Medication Overload: An Overlooked Public Health Burden

The rising cost of prescription drugs has garnered renewed public attention from patient advocates, private and public payers, prescribers, and policy makers over the past few years (Kirzinger et al., 2019). However, not many people are talking about the growing epidemic of medication overload among Americans which has increased markedly over the last two decades and adds to the cost of prescription drugs, a major category of spending in the U.S health care system (Quinn & Shah, 2017; Maher et al., 2014; Papanicolas et al., 2018). According to Kantor et al. (2015), the prevalence of prescription drug use among Americans aged 20 and older increased from 51 percent to 59 percent between 1999 and 2012 (p<.001), a trend that remained statistically significant even with age adjustment. During this same period, the prevalence of polypharmacy nearly doubled from 8.2 percent to 15 percent. This study findings largely matches similar findings published by the Centers for Disease Control and Prevention (2017), which found that between 2007 to 2010, almost one-half of the U.S population reported having used one or more prescription drugs in the past 30 days; this prevalence in prescription drug use increased with age due to multimorbidity. This rapid increase in the number of medications people are taking has led to a sharp rise in adverse drug events and if nothing is done, the Lown Institute estimates that adverse drug events related to medication overload will cause nearly 150,000 premature deaths and reduce the quality of life for millions of older Americans over the next decade. In addition, it will lead to 4.6 million hospitalizations and 74 million emergency room and outpatient clinic visits, at a cost of at least $62 billion (Lown Institute, 2020). These numbers represent a staggering impact on patients and induces undue financial burden on health care systems.

Although advances in pharmaceuticals and pharmacotherapeutics has helped people live longer, this increase in life expectancy has caused a shift in the global disease burden with surge in chronic diseases in addition to communicable diseases (Murray & Lopez, 2013). With greater longevity, individuals are at increased risk for poor health outcomes including incident disability, cognitive impairments, falls, and other complex health issues. This co-existence of comorbidities gives rise to the challenge of polypharmacy (Quinn & Shah, 2017). Polypharmacy may be clinically appropriate in many instances but every additional drug increases the risk of harm and therefore it is important to identify patients with excessive polypharmacy that places them at increased risk of adverse events and poor health outcomes (Lown Institute, 2020). Too often, lots of different medications are used in ways that undermine their value or get prescribed for reasons not necessarily supported by evidence or when no clear clinical indication exists (Masnoon et al., 2017). For example, a patient visiting their primary care doctor may be prescribed an antidepressant medication without being aware of or exploring other alternative evidence-based non-drug therapies such as cognitive-behavioral therapy (CBT), a form of psychological treatment, that can be effective as, or more effective than the prescribed medication but without the risk of side effects (APA, 2021). Wiechers et al (2013), showed that psychotropic medications get prescribed often without a psychiatric diagnosis or the patient being evaluated by a mental health professional. Often times, these prescriptions add to the patient’s long list of medications already prescribed, herbal or dietary supplements, and over-the-counter medicines that they may also be taking thereby increasing their risk of harm from medication overload (Maher et al., 2014). It is therefore important for prescribers to start incorporating initiatives in their clinical practices to help stem the tide of medication overload and reduce associated health care costs.

There is no single driver of medication overload since many factors contribute to this epidemic (Lown Institute, 2020). Among these are drug-marketing to both doctors and consumers by the drug companies that heavily promotes the benefits of medications while downplaying the risks (usually offered in small-print or fast-spoken), clinical prescribing practices that enable over prescription of unnecessary medications, and the highly fragmented healthcare system that makes it difficult to coordinate care between a patient’s various providers and track all of their medications (Lown Institute, 2020).