Responsible Prescribing

Medications are tools for your health. The ideal way to use non-essential medications (essential meaning life- and, sometimes, quality-of-life dependent) is as a bridge of support while you work on the factors that may have placed you in the position to need them in the first place. If you are prescribed a non-essential medication, it should be the responsibility of all providers to discuss an eventual plan for discontinuation. This is what comprehensive healthcare should look like.

The term “deprescribing” emerged in early 2000 in the context of geriatric care due to the high rate of polypharmacy in this demographic. Polypharmacy is generally agreed to be the concurrent use of 5+ medications, and deprescribing is as its name suggests: the intentional discontinuation of prescription medication use. Early in my medical career I carved out a small niche in geriatrics, obtaining additional training in care for this population and becoming a contributing author to the first integrative geriatrics textbook, Integrative Geriatric Medicine, as part of the Weil Integrative Medicine Library. It was at this time that deprescribing was introduced to me. But I have never understood why the concept has not become a universal practice for ALL patients of polypharmacy, which affects over 37% of the adult population, and upward of 66% in certain subsets of adults1. I fear the medical community has become so complacent and narrow-minded in how health is viewed and approached that very few are zooming out for the big-picture perspective and realizing that what we are doing is not working! With pharmaceuticals as one of the only tools in the conventional medical provider’s toolkit, polypharmacy is not an issue of the elderly, it is an issue of the medical system.

Polypharmacy is associated with a multitude of adverse health outcomes. Conventional medicine recognizes these risks to include increased mortality, increased hospitalization rates, increased adverse drug reactions, and risk of fall (especially in the elderly). From an integrative perspective, the risks reach far wider and are not specific to age. They also only compound the growth of the chronic disease epidemic. I add nutrient deficiencies, microbiome changes, mitochondrial damage, cognitive deficits, and the blunting of innate healing capabilities to the list of polypharmcy consequences. Deprescribing should be an essential part of the practice of medicine, and one of responsibility for every prescriber; to prescribe a nonessential medication without a deprecribing plan does a disservice to all patients, setting individuals up for prolonged, and often unnecessary, dependence on them. The medical system needs to do better. 

To be clear, I am not opposed to medications. They are lifesaving, necessary, and helpful in many situations. I am opposed to irresponsible and unnecessary medication use, which is rampant in the current medical paradigm. Pharmaceuticals are the overarching treatment modality taught in conventional medical schools leading most primary physicians to act almost exclusively as medication managers. Medications are often presented as the only treatment available because doctors have not been taught otherwise. This is largely due to a medical system that has been entirely influenced by the insurance industry and bound by whatever insurance will cover, which is whatever will cost them the least and whatever has been backed by multimillion dollar (as in $20 million+) medical trials2. Only pharmaceutical companies can afford this, and this is what becomes “evidenced-based”. We have created an unfair playing field in which herbs, diet, lifestyle, or any medication alternative will never get the nod as potential first-line treatments, and thus pharmaceutical medications dominate.

But those of us that have been trained in alternatives to medications know they work and understand their utility. We can offer options to our patients often resulting in more sustainable and lasting health outcomes. This is what I love about my medical education and why people seek out naturopathic doctors. I can utilize both pharmaceuticals and alternatives, and know how to responsibly and effectively implement them. When I prescribe anything, be it medication or supplement, it is never indefinitely; I strive to always have a plan in place to describe those items as the ultimate testament to health, in my opinion, is when we rely on the fewest things outside of ourselves to maintain it.

Medications that I consider nonessential and eligible for discontinuation depend on your unique situation, but include some of the following:

  • birth control
  • heartburn medication
  • anti-anxiety medication
  • anti-depressant medication
  • stimulant medications
  • thyroid medication
  • cholesterol medication
  • blood sugar medication
  • sleep medication
  • steroids
  • blood pressure medications
  • NSAIDS
  • pain medications
  • OTC medications, and more, including supplements!

Plans to decrease or stop the medications above are designed with full body support to minimize withdrawal, rebound symptoms, or other side effects, and to guide the body into a state that can maintain its own health, as it was designed to do. That said, medications may be best for you and your individual goals, but for those that have a desire to decrease their use and are in the condition to do it, know there ARE alternatives.

Whether in-person from my Santa Monica office or virtually, I would love to work with you a deprescribing plan.

1.https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-022-03279-x

2. https://bmjopen.bmj.com/content/10/6/e038863.full#F1

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