By Karen Born
and Wendy Levinson
University of Toronto
Canadians are living longer than ever and we are also taking more medications than ever. And this can make us sicker, not healthier.
A report from the Canadian Institute for Health Information found that one in four seniors in Canada take 10 or more medications. That’s a total of 1.6 million seniors in Canada who are at significant risk of being harmed by the very thing that’s supposed to help them.
For example, benzodiazepines are a medical term for sleeping pills commonly prescribed to seniors who experience trouble sleeping or anxiety. These powerful drugs were designed for short-term use. Unfortunately, many seniors end up feeling dependent on these drugs for sleep and stay on them for the long term, sometimes indefinitely. These medications can lead to increased drowsiness, falls and possible fractures, and even car accidents.
Antipsychotics are another powerful medication intended for short-term use in seniors that Canadians over 65 are taking for longer durations than necessary. Antipsychotics are sometimes prescribed during a challenging life event like a hospitalization or a move to long-term care. But long-term use can change a senior’s behaviour and personality, and puts them at higher risk for drug interactions and side effects.
Individually, these drugs pose risk to seniors, especially when taken long term. The danger multiplies when multiple drugs are taken concurrently, increasing the potential for drug interactions and side effects.
Unnecessary medications are not just harmful to seniors, but harmful to all Canadians.
The opioid epidemic is a powerful illustration of the harms that potentially unnecessary medications can cause individuals and communities. An article by Ontario researchers published in 2018 found that powerful opioids are being prescribed for longer than necessary and at higher doses for Ontarians. Opioids are addictive and harmful medications when used inappropriately and when not needed.
The data on the amount of unnecessary prescription medications Canadians use, and the many harms associated with this, are staggering. But there are solutions to this complex problem.
Many of the solutions lie within the medical profession itself. After all, it’s mainly physicians who prescribe medications and their clinical colleagues such as nurses and pharmacists who dispense and monitor medication use. Increasingly, Canadian clinicians are recognizing that they can do better. Canadian clinicians are starting the conversation with patients and clients that more medications don’t lead to better health, and that unnecessary medications can be harmful.
The Choosing Wisely Canada campaign works with national clinician societies to develop evidence-based lists of medications and treatments clinicians should question. By thinking twice before prescribing, and talking with patients about the harms and risks of medications, clinicians are starting to tackle overuse of prescription medications.
Choosing Wisely Canada is also working with regional health-care providers and clinician organizations to share evidence-based strategies to help clinicians think twice, offer alternatives and have conversations about when that medication may cause more harm than good. The campaign also offers tools to patients to ask questions and start the conversation with clinicians about when more is not always better.
But more needs to be done.
Clinicians need to be able to work within health-care systems that offer them a fuller picture of what medications patients are taking. Fragmented and poorly designed information systems can make that difficult.
Payment models that incentivize quick clinical interactions can make it challenging to get a detailed medication history and to have a conversation with seniors about how many drugs they take, how often and to properly explain the risks and benefits.
Increasing clinicians, patients and the public’s awareness about the problem of overuse of prescription medications is just a beginning.
Karen Born, PhD is Knowledge Translation Lead of Choosing Wisely Canada and an assistant professor at the Institute of Health Policy, Management and Evaluation at the University of Toronto. Dr. Wendy Levinson is the chair of Choosing Wisely Canada and a professor of Medicine at the University of Toronto.