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Harmful pattern of substance use — Clinical Guidelines

Overview

Harmful patterns of substance use refer to problematic consumption of substances (including medications) that lead to adverse health outcomes, increased morbidity, and potential mortality, particularly prevalent among older adults and those with limited life expectancy 3 4 7.

Diagnosis

Identification of excessive or inappropriate substance use through clinical assessment and patient history 3 13.

Assessment of polypharmacy and potentially inappropriate medication (PIM) use in elderly patients using tools like STOPP/START criteria 3 13.

Evaluation of adverse drug events and their impact on health outcomes 7.

Management

Deprescribing: Reducing unnecessary medications, especially in older adults with limited life expectancy, under careful patient and family consultation 4.

Medication Review: Regular reviews by pharmacists or multidisciplinary teams to identify and rectify inappropriate prescribing 3 13.

Patient Education: Enhancing patient understanding of their medication regimen and its necessity 8.

Special Populations

Elderly: Higher prevalence of polypharmacy and PIM use; focus on deprescribing and medication reconciliation 3 7 13.

Limited Life Expectancy: Tailored deprescribing approaches considering patient preferences and prognosis 4.

Key Recommendations

Implement regular medication reviews using validated tools like STOPP/START criteria to identify and address potentially inappropriate prescribing in hospitalized older adults (Evidence: Moderate 3).

Prioritize deprescribing efforts in elderly patients with limited life expectancy, involving patients and their families in decision-making processes (Evidence: Moderate 4).

Enhance patient education on medication use to improve adherence and reduce misuse (Evidence: Expert opinion 8).

References

1 Yazdani M, Suffridge CP, Liu F, Costello CM, Zhou Z, St John G et al.. Harmful algal bloom species . mBio 2025. link 2 Pace L, Howard M, Makar E, Lee J. The association of patient age, race, and demographic features on reported pain and sedation dosing during procedural abortion: A retrospective cohort study. Contraception 2023. link 3 Damoiseaux-Volman BA, Medlock S, Raven K, Sent D, Romijn JA, van der Velde N et al.. Potentially inappropriate prescribing in older hospitalized Dutch patients according to the STOPP/START criteria v2: a longitudinal study. European journal of clinical pharmacology 2021. link 4 Graabaek T, Lundby C, Ryg J, Søndergaard J, Pottegård A, Nielsen DS. "I simply don't know, because I don't know which drugs I get": Perspectives on deprescribing among older adults with limited life expectancy and their relatives. Basic & clinical pharmacology & toxicology 2021. link 5 Sarangi SC, Medhi B, Prakash A, Prakash J, Gupta YK. Questionnaire-based Pan-India survey for impact assessment of National Formulary of India. Indian journal of pharmacology 2021. link 6 Yan W, Chen Q, Zhang X, Elovainio M, Huang Y. The Chinese version of attitudes towards guidelines scale: validity and reliability assessment. BMC medical research methodology 2019. link 7 Paque K, Elseviers M, Vander Stichele R, Dilles T, Pardon K, Deliens L et al.. Associations of potentially inappropriate medication use with four year survival of an inception cohort of nursing home residents. Archives of gerontology and geriatrics 2019. link 8 Griffiths M. How can we reduce excessive prescribing?. Nursing standard (Royal College of Nursing (Great Britain) : 1987) 2017. link 9 Zhang F, Mamtani R, Scott FI, Goldberg DS, Haynes K, Lewis JD. Increasing use of prescription drugs in the United Kingdom. Pharmacoepidemiology and drug safety 2016. link 10 Uddin MJ, Groenwold RH, van Staa TP, de Boer A, Belitser SV, Hoes AW et al.. Performance of prior event rate ratio adjustment method in pharmacoepidemiology: a simulation study. Pharmacoepidemiology and drug safety 2015. link 11 Sethi N. The promotion of data sharing in pharmacoepidemiology. European journal of health law 2014. link 12 Pedersen CA, Schneider PJ, Scheckelhoff DJ. ASHP national survey of pharmacy practice in hospital settings: monitoring and patient education--2012. American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists 2013. link 13 Page RL, Linnebur SA, Bryant LL, Ruscin JM. Inappropriate prescribing in the hospitalized elderly patient: defining the problem, evaluation tools, and possible solutions. Clinical interventions in aging 2010. link 14 Junius-Walker U, Theile G, Hummers-Pradier E. Prevalence and predictors of polypharmacy among older primary care patients in Germany. Family practice 2007. link 15 Tobi H, Faber A, van den Berg PB, Drane JW, de Jong-van den Berg LT. Studying co-medication patterns: the impact of definitions. Pharmacoepidemiology and drug safety 2007. link 16 Goldblum OM. Electronic prescribing: criteria for evaluating handheld prescribing systems and an evaluation of a new, handheld, wireless wide area network (WWAN) prescribing system. Dermatology online journal 2001. link 17 . Statement of principles: the sale and use of data on individual physicians' prescribing. Canadian Medical Association. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne 1997. link 18 Gaist D, Sørensen HT, Hallas J. The Danish prescription registries. Danish medical bulletin 1997. link 19 Strom BL. Postmarketing surveillance and other epidemiologic uses of drug prescription data in the United States. Annali dell'Istituto superiore di sanita 1991. link 20 Mehta AC. The validation criteria for analytical methods used in pharmacy practice research. Journal of clinical pharmacy and therapeutics 1989. link

Harmful pattern of substance use