deprescribing

A pillar of future professional and lay health education that incorporates disease-mongering awareness must deal with how to discontinue drugs when they are no longer wanted (ineffective, causing adverse reactions, interacting deleteriously with other drugs), no longer needed, or maybe never were needed. But it seems that withdrawing, discontinuing, or deprescribing are topics addressed primarily in publications such as Geriatric Therapeutics. And a substantial number of the references I found, e.g., this recent one on a controlled trial of deprescribing, came from Australia!

Of course, this being 2012, I did locate lots of online consumer-contributed advice about discontinuing drugs, most of it complaints about the unforeseen difficulties.

I found one delicious paper called “Pruning the Prescription” from the 1941 British Medical Journal. Concerned about forestalling wartime shortages, the author cautioned about “aspirin addiction…in Government offices…[where] it seems to be as usual to swallow an aspirin tablet as it is to use a cosmetic.” (ibid, p. 854). The answer? “Cut down the size of containers” and use smaller bottles (as they did, apparently, no jokes here, in Scotland). “The practitioner should have little difficulty in reconciling his duty as a citizen with his duty to his patient.” (ibid., p. 855).

Taking medications now may be more common even than using cosmetics and the need to periodically assess and deprescribe will only increase as an important professional duty.