Polypharmacy – the use of five or more medications on a daily basis – is a modern-day health crisis. A lack of knowledge about drug interactions increases the likelihood of side effects or adverse reactions, with many patients reporting lower quality of life as a result.
In contrast, patients using medical cannabis are often able to reduce the number of prescription drugs they are taking while better managing their symptoms. Could cannabis be the safer alternative prescribers and patients are looking for?
WHAT IS POLYPHARMACY?
For the average person living in today’s world, the older we get, the more drugs we are likely to take. In the United States, 35.8% of older adults take five or more prescription medicines. This increases to 67.1% when we throw in over-the-counter medication and supplements.
Of course, we’re all living longer, and with old age often comes any number of chronic diseases, each with their own prescription pill. Statistically, the more drugs we are prescribed, the higher the risk of adverse drug reactions.
In the UK, 6.5% of hospital admissions occur thanks to adverse drug reactions (ADR),
and an estimated 90% of older adults hospitalized due to ADR are taking multiple medications
.Unfortunately, more drugs doesn’t necessarily mean a patient’s symptoms are well managed or that they have better quality of life. A 2019 study by University of Pittsburgh researchers investigatedthe use of polypharmacy in palliative care and found that patients actually experienced lower quality of life and higher symptom burden.
The authors suggest this could be attributed to medication-associated symptoms rather than the diseases themselves; something known as the “prescribing cascade.”Sir Munir Pirmohamed, a British professor of molecular and clinical pharmacology, has even gone as far as to suggest that pharmaceutical drugs are “poisoning” the elderly.
As he explained to a House of Lords committee hearing on healthier living in old age, “[T]hose drugs are used at conventional doses and those doses have been tested in younger populations who had exclusion criteria for trials – so they have been tested in people who don’t have the multiple diseases,” he said. “So, when we use a drug at a dose which is licensed at the moment, we are often ‘poisoning’ the elderly because of the dosing that we are using.”
Health professionals often struggle to stay abreast of all the medications their patients are taking, particularly when they are not the only prescriber involved in their care.
This was the experience of Eloise Thiesen, a nurse practitioner and current president of the American Cannabis Nurses Association. A chronic pain patient herself, Eloise ended up in the emergency room after the addition of yet another prescription drug caused a potentially fatal adverse effect.
“I was being prescribed multiple medications,” Thiesen told Project CBD. “When they added in the eighth medication and they weren’t communicating with each other, I ended up with serotonin syndrome, which can put you in a coma and kill you. So, they don’t communicate. It may be in your chart, but how do they make sure that information is following you from specialist to specialist. It’s a huge gap in our healthcare system.”
CANNABIS – NATURE’S ANTIDOTE TO POLYPHARMACY
Thiesen’s firsthand experience of how cannabis could effectively manage her pain, allowing her to come off the prescription drugs she was taking, inspired her open the Radicle Health Clinic specializing in medical cannabis.
“On average in my clinic, the elderly patients I see are taking around seven medications to manage their symptoms. So I see a lot of side effects related to the polypharmacy,” says Thiesen.
“For a typical pain patient that comes to me, the standard of care is to use Tylenol or maybe short term anti-inflammatories. If that doesn’t work, they’re put on Tramadol, and then of course if that doesn’t work, they’re put on other opioids. Then they may be put on something like gabapentin to help with their nerve pain. Now they’re on an antidepressant because their pain’s not well managed, and they’re anxious because they’re not really sleeping because their pain is unmanaged.”
A number of studies have shown how in US States where medical cannabis is legal, opioid prescriptions are significantly reduced.
But cutting down on opioids is only part of the story.Thiesen: “I’m really passionate about helping people get off medication to see what life would be like with cannabis and without the pharmaceuticals because I think their quality of life is going to improve dramatically.
“Over and over I hear people say to me, ‘I’m getting my life back.’ Their thinking is clearer, they’re engaged again with their loved ones. They really are in the present moment, and it’s miraculous to see.”