Safe use of medications: lessons from COVID-19

Modern medicine has had a wonderful impact in the last 50 years, but health care can do harm as well as good, as recent events with hydroxychloroquine for COVID-19 have shown.

Experts expressed concern in May, when U.S. President Donald Trump touted hydroxychloroquine, a malaria drug, as a “game changer” ready for immediate use for the treatment of COVID-19 and claimed to be taking it himself. They warned that his promotion of the drug could spark wide misuse by the public, with potentially fatal side effects.

Decisions about the safety and effectiveness of drugs are based almost entirely on what is known as a randomized controlled trial (RCT), in which patients are randomly assigned to receive a treatment or not. Since May, RCTs on the effectiveness of hydroxychloroquine in the treatment of COVID-19 have reported that the drug produces little or no reduction in the mortality of hospitalized COVID-19 patients when compared to control group patients who received standard care. It is certainly not the hoped-for “miracle cure” to COVID-19. 

The situation with hydroxychloroquine highlights the importance of not being persuaded by “miracle drugs,” such as those advertised on TV, and that there are risks associated with every medication. The lessons learned from these events are important, especially for people with underlying health conditions (heart disease and stroke, diabetes, long-term lung disease, and cancer) who are at increased risk of COVID-19. As well, the more underlying conditions an individual has, the greater the risk of both COVID-19 and polypharmacy. Polypharmacy is the concurrent use of multiple medications. On average, people over the age of 65 are on six drugs a day. Often the physicians who prescribe the drugs do not communicate, which can result in a patient getting drugs from each of their specialists, such as their cardiologist, neurologist, psychiatrist, and endocrinologist. Polypharmacy increases the risk of heart disease, atrial fibrillation, high blood pressure, diabetes, long-term lung disease, and delirium. You need to assess with the assistance of your friends, family and health care practitioners the following:

• Are the drugs you are taking incompatible when taken together? 

• Are you able to easily obtain your drugs in your community? 

• Are there reasons why you are not taking the medications? 

• Are you keeping track of how you are doing while you are taking your medications?

To be safe, take medication only at the time and dosage at which they are prescribed. The essentials of medication use are as follows:

• Medication is not a panacea, but part of what is needed to reduce the impact of disease. For example, best results for high blood pressure occur when you take your prescribed medication while also managing your diet and physical activity.

• Medication needs to be monitored, so have regular checks with your physician.

• As we age, some of our bodily functions and organs change our tolerance to drugs, which can require changes in doses.

• Be mindful of acute illness, as common illnesses can change our tolerance to medications.  

• Medication needs to be taken as it is prescribed - omitting or taking excess doses can lead to under-treatment or overdose.

• Remember not all over-the-counter medications are safe for you to take.  

• Think long term. Some medication, such as sleeping tablets, may give you the illusion of short-term gain, but will cause you long-term pain. 

• Speak to your doctor or pharmacist about side effects of your medications to stay informed.

• Just because something is not marketed as a drug, such as alcohol, does not mean it does not have the effects of drugs. 

• Be wary of  ‘food supplements’ and unlicensed products, as they can interact negatively with medicines you take, and all of them potentially cost you money. 

• Bring your complete list of medications to each doctor appointment so they know all the drugs you are taking, not just the ones they prescribe.

Family and friends can be helpful if you have concerns about taking medications and should be encouraged to talk about your medicines. By understanding your present routine for managing drugs you are taking, it may be possible to identify potential problems and how to overcome these. They can also help with opening packages some drugs are in, reading small print on drug labels and reminding you to take your medication.

Rather than looking for another pill to cure your next ailment, look around in your community for other approaches to improving your health and quality of life. Pain control is a good example of the importance of non-drug approaches to ailments. These approaches eliminate the risk of becoming addicted to one of the pain management drugs that thousands of people experience. For example, pain can be decreased and stress relieved with relaxation techniques, such as:

• Aromatherapy. 

• Deep breathing, tensing your muscles and then relaxing. 

• Meditation and yoga to help your mind and body relax. 

• Guided imagery teaches you to imagine a picture in your mind. You learn to focus on the picture instead of your pain. It may help you learn how to change the way your body senses and responds to pain. 

• Music may help increase energy levels and improve your mood. It may help reduce pain by triggering your body to release endorphins - natural chemicals produced by the body that decrease pain. 

• Biofeedback helps your body respond differently to the stress of being in pain. 

• Self-hypnosis is a way to direct your attention to something other than your pain.

• Acupuncture therapy uses thin needles to balance energy channels in the body and this may help reduce pain and other symptoms.

An important fact is that people most at risk may be the group that is least able to ask for a review of their medication. Physicians have a responsibility to de-prescribe drugs. This process is where they review the medications for people with multiple prescribed drugs and stop or reduce some to decrease side effect risk and improve outcomes. If you are concerned you have been prescribed multiple medications by different physicians, you should ask your family physician for a review of all your medications.

Everyone should check with their doctor before mixing medicines, including over-the-counter medications. In addition to medications that physicians prescribe to patients, over-the-counter drugs can also cause problems. For example, your doctor can review your heart medications, and avoid prescribing to you heart medications that when mixed with Aspirin and supplements such as omega-3 fish oil and garlic, are known to cause problems with your thinking ability. Heath care practitioners are instructed through guidelines to consider the following issues in a handbook from the US Agency for Healthcare Research and Quality, called Patient Safety and Quality by Ronda Hughes:

• Whether drugs you are taking are incompatible (medication reconciliation). 

• Where you obtain your drugs (medical procurement). 

• Whether you are not taking the medications and the reasons why (intentional non-adherence).

• Keeping track of how you are doing while taking your medications (ongoing monitoring). 

Medicines are part of the reason modern healthcare has had a tremendous impact on death and disability, but remember, all medicines can have side effects, especially when taken together.

Larry W. Chambers has authored 175 articles and books concerning disease prevention (e.g. dementia), quality improvement in long-term care homes, and innovative approaches for continuing professional development. He is research director of the Niagara Regional Campus, School of Medicine, McMaster University. Eva Liu and Hanna Levy are medical students at the Niagara Regional Campus of the McMaster University School of Medicine. They are interested in improving community wellness of frail older adults in NOTL by narrowing the fitness (physical and brain) gap, diversifying housing options for older adults, and increasing economic activity within the community that also increases ability of our minds to interact with people and ideas.