Why Deprescribing Matters: when cutting back on medications can improve your health

From insulin to anti-depressants, medications have made a significant impact on improving human health. But as the population ages and more people are living longer with chronic health conditions, the use of multiple medications is increasing. Sometimes, the medications we take no longer provide health benefits and might even cause harm. 

Associate Professor Lisa McCarthy is a pharmacist, Co-Director of deprescribing.org and an expert in deprescribing, a rapidly expanding area of health care and health research.

Q&A with the experts:

What is deprescribing?

Deprescribing is part of a good health care plan and a natural part of prescribing.

While medications are effective and powerful treatment options to prevent or manage health issues, we need to ensure they keep doing that job. When they aren’t, it might be time to reduce doses or stop a medication entirely. This is what we mean by deprescribing. It’s important to note that deprescribing is a planned process—a partnership in which people work with their health provider to make decisions and a plan for stopping or reducing certain medications safely. The goal is to make sure your medicines work for you and that they are helping you feel as well as they can.

At deprescribing.org, we create evidence-based resources to help health professionals and the public make decisions and plans about deprescribing.

How many people are affected by taking inappropriate medications?

An appropriate medication is one that meets your current needs, at the right dose and is only used for as long as it is needed. When a medication is no longer providing benefit or causing harm, it is considered inappropriate.

As many as 1 in 5 Canadians aged 40 to 79 take more than 5 prescription medications and nearly 2 million Canadian older adults regularly take at least one risky medication that could potentially be inappropriate. This can lead to potentially preventable health harms with people being hospitalized due to harmful effects of their medications.

Polypharmacy (taking multiple medications) and use of potentially inappropriate medications is a global problem recognized by the World Health Organization. In Canada, we’ve recently seen more awareness and attention around this issue at the federal government level with a recently published a report and recommendations on the appropriate use of medications.

When should people get their medications reviewed?

A periodic medication review or ‘prescription checkup’ is a good idea for anyone who takes multiple medications regularly.

Medication reviews are especially important when your health changes or if you are at higher risk for medication harms. You might be at higher risk if you are an older adult and have a lot of health conditions. You are also at higher risk if you have problems with your liver of kidneys because this changes how your body processes your medications and can lead to harmful effects.

Why does our response to medication change over time?

As we age, our bodies and our life circumstances change. That means our medication needs change too and sometimes medications that were once a good fit for us are no longer that. When medications are a poor fit, they can lead to adverse effects like falls, memory problems, and visits to the hospital. Over time, our digestive system changes and can affect how quickly medications work in our body. Our muscle to body fat ratio changes which can mean some medication stay in our body longer and our kidneys and livers work differently, so how our body processes and removes medications also changes.

What is important for people to know about managing their medications?

First, if you take medications regularly, periodically ask a trusted health professional: Do I still need these medications?

Second, if your health is changing and you take multiple medications, ask: Could this change be related to one of my medicines?

Finally, keep a list of your medications for yourself and your loved ones. At a minimum, this would be what you take, the doses and why. Include prescribed medicines but also over the counter medications, natural products, vitamins and supplements.

It is also helpful to add in when you started each medication and any medicines that you have used in the past that have cause a side effect.

Keeping a list and sharing it with all health professionals you see is one of the most powerful things you can do to advocate for your own health.

Tools to support deprescribing from deprescribing.org:

• Shared Decision-Making in Medication Management
• Medication Record Template

I'm Pharmacy Podcast S2.E7: Optimized Use

In Season 2, Episode 7 of the I'm Pharmacy Podcast, we tackled the topic of optimized use, discussing the process of deprescribing, prescribing cascades, and polypharmacy with Clinician Scientist Lisa McCarthy and Leslie Dan Faculty of Pharmacy Professor and Dean Lisa Dolovich.