least 50 per cent of average family spending on medicines in the country is incurred on irrational or unnecessary drugs and diagnostic tests.

In the US nearly half of those taking psychotropic medications, which include antipsychotic drugs used to treat schizophrenia, had no mental health diagnosis.

BIG IDEAS Quotes attributable to Dr Justin Turner, Co-Director of the Canadian Deprescribing Network, Faculty of Pharmacy, University of Montreal.

We see a lot of patients struggling to take all of the pills they are prescribed. They even end up taking medications to treat the side effects of their medications – this is called a prescribing cascade. Overuse of medicine is a silent pandemic.

Just because a medication was good for you when it was started 10 years ago, it doesn’t mean it’s still good for you now.

PESPECTIVES

(Feature articles available for republishing under CC 4.0)

Overuse of medicine: the silent pandemic By Justin Turner, Universit de Montr al

While modern drugs can save lives, if used for too long, or in the wrong combination, they can be harmful. Deprescribing is increasingly used by health professionals to take back control.

Ban drug ads to promote health Joel Lexchin, York University

Advertising promoting new drugs is effective but often leads to inappropriate prescribing. To protect the health of their citizens, countries should ban it.

The untapped potential of effective non-drug treatments By Paul Glasziou, Bond University

Compiled by the Royal Australian College of General Practitioners, HANDI is the world’s first compendium of drug-free medical treatment.

Not just big pharma: how social factors affect overprescription in India

By Paromita Goswami, Shiv Nadar University and Anindita Chaudhuri, University of Calcutta

Increasing use of antidepressants in India stems not only from pharmaceutical company marketing. Social stigma and economics are pushing people to take a pill.

The set and forget of medication in aged care By Simon Bell, Monash University

Nowhere is the problem of overprescribing as acute as in aged care settings where experts are grappling with the overuse of psychotropic and other powerful medications. (360info.org)

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