Another drug crisis might be brewing

With many communities still struggling to manage the opioid epidemic, the last thing the nation needs is a new drug-related problem — the overprescribing of psychiatric and other medications to senior citizens. A new report in the journal JAMA Internal Medicine raises a red flag about the trend, saying it appears to be particularly common in rural areas where patients with symptoms of mental illnesses may have less access to talk therapy and other nondrug treatments. But even in these communities, there are alternatives to medications that can and should be explored.

Between 2004 and 2013, the study found, the number of seniors taking at least three psychiatric, sleep or pain medications more than doubled. In some cases, patients received the medications even though the prescriptions were not tied to particular diagnoses and even though side effects on seniors can be particularly harsh. The study focused on medications prescribed in the offices of primary-care physicians, who are the gatekeepers to the health-care system, particularly in rural areas.

The findings are disconcerting because the opioid crisis was caused partly by the overprescribing of painkillers. While the study reported in JAMA Internal Medicine covered a period before the crisis broke, it underscores the need for the medical profession and health authorities to monitor prescribing practices closely.

Senior citizens are vulnerable to depression and related illnesses, partly because they are associated with physical maladies, such as heart failure and diabetes, afflicting their demographic. They should be encouraged to discuss mental-health concerns with their doctors, and primary-care physicians routinely should screen patients for depression and prescribe medications when warranted. However, there is no reason for the prescribing to get out of hand, even in rural areas with a shortage of psychiatrists, psychologists or therapists of other kinds.

The study’s findings were no surprise to J. Todd Wahrenberger, medical director and a family medicine physician at Pittsburgh Mercy Family Health Center, who noted that many patients spend 17 minutes or less with their doctors per visit.

“Finding the time to screen for mental illness, assess the multiple dimensions of chronic pain and discuss a treatment that is not simply a pill are challenging,” he said in an email, adding that “a quick prescription becomes the solution for complex problems that require much more.”

If they cannot find psychiatrists or psychologists, rural practices have other options, such as hiring psychiatric nurse practitioners. Telemedicine — in which doctors communicate with other doctors or patients through the internet — is another backstop. If a primary-care physician is unsure about the proper care of a person exhibiting symptoms of mental illness, he or she should consult with a psychiatrist remotely.

Technology might help in other ways, too. While patients struggling with anxiety might not have access to exercise or relaxation classes in rural areas, a virtually endless supply of such programs is available on DVDs and through the internet.

Medications are the best course of treatment for some patients, but not for all. There are other options out there. If the new study is any indication, doctors and patients have to get better at pursuing them.