Overprescribing medicine is the result of social problems, not health issues

There is no doubt that modern medicine has transformed our health and improved the lives of millions. Decades have been added to life expectancy over the last century due, in no small part, to medicines used in the management of coronary heart disease and cancer. However, as a new government report suggests, there are problems with the rapid increase in prescribing in recent years.

The figures published in the report are staggering and worrying. An estimated 10 per cent of medicines prescribed in primary care are unnecessary. Ten per cent may not sound much but, given the millions of prescriptions issued every year, the waste and cost will also be in the millions. But it's about much more than just economic waste, every medicine has risks as well as benefits. This is made clear in the report. The authors point out that 20 per cent of all hospital admissions in those aged over 65 are due to the adverse effects of prescribing medicines. This not only kills some of these older people but leaves many with added health complications that they will endure for the rest of their lives.

We all know the pressure that hospitals are under due to the pandemic and how limited capacity is, so having significant numbers of people admitted due to an avoidable factor is an avoidable problem.

Some of this overprescribing is due to medicines being prescribed to counter the effects of pills already being taken. All drugs interact, some of these interactions are mild or go unnoticed but some create significant harm and can be deadly.

None of this will be news to those involved in prescribing and dispensing medicines and, as with most aspects of healthcare, there are several factors contributing to this issue. One of these is culture, the report points to “a healthcare culture that favours medicines over alternatives and in which some patients struggle to be heard”.

The solution then seems obvious, provide the alternatives to pills and drugs, if only it were. I can hear GP’s and other doctors screaming up and down the country as they hear this, they would love to provide alternative options to patients but simply don’t have access, or at least timely access to these alternatives. One example is “talking therapies” used in the treatment of depression and anxiety, two of the most common mental health problems, affecting millions every year in the UK.

The snag is that despite evidence supporting how effective these therapies are people are waiting months, sometimes years to access trained therapists. In the meantime, GPs are left with patients who are suffering, they have no choice but to prescribe an anti-depressant or anxiolytic to provide some relief while they wait for treatment. These types of medicines come with their own set of risks as well as benefits. According to the new report, up to a third of people won’t experience any benefit in their mental health from newly prescribed medication.

Antidepressants are a good example of another issue that this report raises, namely reviewing medication. The research shows that up to three-quarters of all medicines issued are repeat prescriptions, nothing wrong with that if these repeat prescriptions are reviewed regularly, the problem is some aren’t. Consequently, many patients are consuming medication that they no longer need. Much of this is due to time pressure when many doctors simply don’t have the time to adequately review and consult with individuals about their existing prescriptions.

Like so much in health there is an unequal distribution when it comes to overprescribing. Those living in the most deprived areas are nearly three times more likely to be given two or more medicines compared to those living in the most affluent areas, the research found. There is also a suggestion in the report that ethnicity is a factor, with those identifying as Asian being much more likely than their white counterparts to be prescribed eight or more medicines.

This gets us to the nub of what’s going on here, overprescribing is the result of social not health problems. Doctors are faced with an increasing number of patients living in poverty, are unemployed, living in sub-standard accommodation and who lack any hope of this changing. The prescribers are as impotent as the patients in being able to change or control these factors. It’s little wonder they do the humane thing and reach for the prescription pad.