Swallowing a handful of pills is a daily ritual for many people, from young adults struggling with anxiety to older adults dealing with chronic illnesses. Overall, 13% of people in the U.S. take five or more prescription medications. For people 65 and older, that number is 42%. If you’re taking multiple medications, it’s smart to be aware of potential problems. One pill can cause a side effect, which can lead to another pill and then another side effect, in what experts call a “prescribing cascade.”
Some medications can cause harm if taken for years. Other drugs stop working or react poorly with a new medication. A drug that was initially well-tolerated may later cause side effects, leading to cognitive decline and injuries from falls. “Our metabolism changes as we age,” said Dr. Elizabeth Bellis, who studies deprescribing at Kaiser Permanente’s Health Research Institute in Aurora, Colorado. “Everyone’s ability to metabolize medications that have been taken for a long time can change.”
The nonprofit Lown Institute calls this whole situation drug overdose, which will lead to 4.6 million hospital visits this decade. If your daily pill routine is getting out of control, ask for a medication review. Here’s how to start the process called “deprescribing.”
Ask for a Prescription Checkup
Lisa McCarthy, a pharmacist and deprescribing expert at the University of Toronto, said to start with a trusted professional, like a doctor or pharmacist. If you’re asking your doctor, don’t wait until the end of a 15-minute appointment. Instead, make a dedicated appointment and let them know when booking that you want to talk about your medications, McCarthy said.
If other prescribers are involved, your doctor may not have a full understanding of what you’re taking, and some doctors are hesitant to manage medications prescribed by others. The pharmacist at that time can help you by reviewing everything and writing down suggestions that can be shared with your doctors, said Bradley Phillips, a pharmacist at the University of Florida College of Pharmacy. “We’re considered the medication experts,” Phillips said.
Can my medicine cause any problems?
Bloating, incontinence, restlessness, insomnia — these are all common drug-induced side effects that are sometimes treated with newer drugs. McCarthy wants people to ask their doctors a simple question: Could this symptom be related to one of my medications? “It would be very powerful if we could teach people to ask that question,” McCarthy said. And for a follow-up question, she suggested: Do I still need this medication?
Pharmacist Barbara Farrell has seen dramatic changes in many of the people she works with at an outpatient geriatric centre in Ottawa, Ontario. Some have recovered from drug-induced dementia because their medication doses were reduced. A 77-year-old woman was able to get out of her wheelchair and walk with a cane after reducing her daily pill dosage from 32 to 17. She had been in a coma and unable to communicate, and a few months later, she returned to her hobby of knitting.
It takes time to stop the medication
Some medications can be stopped abruptly, but others have to be tapered down gradually to prevent uncomfortable withdrawal symptoms — or even life-threatening seizures. Slowly lowering doses is especially important in the case of medications for depression, insomnia and anxiety. After taking various pills for two decades for these conditions, Molly Bernardi, a therapist from Spokane, Washington, started reducing her doses.
The 45-year-old woman suspected that these pills were the cause of her increasing problems with digestion, balance, memory, muscle stiffness and flickering dots in her field of vision. When scans ruled out other diseases, she gradually stopped each of the four drugs. “This is the hardest thing I’ve ever done,” Bernardi said.
The last medication she quit was one of the hardest: benzodiazepines, a type of sedative that can be harmful if taken for a long time. Over the course of three months, she used a kitchen knife and nail file to cut her 1-milligram daily pill into ever-smaller pieces. She listened to her body, found support groups on Facebook and used breathing exercises and prayer to cope with withdrawal symptoms.
“Now when I’m having a good day, a good hour, a good moment, there’s this peace and presence that I never felt before I took the drug,” Bernardi said. “I just feel a little bit better. And a little bit better is so good that it helps me keep going.”
Keep track of your medication list
Even in the most well-connected healthcare systems, information about prescriptions isn’t always shared between doctors, McCarthy said. And they won’t know about your over-the-counter medications, vitamins or the CBD gummy you take at night. The only person who knows about everything you take is you, McCarthy said. So keep a current list of everything you take, the reason you took it, and when you started taking it. For an example of a medication list, which McCarthy calls an “extremely powerful” tool, see the workshop materials he and his colleagues designed.
