Drug Misuse A Potentially Lethal Problem, Especially For Seniors

By Elsa C. Arnett, Knight Ridder Newspapers

WASHINGTON -- President Clinton's proposal to make prescription drugs affordable for all Medicare recipients would help millions more Americans get the medications they need to regulate their heartbeats, control their diabetes and ease their arthritis.

But like the drugs themselves, the plan may have some dangerous, unintended side effects. The Journal of the American Medical Association estimates that bad drug reactions may be one of the leading causes of death in the United States. And making powerful medicines cheaper and easier to get may also increase the chances they'll be misused.

''This is an enormous problem, especially for seniors, because they are the most likely to be sick and the most likely to have multiple diseases, and also because they are more sensitive to medication and more likely to have complications with drug interactions,'' said Dr. David Jarry, director of pharmacy at Fallon Healthcare System, an HMO in Worcester, Mass.

Every year, 100,000 people in the United States die because they take the wrong dose, have unexpected side effects or have dangerous reactions from combining medications, according to a recent study by the Food and Drug Administration. Millions more become disoriented or delirious, or suffer from bleeding ulcers, breathing problems or blurred vision because of misuse.

Think of grandma, whose dresser top is filled with an intimidating array of tablets and capsules. Or the in-laws who lug a pouch full of mysterious bottles and vials whenever they visit. Every time they swallow their pills, they may be taking a chance.

But while overmedication is a danger, there is no doubt that there are also many seniors who cannot afford the drugs they need. As many as one in eight seniors say they are forced to choose between buying food and buying medicine.

The president's proposal would deal with that problem by creating a new voluntary prescription Medicare plan that lets beneficiaries buy prescription drugs at discount prices, usually available only to those enrolled in large health plans. The government also would pick up half the premium costs, to ensure that the plan is affordable for all 39 million beneficiaries.

But getting drugs into people's hands is only part of the equation. To confront the additional health risks that are likely to arise from the president's plan, experts say the government, the medical industry and consumers must adopt safeguards to ensure that the newly available medications will be used correctly.

''You can't put the blame on any one person, nor can you put the solution in any one place,'' said Dr. Marcia Ory, chief of social science research on aging at the National Institute on Aging. ''It all has to work together, from the pharmaceutical company, to the doctor, to the pharmacist, to the patient.''

Government and industry efforts already are under way to reduce misuse of prescription drugs.

Jarry at Fallon Health Care recently won an $800,000 federal grant to launch a first-of-its-kind study aimed at improving drug safety for seniors. Pharmaceutical companies are trying to make their labels and instructions clearer, the government is working on designing bold, bright icons to clarify instructions on prescriptions, some pharmacies are experimenting with databases to keep track of patients' prescriptions and some companies are developing software to remind people when to take their pills.

''We're finding ways to relieve people of the worry of taking medications, and to give them some flexibility and peace of mind,'' said Ronald Moran, chief executive officer of MedPrompt Inc., a Houston-based company that has created pagers to alert people when to take their medication.

But it will take some time before the technology and the message trickle down to the millions of seniors who take these medications.

''Unfortunately,'' Ory said, ''The older person is still usually the last to know about the risks.''

The biggest obstacle, perhaps, is that many seniors rarely realize something may be amiss in their medicine cabinet or their bodies. Unless they have had heart bypass surgery, where they leave the hospital with an armload of medications the very next day, the path towards overmedication for most people is usually incremental.

For example, a person may be given medication to control high blood pressure. That might cause a drop in potassium levels, so the doctor writes a prescription for potassium. Several months later, the person might also have trouble sleeping, so he takes some pills to help sleep. That might cause blurry vision or constipation. He takes more medication to relieve the constipation. All the while, he may have a recurring headache, so he pops a few over-the- counter ibuprofen. Then he reads an advertisement praising the herbal supplement ginkgo biloba for preserving memory, so he adds that to his regimen. Throw in the occasional gin and tonic, and you have the makings of a powder keg.

Such combinations can make a person dizzy or disoriented. Sometimes, the consequences can be worse. Drugs to treat arthritis pain and those that thin the blood can cause internal bleeding. Combining sedatives with heartburn or ulcer medications can lead to a toxic buildup in the body.

''The people who are now in their 70s to 90s were raised to revere their physicians, so they aren't used to asking questions about what medications they are given. They do as they're told, and eventually it all adds up,'' said Tedd Perry, educational coordinator at the Rocky Mountain Poison and Drug Center in Denver, which helps educate the community about medication misuse.

More than 2 billion prescriptions are dispensed a year. People ages 65 to 74 use an average of 8.6 prescription drugs a year, according to the National Association of Chain Drug Stores. Those 75 and older use more than 11 per year.

For many who juggle numerous pills a day, keeping track of what to take on an empty stomach, what to take with food, what not to take with dairy products and what not to take with other drugs can be overwhelming.

Just ask Ann Douglas, a Houston grandmother who takes four different prescription medications a day to keep her potassium balanced, maintain a steady heartbeat and stabilize her borderline diabetes. She also takes two daily vitamin supplements, as well as the occasional pill for headaches.

''My days are full with grandkids, bowling and ladies coming by here and there, so it's easy to lose track of what I'm supposed to take,'' said Douglas, who is in her 60s. ''Sometimes I'll be sitting there in the school parking lot, waiting to pick up the grandkids, and I'll think, 'Now, did I take that pill or did I forget?'''

On two occasions, Douglas thought she had forgotten to take her heart medication, so she took some. Soon after, her blood pressure plummeted and she felt weak. Frightened by her lethargy, Douglas' daughter rushed her to the emergency room, where doctors figured out she had doubled- dosed on her medication.

''It all happened because I messed my medication up,'' said Douglas, who now subscribes to a pager device that reminds her six times a day to take various medications and to eat a snack.

To complicate matters even more, potent new drugs flood into the market every year, and it is virtually impossible for doctors or pharmacists to know how they will affect the millions of different people who will take them.

''People tend to want to say, 'Well, A, B and C drug when combined with X, Y and Z drug will cause these problems,' '' said drug education coordinator Perry. ''But in reality, we just couldn't possibly tell you what the problems may be because there are so many different variables now.''

Just last year, a promising new drug to treat hypertension and chronic angina was pulled from the market after it caused serious side affects in many people. It caused dangerous reactions when combined with any of more than 25 drugs.

In a time when people think more pills mean better medicine, health experts urge doctors and patients to remember that simple solutions like a change in diet, lifestyle and exercise may sometimes be the best remedy for certain ailments.

''People need to realize pills are not always the answer,'' said pharmacy director Jarry. ''We have a saying, 'Wise prescribers often don't.'''