The dark side of drugs
Canadians pop an awful lot of pills. In 2004 we filled 382 million prescriptions costing $17.3 billion, according to IMS Health, Canada, a health-care data collection company. (Hospitals and pharmacies spent another $15.4 billion, at wholesale rates.) Some of that medication may be doing more harm than good, especially among older people.
Adverse drug reactions (ADRs) occur four to seven times more frequently in older Canadians than in younger people. Declining kidney and/or liver function and heart failure contribute to the toxic effect in elders. Reactions can include hallucinations, confusion, constipation, depression, heart failure or disorientation that contributes to falls.
Part of the trouble is that drug safety testing usually isn’t focused on the frail elderly or older patients with multiple health issues, but rather on a younger cohort whose bodies cope with drugs differently.
Almost half of Canadians over the age of 65 take three prescriptions daily, a situation that could lead to unintended drug interactions. Health Canada reports seniors consume about 40 per cent of all medications, even though they’re a mere 13-per-cent wedge of the Canadian pulation pie. Last year people 80 and older filled an average of 42 prescriptions while 49- to 59-year-olds filled nine.
Because people can and do react individually to chemical substances, approximately half of adverse drug reactions come as an unpleasant surprise. And there is plenty of opportunity for exposure. The New England Journal of Medicine reports that in the United States there are roughly 1,000 active ingredients in over-the-counter (OTC) compounds alone.
Prescription pharmaceuticals, OTC medications, or herbal preparations can all be involved in adverse drug reactions, and the result can be death, disability or a long stay in hospital. In 1999 a University of Toronto team studying hospital deaths in the U.S., concluded that adverse drug reactions ranked at least sixth among leading causes of death. They estimated that in 1994, 2.1 million suffered serious health consequences from adverse drug events and another 106,000 patients died — many more than the 91,000 military personnel killed in the 11-year Vietnam War.
Next page: Appropriate drugs, and consumer strategies
Some drugs just shouldn’t be prescribed for seniors, especially when safer alternatives exist. Medical experts have developed the Beers criteria, a list of medications that may be hazardous for older people, including drugs like long-acting benzodiazepines (tranquillizers), insidious because they linger, can cause confusion and memory loss, and can be addictive. In April 2005, the CBC released a report that indicated more than a third of seniors had received a drug from the Beers list during the previous year and that a third of seniors who had died had been taking a Beers list medication.
Some drugs can even interact with food. For example, downing certain medications with grapefruit juice, including those that control high blood pressure or high cholesterol levels, can perhaps dangerously interfere with the way the body handles the drug.
However, it is vitally important that patients with concerns about drugs talk to a doctor before making any changes in a medication routine. In some cases, quitting a medication may be downright harmful.
Be a smart consumer
Dr. Amy Wong acknowledges a doctor’s job is to choose the appropriate drug, but the Toronto-based family physician points out that patients (or their advocates) also have to be proactive. They must make sure their doctors and pharmacists know which drugs they are taking, including OTC compounds and herbals preparations, since these have the potential to interact with one another.
She suggests patients also keep notes and use a pill organizer to ensure drugs are taken as directed. “It’s also important for people to know they shouldn’t share medications with each other,” she says. “Your friend’s drug may interact with a drug you are taking and exacerbate a pre-existing unrelated health problem.”
Not all adverse drug reactions can be predicted but Wong says patients can be aware that interactions can occur and act accordingly. “We know some things can interact,” she says. “You have to be cautious when taking these drugs.”
Some drugs require periodic monitoring of the patient’s blood or organ functioning. Awareness of side effects associated with a medication and prompt reporting of any such event to a physician may prevent serious harm.