Just because there’s a drug for everything now doesn’t mean that the answer to everything is a drug.
However, it does mean that doctors may be too quick to offer a pill when time is short, the problem is acute and there doesn’t seem like there are other good options.
Unfortunately, that seems to be the case far too often. Older Americans are being prescribed an unhealthy combination of powerful drugs at a worrisome rate, putting their quality of life, and even their lives, at risk.
According to a recent study in JAMA Internal Medicine, the number of retirement-age Americans taking at least three psychiatric drugs doubled from 2004 to 2013. In rural areas, it more than tripled.
What’s more, nearly half of the seniors who were prescribed a combination of antidepressants, opiate painkillers and sleeping pills had no diagnosis on record of a mood disorder, chronic pain or sleep problem.
That builds on earlier research showing the high rate at which older Americans were given benzodiazepines, a category of anti-anxiety drugs that includes Valium and Ativan, despite the medications’ causing dizziness and confusion, side effects that are particularly prevalent, and dangerous, in seniors.
The new study shows you can add painkillers like Vicodin and sleep aids like Ambien to that equation, even though there are clear risks to co-prescribing opiate pain medications and benzodiazepines, a combination that received the Food and Drug Administration’s “black-box” warning last year.
It’s still a small number of patients, but it is concerning that the number is growing at all.
The researchers behind the latest study say it’s clear what is happening. Seniors are visiting primary care physicians with complaints of low-level anxiety, insomnia, pain and depression, and doctors in some cases are giving them the quickest and easiest solution.
Part of that can be hung on the realities of primary care, in which doctors can’t always afford to give each patient the time they should receive. It speaks to the economics of health care, which emphasize volume, and the shortage of and challenges for primary care physicians.
But it is particularly telling that such a significant rise in what is known as polypharmacy occurred in rural areas, where specialty care is often limited. Psychotherapy or stress management under the right supervision could be just as helpful as a pill, but those options often do not exist, or aren’t well known, in rural areas. In any case, the doctor suggested those methods only 10 percent of the time, according to the recent study.
Instead, those therapies should be the default prescription, not more pharmaceuticals. Doctors should take steps to locate these resources within their communities; there are even opportunities for collaboration with local senior organizations. Patients, too, should be ready to ask questions about alternatives.
There certainly are pills for everything, and they often work just as prescribed. But when there are better options, doctors need to use them.
Send questions/comments to the editors.
