A Crushing Epidemic: Unintentional Misuse of Prescription Drugs in the US

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Brought to you by Collegium Pharmaceutical: Patients with swallowing difficulties unintentionally misuse medication by crushing and/or chewing their pills and unknowingly put themselves at risk.

Brought to you by Collegium Pharmaceutical, Inc.

18 million adults in the United States are estimated to suffer from dysphagia (physiological difficulty swallowing or the inability to swallow), including 16.5 million elderly patients.¹

In addition, a significant number of patients without clinically recognized dysphagia nevertheless have difficulty swallowing tablets and capsules.²

Up to 40% of American adults may have difficulty swallowing pills, according to the FDA²

As patients age, changes in the swallowing process, or presbyphagia, may contribute to increased difficulty swallowing tablets and capsules. Presbyphagia occurs regardless of the neurological, musculoskeletal, and oncological diseases typically associated with dysphagia.^3,4

The hidden risks of unintentional misuse

Studies have shown that patients with swallowing difficulties may self-manage their oral medication by discontinuing treatment or by crushing, grinding, and/or chewing their pills—and unknowingly put themselves at risk.^1,3,5 It is well established that pill manipulation may lead to under- or overdosing, change the release profile from extended to immediate, alter efficacy, and increase the potential for adverse events, including overdose and death.^1,5

What your patients aren’t telling you could hurt them

Patients may be embarrassed, not think to discuss their swallowing difficulties with their healthcare providers (HCPs), or may not realize the importance of the issue.^1,5

A survey of 1051 general practice adult patients showed that⁶: 86% of 393 patients with swallowing difficulties had not informed their doctors about the issue due to shame and the perception that their HCP would not be able to help

Have you spoken with your patients about swallowing difficulties?

Start the conversation by asking:

Do you have trouble or dislike swallowing pills?
Have you ever altered your medication to make it easier to swallow?
How do you prefer to take medication?

References: 1. Argoff CE, Kopecky EA. Patients with chronic pain and dysphagia (CPD): unmet medical needs and pharmacologic treatment options. Curr Med Res Opin. 2014;30(12):2543-2559. 2. US Food and Drug Administration, Center for Drug Evaluation and Research (CDER). Guidance for Industry: Size, Shape, and Other Physical Attributes of Generic Tablets and Capsules. www.fda.gov/downloads/Drugs/Guidance-ComplianceRegulatoryInformation/Guidances/UCM377938.pdf. Accessed July 28, 2015.

3. Stegemann S, Gosch M, Breitkreutz J. Swallowing dysfunction and dysphagia is an unrecognized challenge for oral drug therapy. Int J Pharm. 2012;430(1-2):197-206.

4. Puisieux F, D'Andrea C, Baconnier P, et al. Swallowing disorders, pneumonia and respiratory tract infectious disease in the elderly. Rev Mal Respir. 2011;28(8):e76-e93.

5. Pergolizzi JV, Taylor R, Nalamachu S, et al. Challenges of treating patients with chronic pain with dysphagia (CPD): physician and patient perspectives. Curr Med Res Opin. 2014;30(2):191-202. 6. Schiele JT, Quinzler R, Klimm HD, Pruszydlo MG, Haefeli WE. Difficulties swallowing solid oral dosage forms in a general practice population: prevalence, causes, and relationship to dosage forms. Eur J Clin Pharmacol. 2013;69(4):937-948.

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