Polypharmacy is compounding the opioid epidemic

In the past year, we’ve seen beloved musicians, actors, and other public figures fall victim to the opioid crisis. But it’s becoming clear that for many of these celebrities, it was not just opioid abuse that killed them, but a combination of drugs causing an adverse reaction. 

A dangerous combination

In a recent STAT article, Dr. Lipi Roy, the medical director of the Kingsboro Addiction Treatment Center in Brooklyn, N.Y., uses the case of musician Tom Petty, who died last year of an accidental drug overdose, to unpack the complex intersections between drug abuse, polypharmacy, and mental health.

Roy explains that, like many of her patients, Petty was dealing with chronic pain and depression, as well as a history of substance abuse. The different types of medications Petty had been taking to address these conditions – multiple types of opioids, benzodiazepines, and an antidepressant – further increased his risk of harm.

Roy points out that Petty had many different health providers, so the doctors who prescribed his various medications likely did not know what prescriptions or other substances Petty was already taking. She recommends a state or nation-wide prescription drug monitoring program that would allow clinicians to see the medications patients have been prescribed and avoid potential adverse drug interactions.

Widespread polypharmacy

Petty’s death and others have brought to light the dangers of taking benzodiazepines and opioids together, which the FDA now warns against. But the problem of taking multiple, potentially dangerous drugs goes far beyond just these two substances. The number of people taking multiple prescription drugs has increased greatly in the last twenty years, both in the US and abroad. In the US, the proportion of people taking at least five medications nearly doubled between 1999 and 2011, from 8.2% to 15%. Polypharmacy became even more prevalent among the elderly, with almost 40% of people over 65 taking five or more drugs. 

Despite the growing prevalence of polypharmacy, there is still a lot we don’t know about it. There is no official definition of polypharmacy; five drugs or more is an accepted definition among researchers, but this cutoff is relatively arbitrary. How many drugs are “too many” depends on the patient’s age, medical conditions, and what drugs they are taking.

We know a bit about what can drive polypharmacy – specialty-focused guidelines, uncoordinated care, and lack of knowledge of potential harms of multiple drugs, for example. But we don’t know yet the best ways to safely deprescribe drugs for elderly patients, and many interventions thus far have been unsuccessful.

Framing the problem

The Lown Institute is beginning a new long-term project to review and synthesize the literature on polypharmacy, and bring together experts on the subject to create an “action plan” to reduce harm from multiple medications. As we hold events and publish reports on this topic, we will update the Polypharmacy issue page on our website, so stay tuned for more over the upcoming months!