Healthy Skepticism Library item: 12215

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Publication type: news

Dangerous drugs continue to be prescribed to seniors: CBC report
CBC News 2007 Dec 18
http://www.cbc.ca/health/story/2007/12/17/dangerous-drugs.html

Full text:

Doctors are continuing to prescribe drugs dangerous to seniors in spite of government warnings, a CBC News investigation reveals.

More than two years ago, CBC News first reported that more than a million seniors were prescribed atypical antipsychotics. Atypical antipsychotics are specific kinds of antipsychotic drugs. They are considered by many experts to be ineffective or even dangerous for elderly patients.

Health Canada followed up with warnings pointing to the drugs’ side effects – including a 60 per cent greater risk of death in seniors who were taking the drugs than in patients taking placebos – gleaned from 13 scientific studies. It also warned that elderly patients taking atypical antipsychotics were almost twice as likely to die from side effects such as heart failure.

In its advisory, Health Canada requested that the drugs’ manufacturers include a warning describing the risk in the safety information sheet provided along with the drugs, and that health care providers refrain from relying too much on the drugs to treat dementia.

Atypical antipsychotics are drugs such as Risperidone (Risperdal), Quetiapine (Seroquel), Olanzapine (Zyprexa) and Clozapine (Clozaril). Many of these types of drugs have never been tested on seniors. They are intended to treat severe mood disorders, symptoms of schizophrenia and bipolar disorder in adults under 65.

But a new CBC investigation has revealed that the number of prescriptions of these drugs for seniors actually increased after the Health Canada warnings. They shot up in six provinces, including in Ontario and Quebec. In some cases, they increased by 40 per cent, according to sales data provided by IMS Health, a business intelligence and strategic pharmaceutical and health-care consulting firm.

CBC’s analysis shows that Risperdal prescriptions increased by just over eight per cent in the past two years. Prescriptions of Seroquel increased by 40 per cent.

The CBC News investigation has discovered that doctors are prescribing more of the drugs to their patients suffering from dementia as a way to calm them.

“Antipsychotics are drug therapies that are used in the setting of dementia to manage difficult behaviours,” says Paula Rochon, a Toronto-based geriatrician and senior scientist at the Kunin-Lunenfeld Applied Research Unit at Baycrest Centre for Geriatric Care.

“So they’re often used if people are very agitated, have aggressive behaviours, psychotic-type symptoms – things like that.”

Norma Galloway, an 85-year-old Vancouver native, was prescribed Risperdal when her son Rod requested a medication that would ease her anxiety about a persistent urinary tract infection.

Neither Galloway nor her son were ever told that the drug is intended for psychotic patients with severe dementia or schizophrenia. Following the doctor’s directions, she took one pill in the morning and one at night.

Rod Galloway noticed a change in his mother immediately. “It was like someone that was really groggy or sedated and not really that with it,” he said. “And on the next morning we were debating should we give her another one, and we reluctantly gave her a second Risperdal.

Norma Galloway’s personality changed dramatically from cheery to sullen, her son said. One day she suffered a seizure in her room, something that had never occurred before, and collapsed. She was rushed to hospital.

Only use in extreme cases: doctor

Rochon says antipsychotics should only be used in extreme cases. “Those would be [the] sort of situations where the person may be in danger of causing harm to himself or to other people around them and it’s a very acute situation where you need to do something. But usually the situation isn’t that. Usually you have behavioural problems that are developing over time. And antipsychotics should be one of the last things you should consider in one of those settings.”

She says one of the reasons the drugs are often prescribed is because there aren’t that many drug options around to treat behavioural problems in seniors.

To avoid taking the powerful medications, she advocates discussions that involve the caregivers, family members, nursing staff, physicians and pharmacists to determine the behavioural issues of the individual.

“Often there are simple sorts of interventions that can be put into place that make the behaviours manageable,” she says.

Rod Galloway lost his mother after ten days in hospital. She died at 85, after having a heart attack. He says had he known about the Health Canada warning, he would likely have refused to use such a powerful drug to deal with his mother’s mild anxiety. He believes she would still be alive.