Poly-pharmacy: A Perilous Panacea

Kenneth McCall, BSPharm, PharmD

Associate Professor | UNE College of Pharmacy

President | Maine Pharmacy Association

Disclosure

I, Kenneth McCall, do not have an interest in selling a technology, program, product, and/or service to CME/CE professionals.

Pharmakon (φάρμακον) The ancient Greek word, “pharmakon”, poses

a quandary for modern translators – it’s both a remedy and poison, a cure or the illness, perfume or intoxicant.

Outline: Exploring the Duality of Poly-Pharmacy

National Center for Health Statistics

Trends in Prescription Medication Use

DAWN Surveillance Program

Rates of Drug-related ED Visits

National Center for Health Statistics

National Center for Health Statistics: Prescription Drug Use

• In 2007-2010, almost ½ of all Americans reported taking one or more prescription drugs in the past 30 days; 9 in 10 persons aged 65 and over.

• In 2007-2010, almost 11% of all Americans reported taking five or more prescription drugs in the past 30 days; 4 in 10 persons aged 65 and over.

Trends in the Percentage of Persons Using Rx Drugs on a Monthly Basis: US, 1988-2010

38% 44% 46% 47% 49%

4% 6% 8% 10% 11%

1988-94 1999-00 2001-02 2005-06 2007-10

>1 Rx >5 Rxs

http://www.cdc.gov/nchs/data/hus/hus13.pdf#listfigures

Percentage of Persons Using Rx Drugs on a Monthly Basis, by Age: US, 2007-2010

39%

66%

90%

3%

17%

40%

18-44 Years 45-64 Years 65+ Years

>1 Rx >5 Rxs

http://www.cdc.gov/nchs/data/hus/hus13.pdf#listfigures

Percentage of Persons 65 years and older Using Rx Drugs on a Monthly Basis, by Drug Class: US, 1988-94 versus 2007-10

52%

6% 8% 9% 6% 14%

3%

70%

47%

22% 18% 18% 18% 14%

1988-94 2007-10

http://www.cdc.gov/nchs/data/hus/hus13.pdf#listfigures

What proportion of the entire US population takes at least 1 Rx drug monthly?

25%

25%

25%

25% 1. 10%

2. 25%

3. 50%

4. 75%

What proportion of adults 65 years and older takes five or more Rx drugs?

25%

25%

25%

25% 1. 10%

2. 20%

3. 30%

4. 40%

Among adults 65 years and older, what is the most commonly prescribed class of medications?

25%

25%

25%

25% 1. Cardiovascular medications

2. Cholesterol lowering medications

3. Anti-acid medications

4. Anti-diabetic medications

Drug Abuse Warning Network, 2011: National Estimates of Drug-Related Emergency Department Visits. HHS Publication No. (SMA) 13-4760, DAWN Series D-39. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013.

National Estimates of Drug-Related Emergency Department Visits

In 2011, there were over 125 million emergency department visits in the US. Over 5 million of these ED visits were related to drugs (misuse, abuse, or adverse events) a 100% increase since 2004.

Rates of Drug-related ED Visits per 100,000 Population, by Age Group, 2011

0

500

1000

1500

2000

2500

<21 21-24 25-29 30-34 35-44 45-54 55-64 65+

Misuse/Abuse Adverse Reactionshttp://www.samhsa.gov/data/dawn.aspx#DAWN 2011 ED Excel Files - National Tables

Most drug-related ED visits among adults 65 years and older are caused by misuse/abuse.

50%

50% 1. TRUE

2. FALSE

National Estimates of Drug-Related Emergency Department Visits

In 2011, about 2.5 million ED visits resulted from the misuse/abuse of drugs. ED visits attributed to drug misuse or abuse have risen steadily each year from 2004 to 2011 for a total increase of 52%.

ED visits due to Misuse/Abuse of Drugs per 100,000 population, by age group, 2004-2011

110 156 188 198 207 234 228 256

853 889 939 962 954 927

1,055 1,066

2004 2005 2006 2007 2008 2009 2010 2011

65+ 55-64 45-54 35-44http://www.samhsa.gov/data/dawn.aspx#DAWN 2011 ED Excel Files - National Tables

ED visits due to Misuse/Abuse of Drugs by Age Group and Drug Category, 2011

22% 23% 20% 8%

42% 41% 30%

8%

36% 36% 50%

84%

35-44 45-54 55-64 65+

Alcohol Illicits Rxs

CNS

Cardio

Metabolic

Psych

Coag

Other

http://www.samhsa.gov/data/dawn.aspx#DAWN 2011 ED Excel Files - National Tables

Among adults 65 years and older, the rate of ED visits for misuse/abuse of drugs is increasing.

50%

50% 1. TRUE

2. FALSE

Among adults 65 years and older, what is the most common drug class associated

with ED visits for misuse/abuse?

25%

25%

25%

25% 1. Illicit drugs

2. Alcohol

3. Rx cardiovascular drugs

4. Rx CNS drugs

National Estimates of Drug-Related Emergency Department Visits

In 2011, over 2.3 million ED visits resulted from adverse reactions to prescription medications. ED visits attributed to prescription drug adverse reactions rose by about a quarter million visits per year between 2004 and 2008, leveling off at about 2.3 million visits per year from 2009 to 2011.

ED visits due to Adverse Drug Reactions per 100,000 population, by age group, 2004-2011

528

1,060

1,299

1,653 1,764 1,854

1,678 1,526

301 474

576 732 840 837 825 798

2004 2005 2006 2007 2008 2009 2010 2011

65+ 55-64 45-54 35-44

http://www.samhsa.gov/data/dawn.aspx#DAWN 2011 ED Excel Files - National Tables

ED visits due to Adverse Drug Reactions among Adults 65+ by Drug Category, 2005-2011

0

20

40

60

80

100

120

140

160

180

2005 2006 2007 2008 2009 2010 2011

Tho

usa

nd

s

CNS Cardio Coag ID Agents

Metabolics Onc Agents GI Agents Psych

ED visits due to Adverse Drug Reactions among Adults 65+ by Drug Category, 2011

20%

15%

14% 13%

10%

7%

4%

4%

13%

CNS

Cardio

Coag

ID Agents

Metabolics

Antineoplastics

GI Agents

Psych

Other

Among adults 65 years and older, the rate of ED visits for adverse drug

reactions has increased since 2009.

50%

50% 1. TRUE

2. FALSE

Among adults 65 years and older, what is the most common drug class associated

with ED visits for adverse reactions?

25%

25%

25%

25% 1. Cardiovascular drugs

2. CNS drugs

3. Anticoagulants

4. Infectious disease agents

ED visits due to Adverse Drug Reactions among Adults 65+ by Sex and Drug Category, 2011

19%

21%

15%

14%

12%

18%

16%

9%

10%

8%

7%

10%

4%

3%

3%

4%

14%

13%

Women

Men

CNS Cardio Coag

ID Agents Metabolics Antineoplastics

GI Agents Psych Other

Number of Rxs Involved in ED Visits for Adverse Reactions among Adults 65 or Older: 2011

One Pharmaceutical

82%

Two Pharmaceuticals

12%

Three or more Pharmaceuticals

6%

Disposition of ED Visits for Adverse Reactions to Medications among Adults, by Age Group: 2011

13% 20% 27% 38%

84% 77% 70% 59%

3% 3% 3% 3%

35-44 45-54 55-64 65+

Admitted DC Home Other

Which of the following statements about the rate of ED visits for adverse drug reactions among adults 65 years and older is TRUE?

33%

33%

33%1. The rate of ED visits for anti-infectives is

higher among men than women.

2. Most ED visits are caused by drug-drug interactions involving two or more drugs.

3. The rate of ED visits that result in a hospital admission is associated with age.

SUMMARY: Adults 65 years and Over

• Prescription drug use is increasing; 4 in 10 take five or more Rx drugs monthly.

• Most prescription drug-related ED visits are related to adverse reactions rather than misuse/abuse.

• ED visits caused by misuse/abuse of Rx drugs have increased each year and have more than doubled since 2004.

• ED visits caused by Rx drug adverse reactions have leveled off or declined since 2009.

• The most common class of medicines involved in drug-related ED visits are CNS agents.

References

• National Center for Health Statistics. Health, United States, 2013: With Special Feature on Prescription Drugs. Hyattsville, MD. 2014. Library of Congress Catalog Number 76–641496 For sale by Superintendent of Documents U.S. Government Printing Office Washington, DC 20402

• Substance Abuse and Mental Health Services Administration, Drug Abuse Warning Network, 2011: National Estimates of Drug-Related Emergency Department Visits. HHS Publication No. (SMA) 13-4760, DAWN Series D-39. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013.

QUESTIONS? ASK YOUR PHARMACIST.