Poly-pharmacy: A Perilous Panacea
Transcript of Poly-pharmacy: A Perilous Panacea
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.