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.