How deprescribing supports medication without harm
From insulin to anti-depressants, medications have made a significant impact on improving human health. But as the population ages and more people are living longer with chronic health conditions, the use of multiple medications is increasing.
The prescribing and use of multiple medications can be problematic because people’s health needs change over time and because the more medications a person takes the more at risk they are for harmful drug interactions and reactions. “Sometimes this means people are using medications that they once needed and no longer do, or are taking medications where the risks are just outweighing the benefits,” said Lisa McCarthy a pharmacist and clinician-scientist at the University of Toronto’s Leslie Dan Faculty of Pharmacy.
McCarthy is an expert in deprescribing, a rapidly expanding area of health care and health research. “Deprescribing is a planed process where people partner with their health care providers to reduce doses of medication or to stop them when medications might be causing harm, or are no longer of benefit,” she said.
In Canada, estimates from public drug programs suggest that 67 per cent of older adults take at least five different prescription medications. And, approximately $1.4 billion per year is spent on indirect health care costs as a result of harmful medication effects. To properly address this problem, health providers and patients need to look at both poles of prescribing: how medications are started and how and when they are reduced or stopped, McCarthy said.
“My interest in this work really comes from my clinical experience, every time that I sit down with a person I’m interested in figuring out are their medications giving them the most benefit with the least risk of side-effects or harm”
As the health system’s medication experts, pharmacists are well positioned to help tackle the issue, also known as ‘polypharmacy’ or 'medication overload' and build solutions. “My interest in this work really comes from my clinical experience, every time that I sit down with a person I’m interested in figuring out are there medications giving them the most benefit with the least risk of side-effects or harm,” said McCarthy.
Polypharmacy: a global problem
Inappropriate use of medications is a global problem and polypharmacy is widely-recognized as a chief contributor. In 2017, the World Health Organization (WHO) announced “Medication Without Harm” as the Third Global Patient Safety Challenge.
McCarthy, who is also a scientist at Toronto’s Women’s College Hospital, is part of an internationally-renowned research team that created medication-specific guidelines for deprescribing. The guidelines are tools that help clinicians make decisions around who should undergo desprescribing and what the approach for that should be. “The guidelines have had global interest,” said McCarthy. “We’ve translated them into several different languages and they are being used in different health care settings across the world.”
A future focused on best possible medication use
For McCarthy, the partnership between patient and health care providers is key to appropriate prescribing and deprescribing. “I envision a future where new prescriptions are started with a stop in mind; where people and prescribers partner to decide what benefit a medication is supposed to have and when that will be reassessed.”
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