“Drugs, drugs, drugs. Which are good, which are bad?”
The lyrics from the 1980s Health Canada television jingle warned children that not all medications make you better.
Thirty-plus years later, the kids in that commercial may be asking their parents the same question.
On Nov. 8, the School of Pharmacy’s Medication Therapy Services (MTS) Clinic will welcome Dr. Justin Turner of the University of Montréal and the Canadian Deprescribing Network as the inaugural speaker in its public lecture series.
Dr. Turner, who specializes in research around optimizing the safe and effective use of medications in people over 65, will present Your Dad’s On Drugs: Can His Prescription Pile Be Downsized?
“Any one person’s life can have two totally different outcomes based on whether they continue or discontinue a medication.”
The term deprescribing has only recently begun to gain a more mainstream understanding.
Philosophically speaking, however, it has been around since the Hippocratic oath, says Dr. Turner.
“In my thesis, I quoted Hippocrates as kind of the godfather of deprescribing, because he basically said ‘If it’s not working, stop taking it.’” The reality is that any one person’s life can have two totally different outcomes based on whether they continue or discontinue a medication or combination of medications.”
The key, he adds, is how to notice when a person’s medications are useful and not useful and determine whether to stop taking them when they’re no longer effective before they experience potentially fatal side effects.
Consider the following scenarios:
The prescribing cascade
Pharmacists describe the “prescribing cascade” as using medications to treat side effects of other medications. Typical in older patients, Newfoundland and Labrador has a particular familiarity with the prescribing cascade.
A daughter notices the large pile of pills her dad takes each day and asks him what they’re all for. He explains that some were started to treat the side effects of other medications.
His “stomach pill,” as he describes it, was prescribed a couple of years ago to protect his stomach from the anti-inflammatories he took for his arthritis, which his daughter asks if he’s still taking.
Dad then reveals that he stopped taking the anti-inflammatories because they no longer worked, and then realizes he probably doesn’t need the stomach pills any longer, either. A pharmacist consultation could confirm that he can safely eliminate that medication from his regime.
Annie the sleeping pill aficionado
A widely acknowledged medication that is not only often unnecessary, but also potentially dangerous and highly addictive, is sleeping pills.
Annie is in her 50s and holds a high stress job. To stay sharp and maximize her performance at work, she kickstarts her day with a coffee-plus-coffee-plus-more coffee cocktail. By bedtime her mind still races, but she has to sleep to stay sharp. So what does she do?
She takes prescription sleeping pills (such as Zopiclone) and over-the-counter medications such as Benadryl. The next morning, she’s extra-groggy from her bedtime brew — and so her dangerous cycle continues.
It is quite likely that if Annie continues her upper-downer mixology, her risks include delayed reflexes (particularly dangerous when driving), deteriorating memory and an increased risk of falling.
Driving under the influence of sleeping pills is as risky as driving under the influence of alcohol, Dr. Turner says.
“None of which would help Annie’s work performance very much. With the help of a pharmacist, she could learn more about her medications and realize there are other things she could do to help with her sleeping, such as practising proper sleep hygiene.”
The Medication Therapy Services Clinic
More than 250 patients with diverse profiles have visited the MTS Clinic for in-depth, one-on-one consultations to help them optimize their medications, says Dr. Debbie Kelly, director of the clinic.
“Wouldn’t it be something if we could prevent that hip replacement?”
“We meet these folks to assess whether their medications are working and are still appropriate, and create a plan to safely discontinue medications that have the potential to cause problems,” she said.
“It’s one thing to treat a patient who has had a hip fracture due to a fall that occurred because they were taking sleeping pills and didn’t need to be. Once a person of a certain age has a hip fracture, which usually means a hip replacement, the length of their life and the quality of their life significantly decreases. Wouldn’t it be something if we could prevent that hip replacement?”
The event takes place on Thursday, Nov. 8, at 7 p.m., at the Bruneau Centre for Research and Innovation, room IIC-2001. Parking is available in areas 17 and 18. The MTS Clinic is now accepting referrals. To find out more, visit online.