Polypharmacy: Too much Rx

The consumption of all these drugs inevitably has created problems for the health-care system.

The drug-induced deaths of Michael Jackson and Anna Nicole Smith are high-profile examples of larger problems. In 2008, 1.9 million people were hospitalized because of adverse drug events (ADEs), which is more than a 50 percent increase from 2004.

That does not include the 838,000 treat-and-release emergency-room patients affected by ADEs, a number that doubled from four years earlier. More than a third of those were for misuse of prescription painkillers.

The 28,000 prescription overdose deaths in 2007 are five times more than in 1990. Most of those deaths have been from painkillers. The Obama administration has called the current prescription overdose epidemic worse than those of crack cocaine in the 1980s and heroin in the 1990s. The White House launched an anti-abuse plan in April 2011 to cut the rate of abuse by 15 percent in five years.

A study at Pennsylvania-based Geisinger Health System found that more than one-third of patients treated for chronic pain with painkillers met the criteria for addiction. Between 20 and 40 percent of U.S. adults have persistent pain that lasts more than six months.

Seven out of 10 who abuse prescription painkillers got them from a relative or friend. However, physicians have been quick to reach for the prescription pad when patients complain of aches and pains. Spending on prescription painkillers tripled from 1996 to 2006.

The elderly have a particularly difficult time juggling multiple prescriptions. Researchers examined prescription use by people with chronic heart disease, using CVS Caremark data. Patients filled prescriptions for an average of 11 medications during a 90-day period. One in 10 used 23 prescriptions during that period. Each medication a patient takes causes an average of 10 percent additional adverse drug events in a hospital setting.

Dr. Jerry Avorn, in a commentary in the Journal of the American Medical Association, said, “The use of medications in older patients is arguably the single most important health care intervention in the industrialized world.”

However, the Harvard professor listed a number of factors that hamper medication management in the elderly. The fragmented health-care system causes patients with several chronic conditions to see multiple prescribing physicians, most of whom do not communicate with each other. That, Avorn said, creates “pharmacological chaos.”

Clinical drug trials rarely include many over 80 years old, so safety and side effects are less well known among that group. This population may metabolize drugs differently than younger patients and may experience more side effects. Overmedication, also called “polypharmacy,” can increase the risk of falls, cognitive decline and depression. All of that, of course, calls for more prescriptions.

Taking so many drugs is complicated. According to one study, only 15 percent of older adults could consolidate seven drugs into four doses a day correctly. People with less formal education performed even more poorly.

People with chronic conditions consume a prodigious amount of prescription drugs. They account for $3 of every $4 spent on pharmaceuticals. Those with five or more conditions filled an average more than 57 prescription medications a year.

Taking so many drugs, also known as “polypharmacy,” can create problems. A patient may not react to one drug on its own. When drugs are used together, the risk of adverse consequences increases exponentially. Unfortunately, health-care providers often react to these events by adding still more drugs to the mix – called “prescribing cascading” – which can increase the chance of additional adverse reactions.

On the other hand, about half of people who have three or more conditions do not take medicines as directed – often because of cost. Therefore, the risk of taking too many or too few medications is high for those with chronic illness.