The opioid crisis has captured America’s attention, becoming an official “national emergency” and prompting swift action from government agencies, patient advocates, and health care providers. This is as it should be. Over the past decade, opioid overdoses have led to millions of hospitalizations, more than 100,000 deaths, and caused great harm in communities all across America.
At the same time, we are ignoring another widespread drug problem: The harm caused by taking too many medications, particularly among older adults. In a recently released report, Medication Overload: America’s Other Drug Problem, the Lown Institute exposes this epidemic of harm, which is affecting millions of older adults and their families.
Millions of Older Adults at Risk
Currently, more than 40 percent of Americans age 65 and up take five or more medications regularly, triple the rate found in the mid-1990s. This increased use of multiple medications poses increased risk of serious, sometimes life-threating harm.
In the past decade, there were at least two million hospitalizations of older Americans for adverse drug events; 35 million more visited a clinic or emergency department for an adverse drug event. Older people are hospitalized for adverse drug events at a greater rate than the general population is hospitalized for opioids. Last year alone, we estimate that older people sought medical care five million times and were hospitalized 280,000 times for adverse drug events.
With the American population aging—and upward trends in medication use — medication overload is only getting worse. Over the next decade, we project that adverse drug events will lead to 4.6 million hospitalizations and more than 150,000 premature deaths. These hospitalizations alone will cost the health care system $62 billion. The amount spent on outpatient visits for adverse drug events and the cost of unnecessary and/or harmful medications will add billions more.
Multiple Drivers Contribute to the Epidemic
One of the most powerful forces behind medication overload is cultural: Both medical professionals and patients have come to believe there is a “pill for every ill.” Doctors want to show their patients they care, and often the easiest way to do that is by pulling out the prescription pad. Patients feel better when they leave with a script. As Dr. Jeffrey Linder, physician and researcher at Brigham and Women’s Hospital explained why some doctors prescribe antibiotics unnecessarily: “From this side of white coat, you’re confronted with somebody who has taken half a day off of work to come in. It’s unsatisfying to say, ‘You’re going to be sick for a week or two.’ It’s much more satisfying to say, ‘I have the magic pill that’s going to make you better.'”
Meanwhile, drug companies spend tens of billions marketing to both doctors and consumers, presenting medications as “quick fixes” while downplaying the risks. In one study of drug advertisements aired in 2015 and 2016, not a single ad included a quantitative presentation of the product’s risks.
However, it’s not only drug advertisements that are to blame for medication overload. Clinical practice guidelines, which clinicians use to help them make treatment decisions, often recommend prescribing medications as the first line of treatment and “stepping up” drug regimens when the first effort does not succeed. Unfortunately, these guidelines rarely provide information on how to adjust doses for older adults or advice on how and when to stop medications if needed.
Because older adults are more likely to have multiple chronic conditions, they often see multiple doctors, each of whom prescribes medication for a single condition, without considering the sum of drugs the patient is already on. Even patients and clinicians who try to avoid medication overload are often stymied by the lack of coordination between providers and institutions, and disconnected medical records. Transfers to and from hospitals, nursing homes, and other institutions can add even more medications. While primary care providers might seem like the best gatekeepers, they rarely have time to review long lists of drugs or make decisions with their patients about stopping medications.
The Path Forward
Like the air we breathe, the forces that lead to medication overload are everywhere and yet difficult to see, and not easily remedied. The Lown Institute has convened a working group of experts, including geriatricians, nurses, pharmacists, and patient advocates, to formulate an action plan to address this public health emergency. That plan is scheduled to be released in early 2020.
The first step in that plan will be increasing awareness of medication overload, which despite its impact remains invisible to the vast majority of families and patients, most policymakers, and even many health care professionals. Just as the Centers for Disease Control and Prevention has taken steps to reduce harm from opioid abuse and overuse of antibiotics, government agencies should raise awareness among clinicians and the public about the risks of taking too many medications, especially for older adults.
We also need a public health campaign that will spark conversations between clinicians and patients about making sure patients’ medication regimens work for them. Just as drug advertisements push consumers to “ask their doctor” about brand-name drugs, public service announcements should urge people to talk to their doctors about getting a prescription checkup. The U.S. Food and Drug Administration can also limit drug industry influence by requiring drug ads to include better information about the effectiveness and risks of medications, and by more strictly regulating sales pitches and other marketing to health care professionals.
As with other public health crises, reducing medication overload will require coordinated action from multiple stakeholders – not just government agencies but also clinician specialty groups, patient advocacy and seniors’ organizations, and health care institutions. We must come together to tackle this problem, for the sake of the health and well-being of millions of Americans.
Shannon Brownlee
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