Starting a medication takes a 2 minute conversation with your doctor. Yet stopping one can take a referral, a care plan and three appointments. 

At the Integrative and Personalised Medicine Conference in June, Dr Rangan Chatterjee once again raised the conversation around de-prescribing, reducing the amount or totally eliminating unnecessary medication and a rallying call for a prevention first model.

In the last couple of years, NHS England has named problematic polypharmacy a priority to be tackled, with research showing that each additional medicine prescribed to an older patient is linked to increased mortality. Not to mention adverse drug reactions now accounting for a meaningful share of hospital admissions – 16.5% is not to be dismissed!

We prescribe statins and PPIs all the time. Why is stopping medication still seen as the radical option?

GP’s and pharmacists are themselves becoming increasingly frustrated with this pattern. If a colleague suggested starting a new drug with no clear indication, we’d ask questions. But when a drug has been running for ten years with no clear indication, it is easier for a doctor or pharmacist to simply renew it.

Time is one of the issues. A 10-minute GP appointment simply isn’t long enough sometimes to unpick a comprehensive drug regimen, explain rebound risk and reassure an anxious patient. As a doctor we need to look into why a patient needs to be on the medication in the first place, possible root causes, lifestyle factors which can be adjusted to take them off the medication slowly which will result in multiple appointments. Let’s be honest, starting a drug is faster, simpler and less questions asked than stopping one.

As a doctor we also face liability and a certain amount of uncertainty. We can’t see into the future and do our best given the evidence in front of us to provide justification for our actions. If you stop a statin and the patient has a cardio event six months later, that decision will get scrutinised in a way that continuing the status quo never does.

And as yet no one single individual is responsible for long term drug review. A drug started by a hospital consultant, continued by a GP, and dispensed by a pharmacist for a decade has no single person accountable for re-asking “does this still make sense for this particular patient?” Certain drugs are now eligible for routine annual medication reviews. But some, such as statins, are not routinely subject to the same review because clinical evidence shows the drugs are ‘safe’. However, it is well known that long term statin use is widely linked to the depletion of CoQ10, an antioxidant thought to help protect heart cells from damage and have a role in conducting signals within the heart and generating energy. Ironic?

We’ve built a healthcare system that treats starting a drug as routine but stopping one as a clinical event which has to be justified. Until that changes, polypharmacy will keep being something we manage, rather than we prevent.