#11: Polypharmacy and Adverse Drug-Drug Interactions
Visiting my 90 year old mother in law the other day, I couldn’t help but shake my head as I counted the 22 different prescription medications she was on. This did not count the additional OTC meds she had on her bed stand. Polypharmacy, defined as use of five or more medicines, has a high risk of adverse drug-drug interaction. One does not have to imagine what illegal drug “cocktails” might do. We read about it daily. Many, if not all, of us have been touched by an overdose tragedy. Face it; we are a country that likes to take drugs. Patients get mad at their provider if they go to them with a problem and the provider doesn’t give them something. You can’t sit through one hour of television without seeing an advertisement selling a drug. (Then listen to the speed talker describe the possible side effects and give you the legal disclaimer) The providers have to fight against this crap. There are now drugs being developed to treat side effects caused by other drugs. Legal polypharmacy is an unfortunate consequence of medical advancement. We are living longer and more drugs are being discovered and created to treat more conditions. It makes one wonder if it is such a stretch to fall into the world of addiction when drugs are handed out like candy by some providers. I can hear the nay sayers screaming at me already. My point is we are a society that takes large amounts of medication without a thought of the consequences.
For the most part, we (you and I) deal in the world of pain and addiction medicine where misuse of multiple drugs is common. Patients take stimulants to wake up and then depressants to come down. Opiates and Opioids are abused for the purpose of obtaining the euphoric effect. Benzodiazepines are misused because it is easier to treat anxiety with a pill than to put the effort into cognitive behavioral therapy. Alcohol is abused because the world is temporarily easier to live in when one is slightly tipsy. I realize it is popular to join in the cacophony of voices screaming about the opioid epidemic, but we cannot turn a blind eye to other drugs being used in conjunction with, or in place of opioids. From 2015 to 2016 drug overdose deaths involving Cocaine, psychostimulants with abuse potential, or both substances combined, increased by 42.4%!! If this statistic is not strong enough to convince clinics to appropriately order drug testing, I am not sure what is. Governing authorities have scared many physicians into either not testing enough or not testing enough drugs. We do not want anyone to over test; however you cannot know if a patient is using cocaine, or any drug, without testing for that particular drug. Test correctly, document correctly and tell the governing authorities to ………… Whoops, I do tend to get my ire up when discussing how health care is being governed out of the physician’s hands.
Hopefully all of you had a great Memorial Day weekend and spent at least one moment remembering those that died while in service of the US Military. So thankful for their sacrifice. Thank you for your business.
President/CEO Industry Lab Diagnostic Partners