Let my people know!

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When mother was near the promised land,

Let my people know!

Medicated so much she could not stand,

Let my people know!

Refrain:

Slow down doses,

Way down in the promised land;

Testify, brethren!

And let my people know!

“Slow Down Doses” from the spiritual

“Go Down Moses”

Canadian Deprescribing Network

Janet Currie

Johanna Trimble CaDeN Executive Committee Members

Co-leads, Public Awareness Subcommittee

No conflicts of interest to declare.

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Provider Awareness, Public Awareness, Policy,

Research, Electronic Health Record Integration

Executive Committee Members:

Cara Tannenbaum

University of Montreal, Faculties of Medicine and Pharmacy,

Scientific Director, Institute of Gender and Health, CIHR

James L. Silvius

Addiction and Mental Health & Pharmacy Services, Alberta Health Services

Barbara Farrell

Bruyere Research Institute, Department of Family Medicine, University of Ottawa

Steve Morgan

School of Population and Public Health, University of British Columbia

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We’re singing some false notes

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• 1/3 seniors take 5 or more drugs

exposing them to multiple drug

interactions

• 1/3 take at least one psychoactive

drug – leading to sedation, cognitive

problems and falls. Benzos are

contraindicated in the elderly

• 1/9 visits to the ER are due to AEs

• People who are at the ER because of

a problematic drug often return to the

ER on the same drug within 6 months.

Are we singing from the same song sheet?

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• Women are subject to more adverse

drug events then men.

• Recent studies show a link between

common, anticholinergic drugs and

increased risk of dementia.

• Recent studies show a link between

antidepressants and increased risk of

dementia.

• Studies show sleep disruption is

common with SSRI antidepressants.

Join the choir! It’s not just the elderly

Almost 18% of women, aged 25-44, use

antidepressants; many may never be able to stop

using them even when they have significant AEs

Antipsychotic prescribing to children has increased

by 33% over a 4 year period; antidepressants by

63%. We don’t understand the effect of these drugs

on developing brains

2.4% of the BC adult population have used opiates

long-term. The problem is steadily getting

worse……..

“I Can’t Stop Drugging You” From the song: “I Can’t Stop Loving You” by Ray Charles

• Fear/caution: I need to protect my patients/follow

treatment guidelines

• Overestimate benefits, underestimate harms (doctors

and patients)

• “Just in case” continuation of drugs

• The specialist prescribed it, who’s in charge?

• New symptoms arise: Is it the drug or the health

condition?

• No time/no support to deprescribe (Pharmanet access,

short appointments, billing codes)

• Patient expectations: treatment = prescribing:

“I have had this cough for days.”

“I read about it on the internet.”

Deprescribing: Where to

Start?

• Frequent, structured medication reviews and check-

ins with patients

• Developing a deprescribing plan based on patient

needs and treatment priorities

• Explaining deprescribing to the patient/ reassurance

about withdrawal symptoms

• Slow tapering of some drugs considering dose

levels, drug half-life and ability to tolerate withdrawal

• Resource: http://medstopper.com

What are the barriers to deprescribing? (We’ll record responses on the flip chart)

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Fewer drugs! Hallelujah!

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References

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Arora N, Knowles S, Gomes T, Mamdani MM, Juurlink DN, Carlisle C, et al. Interprovincial Variation in Antipsychotic and Antidepressant Prescriptions Dispensed in the Canadian Pediatric Population. The Canadian Journal of Psychiatry 2016 12/01; 2017/02;61(12):758-765.

Canadian Institute for Health Information, Canadian Electronic Library (Firm). The use of selected psychotropic drugs among seniors on public drug programs in Canada, 2001 to 2010. : Canadian Institute for Health Information; 2012.

Credible Meds (up-to-date list of QT-prolonging drugs for healthcare providers https://crediblemeds.org/healthcare-providers/

Harris N, Baker J, Gray R, Dr, Ebrary Academic Complete (Canada) Subscription Collection, Wiley Online Library. Medicines management in mental health care. 1st ed. Chichester, U.K; Ames, Iowa: Wiley-Blackwell; 2009. Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opinion on Drug Safety 2014; 2013;13(1):57-65.

Public Health Agency of Canada. Seniors Falls in Canada: Second Report 2014. Available at: http://www.phac-aspc.gc.ca/seniors-aines/publications/public/injury-blessure/seniors_falls-chutes_aines/index-eng.php

Roterman, M, Sanmartin C, Hennessey D, Arthur M. Prescription medication use by Canadians aged 6-79. Statistics Canada 2014. Available at: http://www.statcan.gc.ca/pub/82-003-x/2014006/article/14032-eng.htm

Worst Pills Best Pills. Drugs that affect the risk of falling (2017) https://www.dropbox.com/s/e9dyxatibb7jm5d/Drugs%20That%20Increase%20the%20Risk%20of%20Falling.pdf?dl=0

Zed PJ, PharmD, Abu-Laban RB,MD MHSc, Balen RM, PharmD, Loewen PS, PharmD, Hohl CM, MD, Brubacher JR,MD MSc, et al. Incidence, severity and preventability of medication-related visits to the emergency department: a prospective study. Can Med Assoc J 2008;178(12):1563-1569.