They’re Not Taking Their Pills

Medication nonadherence is widely recognized as a common and costly problem. Approximately 30% to 50% of U.S. adults are not adherent to long-term medications leading to an estimated $100 billion in preventable costs annually. The barriers to medication adherence are similar to other complex health behaviors, such as weight loss, which have multiple contributing factors. (JAMA HT: Michael Ramlet)

Comments (16)

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  1. Richard says:

    Some if it’s an inability to follow a set schedule (taking the pill at the same time, each day, by setting an alarm).

    Some of it’s an unwillingness to endure the side effects when you don’t feel as bad (AIDS drug cycling, seizure medication and drowsiness).

    Some of it’s the feeling that, when you appear healthy, you no longer need the medication (bi-polar and schizophrenia medications).

    Some of it’s plain forgetfulness.

    And it’s all a problem.

    • Richard says:

      These are not an exhaustive list, either. As mentioned, it’s a multi-faceted problem.

    • Harley says:

      I’m curious if Jama’s insistence on phenotypes under medication take into account that medication in of itself rarely solves anything.

    • Jack says:

      It’s also possible that we weren’t meant to be medicated. Does that 100 billion include the costs to patients of maintaining medications?

  2. Dewaine says:

    Humans really are amazing. Whatever the individual reason for medication nonadherence, it seems like we would recognize that it isn’t worth the risk.

    • Tim says:

      True. Others are also realizing alternative medicines coming from more natural supplements while others just don’t even bother and rather live with whatever their condition is. In essence, we have become an overly-medicated society and that is also contributing to a wide array of addictions and deaths.

      • Dewaine says:

        I guess for some it is worth the risk, while others simply fail to properly assess it.

  3. Tim says:

    It all depends on what the condition is and how important the drug is. I think for chronic and very intense conditions, most people take the responsibility to adhere to their medications. Non-adherence most likely becomes a problem when we’re dealing with less pressing conditions where the cost of side effects outweighs the benefits of the drug.

    • Richard says:

      I’d argue that HIVis chronic and very intense.

      Yet study after study show cycling on and off the medications, based on white blood cell counts.

      Same with schizophrenia and bi-polar medications.

      Either masking the symptoms so that they aren’t visible when you decide to stop taking the medicine, or the side effects (which for HIV drugs can be pretty sizeable) all play a role.

      Not sure of the relative prevalencies of the two types, though.

  4. Buster says:

    Medication nonadherence is widely recognized as a common and costly problem.

    It would be interesting to conduct research on matched sets of nonadherent patients with those who took their medications for a variety of conditions and different drugs. Lifestyle would have to be taken into account. I suspect the results would be less than many people believe. It would be most interesting to see which drugs and which conditions provide the least benefit for the cost.

    • Dewaine says:

      You’re right. We have one side of story:

      “Approximately 30% to 50% of U.S. adults are not adherent to long-term medications leading to an estimated $100 billion in preventable costs annually”

      But how much does medication adherence when it isn’t necessary cost people? Good question.

  5. August says:

    It’s behind a paywall so I cant get at it, but this sounds interesting:

    “We propose that the first step is to view medication nonadherence as a diagnosable and treatable medical condition.”

    • Cabaret says:

      It looks like they identify 6 reasons why the medication is not being taken, and then propose screening mechanisms to identify patients with the “condition” and fix it.

  6. Ronnie says:

    Always need to take your medication!

  7. Linda Gorman says:

    Weight loss is a “complex health behavior?” Really?

  8. Erik says:

    After my Cancer treatment I was put on a couple maintenance drugs I will have to take forever. After the first year I experimented to see if I still needed them so I stopped taking them. After about a week I ended up in the hospital with chest pain I have never had before. It was like my whole system locked up. I will never do that again. I suspect other people do the same.