Problems with multiple medicines (part 2)
Listen to patients taking multiple medicines talk about where they’ve experienced undesirable outcomes from their medications, such as side effects & interactions, & how they have managed these problems
This talking point is a continuation of Problems with multiple medicines (part 1).
Accidents and making mistakes with medicines
Accidents and mistakes can happen with medicines that put people in danger. The people we spoke to experienced some of these when they started a new medicine that interacted with their current medicines or conditions, or when they made a mistake such as taking the wrong over-the-counter medicine or introducing a medicine incorrectly. Some medicines also need to be introduced gradually and problems happen if this is not understood.
Lyn did not know that the morphine patches she uses were making her sleep apnoea worse.
Glenn once took the wrong pain reliever by mistake and it interacted with one of the medicines he takes.
Fred became increasingly ill when two of his medicines interacted. This was not picked up until it was a medical emergency and his life was in danger.
Allergies and intolerances to medicines
A few people we spoke to have allergies to medicines or other issues that pose certain limits to the medicines they can take. Sometimes they are allergic to the active ingredient of the medicines. Others are allergic to, or suspected of being allergic to, the excipients or ‘inactive ingredients’ in medicines (such as those used in the fillers or coating of a tablet) and are unable to take certain medicine formulations.
Micaela has unpredictable allergic reactions to things like food because of the effects of the immunosuppressants she is taking for Crohn’s disease.
Suzanne cannot take slow-release or coated medicines because she has a stoma. She is careful to remind her doctors of this when they are prescribing a new medicine.
Limited access to doctors and pharmacies
A number of people have experienced limited access to pharmacies and specialists to prescribe their medicines. Some people have had to wait a long time to get an appointment with their regular GP, which is of great concern. Because of the complexity of their conditions and their medicines, everyone we spoke to wants to maintain a relationship with the one GP.
Access is a particular problem in rural areas, but not exclusively. Problems of access are evident in major cities and also occur when people move house and want to keep their usual doctor, when their doctor reduces his or her hours or when their doctor moves away.
Emma finds pharmacy opening hours are not always convenient, particularly with her limited mobility and full-time work hours, and they do not always have what she needs in stock.
Glenn lives in a rural area, which means he has to travel long distances to see his preferred psychiatrist.
When Dorothy moved into a retirement village, she found her usual pharmacist was too far away. She then discovered the village offered a pharmacy service, which was a big help.
‘Authority-required’ medicines
Some people are taking what are known as ‘authority-required’ medicines, which means that they require approval from Medicare or the Department of Veterans’ Affairs (DVA) before they can be prescribed on the Pharmaceutical Benefits Scheme (PBS). (These medicines can still be prescribed, but will not be subsidised on the PBS without authority approval.) Their doctor telephones Medicare or the DVA for an authority code before writing the prescription.
Sometimes a medicine has a standard code if the medicine is ‘streamlined’, which the doctor can write on the prescription without needing to make a call. Some of the people we spoke to had problems with these medicines if they could only be dispensed through a major hospital pharmacy or if their doctor made a mistake with the prescription.
Emma has to be especially organised with her medicine that requires authority, so that she does not run out.
Jane had a lot of problems when her doctor made a mistake with one of her prescriptions requiring authority. It was a frustrating process that took a great deal of her time and effort to have this corrected.
Addiction
Some people we spoke to reported becoming dependent on (or ‘addicted to’) a prescription medicine. This happened within a few days with some medicines. Some people did not realise this was the case until they experienced withdrawal symptoms when they tried to stop the medicine.
Mary became dependent on codeine. She realised that she could not continue taking codeine in hospital, so she stopped taking it and reduced her dependency on her own.
Peter S noticed he had a growing dependence on morphine. He now insists he does not receive morphine in hospital unless the circumstances are exceptional.
Glenn was prescribed pethidine for migraine before his conditions were correctly diagnosed. He felt more stable after taking pethidine, became dependent and ‘doctor shopped’ to find a willing prescriber.
Minor problems or no problems at all
Importantly, most of the people we spoke to have had either very minor or no problems at all, despite the many kinds of problems that can happen. A number of people had problems when they first started taking medicines, but they became accustomed to the medicines over time. Others had a problem with only one of their medicines.
Aside from occasionally forgetting to take his medicines, Don has no problems taking his medicines.
Judy feels well and finds her tablets easy to take. Any problems with her medicines have been minor and very easy to resolve.
Views of health professionals
The health professionals we spoke to also offered their views on some of the problems with medicines people can have.
Dr Elisabeth Wearne, GP, works in rural and remote areas. She describes some of the problems with accessing medicines in these areas and what the local pharmacies can do to help.
Dr Susan Connelly, geriatrician, describes some of the most common problems she sees in her older patients.
Associate Professor Sarah Hilmer, clinical pharmacologist and geriatrician, describes some of the problems with multiple medicines that can mean people have to go to hospital.
What people also talk about
The Living with multiple medicines project was developed in collaboration with
