America’s Love Affair with the Car – and Medicines – Can Be Deadly  

First, some recent, eye-opening facts:

  • In the US there are over 276 million registered vehicles with 222 million drivers holding a valid license. Of this number, nearly 43 million are 65 or older. That’s roughly one in every five.
  • 40,100 people died in accidents involving motor vehicles in 2017 a 1 percent drop from the year before.
  • Almost a third of traffic fatalities involve drivers who were impaired by drugs or alcohol, according to data from the National Highway Traffic Safety Administration (NHTSA).
  • According to NHTSA there were 795 fatalities that were drowsy-driving-related in 2017.

 

Adding Medicines into the Mix

Often people use more than one medicine at a time. The combination of different medicines can cause problems for some people. This is especially true for older adults because they use more medicines than any other age group. Due to changes in the body as people age, older adults are more prone to medicine related problems. The more medicines you use, the greater your risk that your medicines will affect your ability to drive safely.

If someone has a couple of glasses of wine with dinner, he or she will probably feel impaired and know not to get behind the wheel. But many people could be unwittingly taking medications that may slow their coordination and responsiveness or increase fatigue—making it dangerous to drive. The following broad categories of medications can impair the ability to drive:

  • Anxiety and depression medications
  • Products containing codeine
  • Some cold remedies and allergy products, particularly those that help you sleep; decongestants and cough suppressants
  • Tranquilizers
  • Sleeping aids
  • Narcotic pain relievers
  • Diet aids
  • Stimulants

In particular, consumers need to be knowledgeable about the adverse effects of two frequently used medicines – sleeping aids and antihistamines.

It is well known that sleeping aids can cause problems when driving. Pharmacists recommend that patients using sleeping aids know to take most of these medications when they will be able to sleep for a full 7 to 8 hours. If it is a new prescription, it is recommended that it be taken on an evening when no driving is planned the next morning. FDA has even recommended that people don’t drive the day after taking sleep aids such as Ambien (zolpidem) and Lunesta (eszopiclone).

Consumers taking antihistamines should avoid using alcohol, sleeping aids, and tranquilizers if they plan to drive.

 

Tips about taking medications that may affect driving

Most people can drive safely if they are using medications. It depends on the effect those medicines – both prescription and over-the-counter – have on your driving. In some cases you may not be aware of the effects. But, in many instances, your doctor can help to minimize the negative impact of your medicines on your driving in several ways. Your doctor may be able to:

  • Adjust the dose;
  • Adjust the timing of doses or when you use the medicine;
  • Add an exercise or nutrition program to lessen the need for medicine; and
  • Change the medicine to one that causes less drowsiness.
  • Patients who have conditions such as high blood pressure, anxiety, Parkinson disease, or liver problems — particularly if taking more than one medication – should be aware of potential interactions that could inhibit their driving.
  • Take only the prescribed dosage of any medication that may cause drowsiness or impair driving. If the medication isn’t effective, check with the physician instead of adjusting it on their own.
  • Monitor reactions to new medications. Does it make you tired, affect your vision, or make you dizzy, faint, or inattentive? If so, how long does it take to “kick in”?
  • If a medication(s) are affecting you, talk to your physician, who can adjust the dosage, change the time when it is taken, or try another medication that doesn’t cause problematic symptoms.
  • Never combine medication, alcohol, and driving.

 

What You Can Do

To help avoid problems, it is important that at least once a year you talk to your doctor, nurse, or pharmacist about all the medicines – both prescription and over-the-counter – you are using. Also let your doctor know what herbal supplements, if any, you are using. Do this even if your medicines and supplements are not currently causing you a problem.

 

Check out how medications may affect safe driving

Eight out of ten older adult drivers age 65 and older take medications on a regular basis. And despite high prescription and over-the-counter medication use, almost half of older adult drivers using medications have never talked with their health care providers about how the drugs might affect their safe driving abilities. Roadwise Rx is a free online tool from the AAA designed to help drivers and their families understand common side effects of prescription drugs, over-the-counter medications and herbal supplements.  It also flags interactions between these medications that can impact safety behind the wheel. Print the free list and report, then discuss the confidential results with your doctor or pharmacist to learn how to mitigate possible crash risks.

 

(With permission from the American Pharmacists Association, this blog was adapted from Awake at the wheel: Certain scrips mean no trips, Pharmacy Today, July 1, 2014).

AIDS/HIV Awareness

World AIDS Day—which became the first ever global health day in 1988—recognized 30 years this past December 1st. Since HIV/AIDS became a public health concern in 1981, over 35 million people have died from AIDS-related complications worldwide. An estimated 940,000 people died from HIV-related causes in 2017 alone. At the beginning of 2018, approximately 36.9 million people were living with HIV, with 1.8 million newly diagnosed in the year prior. The World Health Organization (WHO) estimates that only 75% of people with HIV are aware of their status.

AIDS (Acquired Immune Deficiency Syndrome) is the advanced stage of HIV (Human Immunodeficiency Virus) which can be transmitted through the exchange of bodily fluids, most commonly through sexual contact or transfusing blood unsafely (i.e., intravenous drug use) with someone who is infected. A mother could also transmit the virus to their child during pregnancy, birth, or breastfeeding. The HIV infection attacks the immune system until an opportunistic infection such as certain kinds of pneumonia, toxoplasmosis, as well as rare cancers and brain illnesses are contracted, at which time the diagnosis has progressed to AIDS. There is no cure for HIV or AIDS, though there are life-extending treatments.

In the US, 1.1 million people were living with HIV in 2015 (the most recent year the information was available)—with over 15% of whom were unaware. In late 2017, President Trump fired the Presidential Advisory Council on HIV/AIDS (PACHA) which concerned advocates believe is part of an “effort to erase LGBTQ people.” The mass dismissal followed six members resigning the previous summer, citing the Trump administration’s apparent disinterest in helping the HIV/AIDS community. This year the Trump administration has proposed eliminating funding for AIDS Education and Training Centers (AETCs) and Special Projects of National Significance (SPNS), as well as cutting funds for the Housing Opportunities for Persons with AIDS (HOPWA) program, and domestic HIV/AIDS research and prevention efforts. AETCs and SPNS are essential for pioneering, evaluating, and implementing innovative HIV care models for vulnerable populations that are disproportionately affected by HIV including transgender women, gay men, and people of color; HOPWA gives grants to states, nonprofit organizations, and local communities to fund projects that help low-income people living with HIV find and maintain affordable housing.

World AIDS Day may be once a year, but you can still support people living with HIV all year. While others work towards an AIDS-free generation, NeedyMeds has information for those looking for help with a diagnosis. In a previous blog post we have outlined Ryan White HIV/AIDS Programs . The NeedyMeds website also has a Disease Information Page for HIV/AIDS with links to other resources . There we list the medications often prescribed, some of which offer drugs at low- or no cost through Prescription Assistance Programs. For those ineligible for a program’s unique guidelines, the NeedyMeds Drug Discount Card is available to help save patients money on their medication. We also link users to the Diagnosis-Based Assistance available for those in need and camps for those affected by the illness. For more help finding information, call our toll-free helpline at 1-800-503-6897 available Monday through Friday 9am to 5pm Eastern Time.

National Diabetes Awareness Month

November is National Diabetes Awareness Month. In the United States, more than 100 million people are living with diabetes or prediabetes; that’s nearly 1 out of every 11 people with diabetes, with 1 out of 4 unaware they have the condition. Awareness of the disease cannot only prevent future cases for those at risk, but also help raise funds to develop new treatments for those living with diabetes.

There are different types of diabetes. Type 1 diabetes presents with the body not making insulin, and those diagnosed must take insulin injections every day. Only 5% of those diagnosed with diabetes have type 1, and there is no known method to cure or prevent type 1 diabetes. With type 2 diabetes, one’s body doesn’t use insulin well and is unable to keep blood sugar at normal levels. Type 2 diabetes has a number of risk factors:

 

  • Being overweight;
  • Being 45 years or older;
  • Having parents or a sibling diagnosed with type 2 diabetes,
  • Being physically active less than three times per week.

Race and ethnicity also can affect one’s risk. African Americans, Hispanic/Latino Americans, American Indians, Pacific Islanders, and some Asian Americans are at particularly high risk for type 2 diabetes. Preventing type 2 diabetes can be as easy as eating healthy food such as fruits, vegetables, and whole grains; staying physically active; and stop (or don’t start) smoking.  These methods are also used to manage diabetes once diagnosed, along with testing your blood sugar and taking medicine/insulin as prescribed.

Insulin therapy was developed and patented in 1923. The team of Canadian researchers intentionally set the price of the patent at only $3—$1 for each member of the team—to ensure that the life-saving treatment would be widely available and affordable for those who needed it. Despite the intentions of the developers, several pharmaceutical companies were indicted in an insulin price-fixing scheme in 1941. Insulin prices have steadily increased since synthetics were developed in the 1970s, leading to a billion-dollar industry.

 

The increasing costs of insulin can be fatal to those with diabetes. The price of insulin in the U.S. has more than doubled since 2012, costing upwards of $1300 a month without insurance. Twenty-five percent of diabetes patients admit to rationing insulin—using less than necessary to make it last longer. Rationing insulin can lead to lethal diabetic ketoacidosis—when your blood sugar becomes so high that your blood becomes acidic, your cells dehydrate, and your body stops functioning.

 

The NeedyMeds’ Patient Assistance Programs (PAPs) database has programs offered by pharmaceutical companies that provide medication at low- or no cost for those who qualify. There are also coupons and our Drug Discount Card for those unable to use or find a PAP. The card can also be used for purchasing diabetes supplies, such as glucose meters, strips and lancets, as long as they are written like a prescription. There are also many national and local resources for those with diabetes in our Diagnosis-Based Assistance area of our site. All of our information is available for free on our website or through our toll-free helpline at 1-800-503-6897.

Transgender Awareness Week

Transgender Awareness Week falls between November 12-19 every year and is meant to help raise visibility of a vulnerable and underserved community.  ‘Transgender’ is an umbrella term for people whose gender identity is different from the sex assigned at birth; ‘gender identity’ is one’s innermost concept of self as male, female, a blend of both, or neither.

Transgender Pride Flag

Transgender Pride Flag

Transgender and gender-nonconforming people can face significant problems with accessing health care. Finding a healthcare provider who is knowledgeable of transgender health issues can be a hurdle itself; some healthcare professionals may believe that there is something wrong with someone because they are transgender—they are wrong. Even after finding a knowledgeable and sympathetic doctor, insurance may not cover the cost of treatment. Many transgender people are on a dosage of hormones which can affect one’s blood pressure, blood sugar, or in rare cases contribute to cancer. Some cancers found in transgender people can appear atypical—trans men are at risk for ovarian and cervical cancers, and trans women can be diagnosed with prostate cancer.

Transgender/gender non-conforming people experience gender dysphoria, a clinically significant distress recognized by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) caused by a person’s assigned birth gender differing from the one with which they identify. This leads to increased depression among the transgender community, which can be exacerbated by being rejected by family and friends, abuse/violence, or experiencing discrimination.

According to the U.S. Department of Health and Human Services, the Affordable Care Act (ACA) protects against discrimination based on gender identity. Despite these protections, over 27% of transgender/gender non-conforming people report having been denied healthcare. Even paperwork can be a barrier to access for transgender individuals as standard forms often only list “male” or “female.” Nearly 21% of transgender people in the US report being subjected to harsh or abusive language from a healthcare professional, and an almost equal amount say healthcare providers have blamed them for their own health conditions. Transgender people report the highest rates of discrimination and barriers to care among the LGBT community.

Transgender rights and protections have been scaled back by the Trump administration. The Department of Justice announced in October 2017 that civil rights laws do not protect transgender people in the workplace, reversing a guideline instituted by President Obama on Title VII of the Civil Rights Act. Earlier last year, the Department of Education rescinded Obama’s Title IX guidance for transgender/gender non-conforming people in schools. Critics of these changes to remove protections from an already vulnerable population call the new guidelines “license to discriminate” while supporters claim it is their “religious liberty” to deny services or access to individuals based on belief.

According to a drafted memo from the Department of Health and Human Resources from October 2018, there are plans to define a person’s gender as immutable from birth—invalidating the experience and gender transitions of transgender people while going against established biological understandings of gender, including intersex individuals (people born with any of variations in sex characteristics including chromosomes, gonads, sex hormones, or genitals that do not fit the typical definitions for male or female bodies). Critics decry these actions by the Trump administration as attempts to “erase” the transgender community for politically motivated purposes that could have a major effect on people’s health and lives.

Human Rights Campaign (HRC) has information on finding insurance for transgender-related healthcare. To further help those in need, NeedyMeds has a growing list of programs in our Diagnosis-Based Assistance database for transgender/gender non-conforming people that offer various forms of assistance such as financial aid or legal services. We also have listings for recreational camps/retreats and academic scholarships for LGBT youth and their families. NeedyMeds’ unique crowdfunding platform HEALfundr is also available for individuals trying to raise funds for their transition. If you know any programs assisting transgender/gender non-conforming people that we don’t have listed on our site, leave a comment and let us know about it.

Don’t Risk a Fall – Know Your Medicines

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It will come as no surprise to many that the 65+ year old crowd – aging baby boomers and older adults – are taking a lot of over-the counter (OTC) and prescription medicines, along with vitamins, dietary supplements and herbal remedies. As many as 55 million Americans will be older than age 65 by 2020.

With the population of older adults soaring in the coming years, the prevalence of patients with chronic disease – who often take numerous prescription medications daily – is likely to increase as well.  Add in those over 65 taking medicines for occasional or chronic pain — in sheer numbers, it’s pretty staggering, putting them at significantly higher risk for drug-drug and drug–alcohol interactions, adverse events, medication errors and falls.

One of the major risk factors for falls is medications and their adverse effects. According to CDC, falls are the number one cause of injury and deaths from injury among older Americans. One in four Americans aged 65+ falls each year. Every 11 seconds, an older adult is treated in the emergency room for a fall; every 19 minutes, an older adult dies from a fall. Falls are the leading cause of fatal injury and the most common cause of nonfatal trauma-related hospital admissions among older adults.

Consider:

  • Older adults use more medications, including prescription, OTC, and supplements, than any other age group in the United States.
  • Older adults often use multiple medications, increasing the risk of drug–drug interactions, mix-ups, and the potential for harmful adverse effects.
  • Older adults tend to receive prescriptions from different health care providers. This can make it more difficult to track medications and identify drug–drug interactions, harmful doses, and unnecessary or ineffective medications.
  • Chronic conditions such as diabetes, high blood pressure, arthritis, and cancer are more common in older adults and often require a more complex medication management regimen.
  • Age-related changes, such as weight loss, decreased body fluid, and increased fatty tissue, can alter the way drugs are distributed and concentrated in the body.

Falls are Common & Costly

Falls threaten older adults’ safety, quality of life and independence, while generating enormous economic and personal costs. According to the National Council on Aging (NCOA), 1 in 4 Americans aged 65+ falls every year, making falls the leading cause of fatal and non-fatal injuries for older Americans:

  • Every 11 seconds, an older adult is treated in the emergency room for a fall.
  • Every 19 minutes, an older adult dies from a fall.
  • In 2015, the total cost of fall injuries was $50 billion (75% paid by Medicare and Medicaid).
  • This total cost may reach $67.7 billion by 2020.
  • Even falls without injury can cause fear of falling, leading to physical decline, depression, and social isolation.

Think Before You Drink: Medications, and Alcohol Use

Drinking alcohol when you are taking some prescription medications is a health risk for many baby boomers (ages 51-69) and older adults. This practice can have far-reaching health effects.

Aging bodies don’t work well when some medications and alcohol are mixed — Even if you still feel at the top of your game, health-wise, aging can work against your health. The most obvious sign: Your body likely just doesn’t feel like it used to feel.  Older bodies work more slowly to clear medications and alcohol, which can make older adults more sensitive to their effects. There is also less tolerance to alcohol than do younger adults.  Memory problems, mood disorders, poor balance and coordination, and weakness are other age-related health challenges. Prescription medications can make these health issues worse, if the medications are misused, abused, and/or combined with alcohol.

These common prescription medications may display a label warning not to consume alcohol while taking them. Is your medication on this list?

  • Antibiotics
  • Anxiety or depression medication
  • Arthritis medication
  • Blood thinners
  • Cold and allergy medication
  • Diabetes medication
  • Epilepsy/seizure medication
  • Heart burn medication
  • Heart medication
  • High blood pressure medication
  • High cholesterol medication
  • Medication for enlarged prostate
  • Pain relievers
  • Sedatives or sleep aids

 

Communication is the Key: Avoiding Medication-Related Falls

Effective communication is a two-way street – messages sent which are clearly understood and actionable. If only it were that simple. Yet, there are some important questions consumers should ask their doctor and pharmacist  whenever prescription medicines are being considered as a part of treatment regimen. Additionally, it is important for healthcare professionals to initiate a dialogue with older patients at risk for falls. The following tips and questions for older adults, caregivers and healthcare professionals can help trigger this important conversation.

Older Adults and Caregivers

When you have questions about your medications and alcohol use, consider your local pharmacist and your physician or other prescriber your “go-to” sources of information [http://bemedwise.org/medication-safety/elderly-care]. Remember these 5 tips to help your health care professional help you safely manage your prescription medications:

  1. Tell your health care professional about all the medications you take—prescription, over-the-counter, vitamins, and herbal supplements.
  2. Read and follow all instructions on your medication’s label.
  3. Follow instructions provided by your health care professional about your medication.
  4. Report any side effects from your medication to your health care professional.
  5. Don’t stop taking your medication unless your health care professional says to stop.

Pharmacists, Physicians and other Prescribers

Effective communication is a two-way dialogue. If you are a health care professional looking to help raise your patient’s awareness about the potential for harmful interactions between prescription medication and alcohol use, start with a discussion. Use these tips:

  • Review the NIAAA recommended drinking guidelines with your patients.
  • Remind your older adult patients about the potential for increased sensitivity to medication and decreased tolerance for alcohol.
  • Explain that medication can linger in the body for hours and that alcohol can still interact with prescriptions long after taking them.
  • Discuss the importance of reading and understanding medication label instructions and warnings.

 

Here are suggested questions to get a conversation started with your older patients:

 

  1. Do you know how to read the labels on your prescription medications?
  2. Do you have questions about how to take your prescription medications?
  3. Do you drink alcohol? How much? How often?
  4. Can you stop drinking alcohol when you use this prescription medication?
  5. Do you understand the potential risks of drinking alcohol when you take your prescription medication?

 

(With permission from the American Pharmacists Association, this blog was adapted from Help older adults manage their meds with these resources and tips, Pharmacy Today, October 2017, and A time to focus on falls prevention,Pharmacy Today, February 2017.)