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WTF Wednesday: Nursing homes are prescribing drugs and are fully aware they may kill residents

Kelsey Braithwaite

Many nursing homes’ workers are giving residents potentially lethal pharmaceuticals to help with dementia. These nurses and doctors are well aware the drugs may kill those suffering from the disease. But it’s still happening all across the province.

The Star recently conducted an investigation into the usage of these pharmaceuticals in Ontario nursing homes. It discovered that in over 40 homes across Ontario, nearly half of the inhabitants are given these anti-psychotics. In about 300 homes, more than a third are on the pills. One home uses them on about 75 percent of patients.

The pills include olanzapine, quetiapine, and about 10 others, but none of them are approved by Health Canada for use on people suffering with dementia. Some of these medications even have a “black-box” warning on the label—the strongest possible warning on a pharmaceutical. Commonly the label cautions that patients with dementia have a 60 percent increased risk of death after using the drug.

Then why are nursing homes offering these drugs to its residents?

Olanzapine and quetiapine were approved in 2004 and 2005 by the U.S. Food and Drug Administration (FDA) for use on people with schizophrenia, bipolar disorder, and episodes of mania.

Yet, doctors continue to prescribe these drugs off-label, even though the government was warned about overuse of this anti-psychotics in 2007 by the auditor general. Yesterday, Ontario Health Minister Deb Matthews told the Star, “Let’s remember, it’s the doctors who prescribe these drugs, not the government.”

This sounds suspiciously like the blame game. Doris Grinspun would agree. She’s head of the registered nurses association and told the Star she is “quite frankly, outraged at anyone, let alone the minister, who tries to divert responsibility. It’s all of our responsibility.”

But it is a doctor’s choice to medicate a patient without fully divulging potential danger to relatives.

One family explained to the Star their aunt, lovingly known as Aunt Gerry, died four months after Wellesley St. nursing home used olanzapine to “quiet her down”. Her husband had no idea what the drug would do and would not have consented to it if he had.

This isn’t the first time Canada has been in trouble for its misuse of anti-psychotics. Prisons use these methods as well. A large amount of female inmates are given quetiapine to help them sleep. Last year, CBC and the Canadian Press discovered that about 400 of the 600 prisoners in five different correctional institutions are given “psychotropic medication—drugs that impact mood and behaviour,” the Star reported.

Quetiapine’s side effects include: diabetes, hyperglycemia, high fever, intestinal obstruction, and rigid muscles, to name a few.

Clearly, prescribing off-label is a common issue.

Matthews acknowledges it is a serious issue but did not explain any specific, rectifying action the government is suggesting doctors take. She did mention “doctors cannot prescribe this kind of medication without the consent of the individual or their substitute decision maker.” Which doesn’t say enough.

Grinspun has some suggestions of her own. She believes the province should increase staff numbers and provide in-depth training focused on those with dementia. Some homes mention trying to get their prescription rate down by learning to recognize triggers for agitation in seniors.

Dr. Andrea Moser told the Star good work has been done to limit the use of these drugs in nursing homes. “We’re making progress. We still have a long way to go.”

A long way sounds ominous. Especially for current patients like Aunt Gerry. The government and doctors owe these families better work to ensure a long way does not translate into a long time.

 

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