Deprescribing with Adam Livingston

January 31, 2018

Deprescribing with Adam Livingston

For what seems like a million years, the conventional pharmacy model has been built around the idea that pharmacists must dispense more prescription medications in order to make more money. This business model has served many pharmacists well since Canada is one of the most drug-dependent countries in the world, dispensing more than 400 million prescriptions annually and spending nearly 30 billion dollars on prescription medications last year.

 

And these numbers are steadily increasing. Behind only the United States, Canada uses the most prescription medications per capita in the world and spends more than any other nation on our drugs. We love to pat ourselves on the back when we look at our neighbours to the south and tsk-tsk them for not having “free” public healthcare, but I can assure you that our healthcare is far from free.

 

With our use of more and more prescription medications, one might expect to see rates of chronic conditions declining, right? Since these evidence-based drugs are so effective, and we use them so frequently, we should also be seeing a steady decline in the conditions these drugs are treating, right? Wrong. We are in the midst of an opioid crisis and rates of opioid dispensing have never been higher.

 

We are also in the midst of a mental health crisis, and though pharmacists like myself are dispensing more antidepressants and benzodiazepines than ever before, rates of depression and anxiety have never been higher. We are in the midst of an obesity and diabetes epidemic, yet most pharmacists would rather collect a $2.00 co-pay dispensing a diabetic medication than have an honest conversation with a patient about diet and exercise.

 

With decreasing mark-ups and co-pays on prescriptions, the conventional dispensing model of pharmacy is dying. Pharmacists are going to have to take on new roles and responsibilities to actually help patients get real results. This raises an important question that seems completely counter-intuitive to most pharmacists: can pharmacists build a new business model around helping people to come off of inappropriate medications? If pharmacists play a role in helping patients to use drugs safely, could there be a role for them to help patients discontinue drugs safely? This is what we do at NutriChem Pharmacy, and it is called Medication Deprescribing. It is the safe reduction or discontinuation of inappropriate prescription drugs.


Now, don’t get me wrong, drugs certainly play a pivotal role in medicine. When it comes to acute conditions treated, for example, in hospital emergency departments, surgery units, intensive care, or cancer wards, drugs can be miracle molecules. But for many chronic conditions commonly seen in the realm of community pharmacy, they simply aren’t that effective and patients are faced with a poor risk-to-benefit ratio when they start to experience the long list of side effects associated with many of these drugs. As a pharmacist, few people support the appropriate use of prescription medications more than I do.

 

However, now that overprescribing has become so rampant- from PPIs, to opioids, benzodiazepines, antidepressants, and so on- there comes a point where healthcare professionals have to take a stand and start to change their thinking to get real results for patients. I believe pharmacists, in combination with teams of other healthcare providers, are in a prime position to help deprescribe inappropriate medications and replace them with safer, more effective alternatives.

 

At NutriChem, we work as a comprehensive team of drug, supplement, and nutrition experts to customize treatment plans for patients and optimize their health. Our goal is not to use a specific drug, or a supplement, or a diet, but to achieve each patient’s individual health goals no matter what the best treatment path may be. So if you have questions or concerns about your medications and you’d like a second opinion, come on in to NutriChem and any of our staff would be happy to chat with you. Our current focus is the deprescribing of proton pump inhibitor (PPI) drugs.


Dr. Adam Livingston, PharmD, is a clinical pharmacist at NutriChem Compounding Pharmacy and Clinic. He is NutriChem’s Deprescribing Program Coordinator. Adam’s areas of focus include medication deprescribing, gastrointestinal health, mental health, and addiction.

 

This article was featured in the Kitchissipi Times







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