How to be an Active Participant in Managing Your Health: Some Considerations Related to Medication
- Jul 24, 2023
- 10 min read
Part One: Some Considerations Related to Medication
It is not easy these days to pull off good health. It takes a great deal of work. And often, we as "patients" can feel as if we are just along for the ride. In Western medicine, the professional is the main player and the expert, and our job is to defer to the practitioner's professional judgment without much active participation required. Many less traditional medical models (the VA's medical model included) acknowledge that the best health management always includes an active and educated participant. Many of those models do not elevate the practitioner above the patient, but consider the patient to be an equal participant in their own health. In my 30 years of experience working in traditional and not-so-traditional medicine, it has become clear to me that the clients who manage the most effectively are clients who are educated, involved, understand their own health goals, and can work effectively with their provider.
The Greek physician, Hippocrates, born approximately 460 BC, is credited with being the Father of Modern Medicine. Over the past year, in perusing some of Hippocrates' quotes, I have found a new hero. I love this guy! His wisdom about the human body and disease is amazing. The medical community is finding, almost 2500 years later that his theories hold quite a bit of weight! Two of my favorite quotes from Hippocrates are as follows:
" If you are not your own doctor, you are a fool" and "The greatest medicine of all is teaching people not to need it." Hippocrates
Let's be clear. The first quote cannot stand without the second. Most people would not consider it wise to take the reigns of their own health management in order to "be their own doctor" if they have no knowledge about how to do so. If however, an individual learns about how the body works and how to move toward health, they will be able to be a much more effective participant in their own wellness and be less reliant on the medical establishment to determine the course of their health.
So let's talk first about what patients may need to know and consider about medications in order to be an effective advocate for their own health.....
Some Education/Considerations about Medications
One of the most important requirements that prescribing providers have is the medication reconciliation or review. Providers are mandated to review their patients' long-term prescriptions on a regular basis. It is important that patients also stay on top of their medications and ask questions regularly about new and chronic prescriptions. Make sure that your provider is aware of your medication and overall health goals and demonstrates the ability to consider them in their practice. Ask for a "layman's" explanation about how the drug works, what should be expected, and what should be monitored.
The following is a non-exhaustive list of some topics you might discuss with your Provider/Physician as you review your meds:
1.Drug-drug interactions, or the impact of one drug on another.
2. Consider how a drug is processed in respect to your kidney or liver function (all drugs are processed primarily through the kidneys or the liver). If you have compromised kidney function, for example, you might want to avoid drugs which are processed by the kidneys if there is another alternative.
3. Consider whether multiple drugs have overlapping function. For example, multiple drugs have impact on serotonin level. If an individual is on multiple drugs that effect serotonin, toxicity can easily occur. Also, if multiple drugs can impact the same function, often one or more of the drugs may be decreased or eliminated. For example, a patient with chronic pain and depression may be on a class of drugs that decreases both pain and depression. This may allow for changes to other meds which are being prescribed for pain or depression.
4. Consider if additional medications are being prescribed to manage the side effect of other prescriptions.
It is not unusual for individuals to experience adverse side effects to drugs, especially drugs taken on a long-term basis (see the stats below). Often, then, in lieu of discontinuing or changing that drug, additional medications are prescribed in order to manage those side effects. Many times, this leads to polypharmacy (being on 5 or more drugs chronically). We will discuss the dangers associated with polypharmacy below.
5. Consider whether a drug can be decreased or eliminated if an individual is willing to engage in behavior which can effect the same change. For example, "Can blood pressure meds be eliminated or decreased if I begin to practice daily meditation?", or "How might insulin need to be modified if I engages in daily walking?"
6. Consider whether a patient HAS changed a health behavior which should allow a trial of decreasing or eliminating a medication. For example, if an individual has lost 20 pounds by beginning a walking program and changing eating habits, is it possible that they could manage with less blood pressure medication? It is important that you keep your medical provider in the loop as to the status (both positive and negative) of any major changes to your health behaviors (Sleep, activity, nutrition, stress management/mental health).
7. Consider working from a position of "More is not always (not generally) better." We will talk shortly about the statistics related to polypharmacy and medication errors. Remember that our society is very "pro-pharmacy". We often consider medication as the primary and necessary strategy to manage our health. Medication is often the most convenient option, but not often the best option as a stand alone strategy.
8. Remember that things change: good tolerance does not always last. Realize that not all side effects or adverse effects of a drug occur immediately. It is not uncommon for an individual to be on a medication, manage without too much difficulty, and then experience significant adverse reaction to a medication in the future. According to the CDC, "In 2020, an average of 44 people died each day from overdoses involving prescription opioids, totaling more than 16,000 deaths. Prescription opioids were involved in nearly 24% of all opioid overdose deaths in 2020, a 16% increase in prescription opioid-involved deaths from 2019 to 2020." These statistics are not 100% related to individuals who were trying to misuse their prescription opioids. It is not unusual that an individual might experience a drug overdose by taking their prescriptions EXACTLY as prescribed! A change in function (such as liver function where opioids are primarily metabolized) can lead to a serious adverse event.
9. Consider that all drugs have a target tissue and function. And drugs that share a target/function can cause "too much of a good thing". A prime example of this is seen in the prescribing of "benzos" and opioids. In 2021, according to the NIDA (cited below), 14% of accidental opioid deaths occurred in individuals who were also taking prescribed benzodiazepines. This co-prescribing of benzos and opioids had occurred for decades, but has recently fallen out of favor, because both of these drugs have a central nervous system target and a function of suppressing critical central nervous system function, which includes things like breathing, Opioids are intended to decrease central nervous system function to decrease pain sensitivity, and benzos are intended to decrease central nervous system function to decrease anxiety, but because they have an overlapping target and functions, they can be a very deadly combination.
10. The pace of traditional medicine might make thorough conversations with your provider a challenge. You may need to ask for extra time in advance, or find a provider who is committed to allowing extra time. The study cited from 2009 by NCBI states that "Comprehensive discussions about chronic medications are uncommon in routine practice. " Their review indicates that often what was documented as a medication review was not a thorough examination of medications. I suspect that if that was the case in 2009, it may even be more of an issue 14 years later. Some individuals have access to clinical pharmacists who can assist in a more thorough dissection of medications, med goals, and potential or present med complications or options. Consider making it a practice to discuss medications/med goals/your health behaviors every visit, as well as to contact your provider with any suspected changes to your tolerance.
11. Remember to discuss non prescription drugs, supplements and homeopathic treatments. Supplements can be very powerful biological agents and should be taken seriously. It is important that you inform your provider about supplements, homeopathic treatments, as well as prescriptions your are taking from other providers.
12. Understand that drugs, in general, all have some associated risk. That risk may show itself early on, or it may be a risk that will show itself later in life in response to taking a medication chronically. Research confirms that the more drugs you are on, the greater the risk.
* The following 2021 research analysis showed significant adverse events related to medication use. In analyzing groups of individuals who were being admitted to the hospital as inpatients, seeking treatment as an outpatient, and then in analyzing a group that was not seeking medical assistance, they found that,
"The prevalence of adverse drug events was 13.0%, 10.9%, and 16.0% among all patients, the outpatient group, and the inpatient group, respectively. Multivariate analysis showed that polypharmacy (≥5 drugs) significantly increased the risk of adverse drug events in all patients." And " The prevalence of adverse drug events significantly increased with each additional drug used. " They concluded the following: "We expect that minimizing the number of medications through moderation of the number of prescription drugs and elimination of polypharmacy will reduce the number of outpatient visits and hospitalizations due to adverse drug events." https://pubmed.ncbi.nlm.nih.gov/34078523/#:~:text=The%20prevalence%20of%20adverse%20drug%20events%20was%2013.0%25%2C,risk%20of%20adverse%20drug%20events%20in%20all%20patients.
13. Understand the process of how drugs are approved: According to the below International Journal of Health 2016 estimate, "Each year more than 2 million serious adverse drug reactions occur in the United States, causing an estimated 100,000 deaths. "The FDA initiated a series of programs in the 1980s and 1990s that allowed the expedited review of certain drugs. Perhaps as a consequence of these programs, the FDA approves new drugs significantly faster than the regulatory bodies of Europe, Canada, and Japan. Unlike the United States, most European Union countries require that new drugs undergo a secondary review process comparing their efficacy to the existing standard of care before health insurance plans will pay for them. Pharmaceutical firms often heavily market newly approved medications in the United States, and doctors frequently prescribe them. After the FDA relaxed regulations on direct-to-consumer advertising in 1997, including allowing less reporting of product risks, pharmaceutical spending on advertising increased more than three-fold. Patients commonly ask for advertised drugs in the United States and clinicians often feel pressured to prescribe them. Hence, many Americans may be exposed to drugs that pose a risk to their health before their dangers are adequately appreciated."
* The above citation refers to this research study from 2016, which found that between 1993 and 2010, seventeen drugs were removed from the market because of safety issues (an average of almost one/year). These seventeen drugs, which were later recalled, were prescribed a total of 100 million times before being removed from the market! https://journals.sagepub.com/doi/abs/10.1177/0020731416654662
14. Talk to your prescriber about the period of time a drug has been in use. Understand that there have been changes to the process of approving prescription drugs which might impact their safety (referred to above). The fact that a drug is being prescribed does not indicate that it will actually be safe to use or that its side effects are fully known. There were more than 1300 drug recalls by FDA in 2022. The median time from a drug coming out on the market and being removed is 5 years. Have a healthy skepticism about your medications and discuss this with your provider. Consider whether you are willing to take the risk associated with a new drug or whether you prefer medications who have a longer history with known side effects and risks.
15. Realize that some drugs are prescribed in a recommended manner for decades before prescribers are required to change how they are prescribed. We discussed the history of opioid and benzo prescribing above. For decades, physicians believed and patients were informed that long term use of opioids (with increasing dosages because of tolerance) posed no real adverse health risk. After decades, and after billions (?trillions) of prescriptions (More than 191 million opioid prescriptions were dispensed to American patients in 2017 alone!) were written, the rules about what is safe and effective took a 180! Many patients who were prescribed opioids for decades have had a hard time believing that opioids could pose some safety risks because they were promoted as "safe" by the medical community for decades.
16. Ask your prescriber if a medication is formualry or non-formulary (prescribed for purposes other than what it was approved for). Some medications have passed the safety test and are considered safe when they are used in a particular manner, but are then prescribed routinely in a manner which has not been studied sufficiently to suggest that the drug would be without side effects.
17. Consider whether taking a medication is only quieting the messenger : I recently listened to a podcast by Dr Richard Schwartz (Internal Family Systems) about taking medication for the anxiety related to trauma. He is quoted as saying the following, "Medication is designed to kill the messenger so that we do not have to listen to the message." Although he made this statement in respect to using medication to mask what the body is trying to convey to an individual after trauma, it can be reasonably considered in respect to our overall use of medication as well. The body is a complex and amazing system which uses countless forms of messaging (feedback) to keep us safe/warn us of impending danger. For example, if I am working 12 hours a day, not getting good nutrition , and not giving myself sufficient rest and recovery, my body would likely eventually sense that I am functioning under high levels of stress . In response to this feedback (about constant stress hormones), I very likely may begin to have difficulty sleeping. This would be my body's message to me that the way that I am operating on a daily basis is not working for me. It is not sustainable, and my health behaviors are pushing my body's ability to adapt to the limit. If, then, I immediately choose to take a medication in order to help me sleep ,I am very likely just killing the messenger (with meds to fix my sleep); but ignoring the message that my health behaviors are driving high stress levels which will ultimately need to be managed.
18. Remember that you are an integral part of your own health management! Make sure your provider knows your goals, preferences and beliefs and that they are willing to consider these in helping to manage your health. Be a healthy, but educated, skeptic! Remember that medication is often the easiest "fix" , but not always the most ideal long term solution. Sometimes medication is absolutely necessary. Make sure you work closely with your provider to known how to most effectively manage your health.
Disclaimer: This BLOG is for Educational Purposes, Only. This information provided is educational and informational in nature and is made only as general information. The information does not establish a patient-provider relationship, establish a standard of care, or offer medical, dietary, or therapeutic care, advice, opinion, diagnosis, or treatment. This information does not replace independent professional or medical judgment and should not be relied upon as medical, psychological, or other professional advice of any kind or nature whatsoever. This information should not be used for diagnosing or treating any mental or physical health problem or disease. You are solely responsible for any action taken based on your interpretation of this information and you are responsible for your own health care decision-making by obtaining any necessary consultations with appropriately licensed health care professionals such as physicians and psychologists.
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