When you&rsquo;ve been diagnosed with a long-term or chronic condition, you&rsquo;ll often have to take medications long term. But keeping up with your medication schedules can be a struggle.

In fact&mdash;whether because of motivation, costs, lack of understanding about conditions, overly complex prescribing information, honest mistakes like <a href="https://www.sharecare.com/health/healthy-habits/article/easy-ways-remember-take-meds">forgetting to take them</a> or a host of other reasons&mdash;about one out of every two people does not take a prescribed medication according to directions.

But in order to get the maximum benefit from your treatment plan, it&rsquo;s important to follow your prescription as closely as possible.

What is medication adherence? 
<a href="https://www.sharecare.com/health/prescription-drug-medication-adherence/medication-adherence">Adherence</a> is the act of taking a medication as it&rsquo;s prescribed for as long as it&rsquo;s been prescribed. Clinicians used to call this &ldquo;compliance.&rdquo; But with a shift to an understanding that patients are partners in their own care, the term changed. Now, instead of complying with&mdash;or, simply obeying&mdash;what their clinician says to do, patients instead &ldquo;adhere&rdquo; to the plan they&rsquo;ve made with their clinician to ensure their best health.

For some people, adherence simply means that they complete their course of antibiotics as their doctor has recommended. Doing so helps ensure that they get well and stay well after a short-term infection, and using antibiotics as directed can also help tamp down the broader problem of <a href="https://www.sharecare.com/health/patient-drug-education/what-is-antibiotic-resistance">antibiotic resistance</a>.

But for people who have long-term or chronic conditions, adherence is more than a week-long commitment. For many patients, it&rsquo;s a commitment for life.

If you have a chronic condition that requires you to take medication over the long term, knowing the obstacles that can undermine your adherence can help you avoid them&mdash;and understanding the downsides of non-adherence can <a href="https://www.sharecare.com/health/prescription-drug-medication-adherence/article/track-meds-save-money-sharecare">remind you to stay on track</a>.

Understand your condition 
People who struggle with adherence do so for different reasons, some of them specific to the medication or to the condition that they have. But generally, there are some common factors that you can foresee and possibly control.

One main reason people stop taking medications prematurely or take them incorrectly is because they don&rsquo;t understand why they&rsquo;re taking them in the first place. They may not fully grasp the dimensions of their condition and how it can be treated with medication. In the case of conditions that have no symptoms&mdash;such as high cholesterol or high blood pressure&mdash;they may not realize that taking medication can improve a condition even if they don&rsquo;t &ldquo;feel&rdquo; better outwardly.

In many healthcare situations, patients often feel as if the burden is on them to seek the information. But improving understanding of the need for a prescription is a two-way street. Doctors can work on explaining things to patients so that they understand the importance of taking their medications correctly, and patients should seek information from their doctors until they do understand.

Ask the right questions about your prescription 
When it&rsquo;s time for your appointment or when you&rsquo;re picking up a prescription from your pharmacist, make sure you have your questions ready. You might want to ask any or all of the following:

<ul>
	<li>What condition do I have that requires this medication?</li>
	<li>What will the medication do for my condition?</li>
	<li>What is the name of the active ingredient in my drug, in addition to the brand name?</li>
	<li>What are the best timing and conditions for taking it (Mornings? With food?)</li>
	<li>Will the drug begin working immediately or take longer?</li>
	<li>Are there special storage requirements?</li>
	<li>Are there drug interactions with other medications or supplements I already take?</li>
	<li>Should I avoid any specific food, alcohol or activities when taking this drug?</li>
	<li>If I want to stop the medication, what should I do?</li>
</ul>

Getting answers you need goes a long way toward resolving many of the obstacles in the way of achieving your adherence goals.

Stick with your prescription when your condition improves 
Sometimes, when a medication produces improvement, you might be inclined to stop taking it because you feel better or you begin to see progress toward improving your condition. The problem with that, especially with chronic conditions, is that stopping the medication can reverse progress.

Take statins, for example. Statins are drugs that help reduce levels of &ldquo;bad&rdquo; cholesterol (called low-density lipoprotein, or LDL) and other fats in the blood. These drugs can reduce the risk for stroke, heart attacks and death among people who have hardening of the arteries or increased risk for heart disease.

The hitch is that statins will work only if you take them as prescribed&mdash;if you &ldquo;adhere&rdquo; to your treatment plan. You might start a prescription for a statin and learn at a doctor&rsquo;s visit that your cholesterol values have temporarily moved into a healthy range. But if you stop taking the drug, your values will likely climb again, setting you back on the path toward more serious heart disease.

In fact, people with heart risk factors who quit taking their statins may see an increased risk for mortality. Yet according to some research, half or fewer of patients who take these drugs don&rsquo;t take them as prescribed or even quit them altogether. What&rsquo;s more, as many as four out of five don&rsquo;t end up hitting their target cholesterol levels, in part because these highly effective drugs go underused. The patterns are similar for people who take medications for high blood pressure.

It&rsquo;s crucial to continue to stick with your medication as prescribed, even if your symptoms or numbers improve.

Stay the course when you feel worse 
The other side of the coin is when your medication makes you feel bad, or you&rsquo;ve taken a medication like it that previously produced bad side effects. The reality is that many drugs involve side effects, some worse or more significant than others.

When you start taking your medication, you should have a discussion with your healthcare provider about side effects. In particular, find out which ones are most common, which ones usually go away with time and which ones warrant a call to the doctor.

If you feel that the side effects simply outweigh the benefits the drug is supposed to offer, don&rsquo;t stop taking it without first talking with your doctor. With some medications&mdash;such as corticosteroids, antidepressants and beta-blockers&mdash;stopping cold turkey can be dangerous.

Lower drug costs when you can 
Drugs can be costly. If you find that you are becoming nonadherent because of drug costs, don&rsquo;t give up. You have some options.

Your first step should be to ask your doctor whether your prescribed drug is in your insurance plan&rsquo;s formulary, its list of covered drugs. If it&rsquo;s not, switching to an appropriate drug that&rsquo;s covered by insurance can help you save money.

You can also ask about potentially less-expensive alternatives, including generics. <a href="https://www.sharecare.com/health/pharmaceuticals/article/essential-facts-generic-drugs">Generic drugs</a> are regulated and established as direct substitutes for brand-name drugs. Check with your insurance company to see if you get more coverage for specific generics.

The companies that manufacture these drugs sometimes offer patient-assistance programs. These programs subsidize drug costs for patients who qualify based on income and other factors. You can also look into cheaper options for obtaining prescriptions: Some mail-based pharmacies offer a price break and ship a 90-day supply of some drugs for less per unit.

Automate your prescription to save time 
Getting your prescriptions delivered by mail in 90-day supplies helps solve another issue with adherence: time.

It takes time to refill and pick up medications at the pharmacy. And you have to remember your refill and make sure you have refills available or you&rsquo;ll risk missing doses while you wait for your doctor&rsquo;s approval. Many major pharmacies offer auto-reminders for refills, by text, phone or email and will contact your doctor&rsquo;s office for you to handle refill requests.

Living with&mdash;and treating&mdash;a chronic condition presents a host of challenges. If you encounter any of these stumbling blocks, don&rsquo;t hesitate to reach out to your healthcare provider. Your doctor can answer any questions you have about your condition&mdash;and remind you of the myriad of benefits that come from following your treatment plan.

6 Prescription Drug Challenges—And How to Overcome Them

Metformin, a common prescription drug that&rsquo;s used to <a href="https://www.sharecare.com/health/diabetes/article/how-develop-diabetes-action-plan">treat type 2 diabetes</a>, is making headlines worldwide&mdash;but the big news has nothing to do with diabetes. Some experts believe that metformin may be the key to a longer life, boosting potential life span up to an incredible 120 years.

While that sounds too good to be true, the drug caught the attention of the Food and Drug Administration (FDA), which approved the first human clinical trials&mdash;called Targeting Aging with Metformin, or TAME&mdash;to test the use of metformin in people who already have or who are at risk for cancer, heart disease or cognitive impairment. The goal: to see if the drug can actually help delay the onset of such illnesses and increase longevity.

Have scientists really stumbled upon the Fountain of Youth? We talked to Keith Roach, MD, Associate Professor in Clinical Medicine in the division of general medicine at Weill Cornell Medical College and New York Presbyterian Hospital to separate fact from fiction.

Sharecare: What&rsquo;s the background on metformin? 
Dr. Roach: Metformin&rsquo;s been around for decades and is one of the most widely used drugs for diabetes. And while it&rsquo;s very effective for diabetes, for the past 40 or so years, some have also thought that medications in the class of metformin&mdash;called <a href="https://www.sharecare.com/health/diabetes/article/medications-for-diabetes">biguanides</a>&mdash;might have anti-aging properties.

Sharecare: What&#39;s behind the anti-aging claim? 
Dr. Roach: Metformin inhibits a protein called IGF1. This protein is associated with a lot of bad things that happen in the body. And there&rsquo;s a fairly large amount of evidence that giving animals&mdash;from worms to mice&mdash;metformin and drugs like it, tends to decrease some of the changes in the cell that we associate with aging. This in turn may lead to a greater degree of longevity.

Sharecare: Metformin working for mice and worms is one thing, but does it have the same effect on humans? 
Dr. Roach: It&rsquo;s unclear. So far, the only thing that&rsquo;s been proven in humans to reliably decrease disease and slow aging is extreme calorie restriction. One of the things you see in extreme calorie restriction is a decrease in IGF1. So, the idea is that maybe we can give this drug, which does the same thing, and get the benefit that&rsquo;s associated with extreme calorie restriction without the health risks.

Sharecare: But what about people with diabetes who seem to be living longer on metformin? Can you explain that? 
Dr. Roach: In long-term studies that have been done in people with diabetes, it&rsquo;s pretty clear that metformin works better than insulin or other oral drugs. But people who take metformin for their diabetes don&rsquo;t just magically live forever&mdash;it&rsquo;s just that they may live longer than if they had been put on insulin or not been taking it all.

Sharecare: What&rsquo;s your take on metformin for longevity? 
Dr. Roach: I&rsquo;m really happy that we&rsquo;re doing this research, and I can&rsquo;t wait to see the results. I think this is brilliant. But I&rsquo;m skeptical. The clinical trial is trying to replicate the longevity benefits that are associated with extreme calorie restriction&mdash;but the data in humans that this type of calorie restriction leads to longer life just isn&rsquo;t there. Look at it this way: there have been people living in monasteries for thousands of years who practice extreme calorie restriction, and they don&rsquo;t live to 120 years. Plus, if you look at people who do make it to very old age, extreme calorie restriction isn&rsquo;t something that we universally see. Also, this isn&rsquo;t a benign drug&mdash;it&rsquo;s not without its side effects. For example, metformin can lead to serious 24/7 diarrhea symptoms and may even be fatal for those with kidney problems.

Sharecare: So, what do you think of all the hype?&nbsp; 
Dr. Roach: This should be an exciting time as a clinical trial, but it&rsquo;s not a license to beg physicians for a metformin prescription in order to live forever. Nobody should take metformin yet, just for the purpose of trying to live longer. And that&rsquo;s really my take-home point: If you want to <a href="https://www.sharecare.com/health/live-to-one-hundred/slideshow/things-you-need-know-aging">boost longevity</a> and reduce your risk of chronic disease, try these top three tips: get regular exercise, eat smart and manage stress.

Medically reviewed in August 2019.

Metformin: Could This Common Drug Prolong Your Life?

From lowering cancer risk to boosting your beauty regimen, aspirin&rsquo;s a versatile little pill&mdash;but it&#39;s important to know the potential side effects.

Surprising Reasons to Take Aspirin (And When to Skip It)

Taking medication is necessary for millions of people; it&#39;s estimated between 50 and 70 percent of US adults have a prescription at any given time. While adherence to those drugs&mdash;meaning, using them as prescribed by your physician&mdash;is critical for your health and overall wellbeing, many people skip them completely or take them incorrectly. In fact, the Centers for Disease Control and Prevention notes that about half of Americans don&#39;t take their meds as prescribed.

What&#39;s more, a December 2012 review in&nbsp;Annals of Internal Medicine&nbsp;estimated that lack of adherence to prescriptions causes 125,000 deaths and a minimum 10 percent of hospitalizations yearly, and costs our healthcare system up to $300 billion annually.

Reasons for medical non-adherence 
&ldquo;It happens all the time,&rdquo; says&nbsp;Jennifer Caudle, DO, a board-certified family medicine physician and Associate Professor in the department of Family Medicine at Rowan University School of Osteopathic Medicine. While reasons for not taking medication vary from person to person, the most common explanations from patients include:

<ul>
	<li>Forgetfulness</li>
	<li>Financial hardships</li>
	<li>Unpleasant side effects</li>
	<li>Concerns about possible side effects</li>
	<li>Confusion regarding how the medication works</li>
</ul>

&ldquo;Another reason is the fact that some patients are not entirely comfortable taking medications, period!&rdquo; states Dr. Caudle. &ldquo;This could be due to a whole set of in-depth reasons&mdash;perhaps they&rsquo;d prefer what they consider to be a natural or holistic solution&mdash;but there are people who feel they would rather do without, and that&rsquo;s a big issue.&rdquo;

Also, some adults are unaware of how medication works to improve or manage their health condition. &ldquo;I don&rsquo;t blame patients for this lack of knowledge, especially those who think, &lsquo;Now I feel better, I can stop,&rsquo;&rdquo; she continues. &ldquo;It could simply be a misunderstanding, and this is where physicians and patients need to do a better job of communicating.&rdquo; The flip side of this: patients may expect to feel differently when they&#39;re on medication, and if they don&#39;t, they may not believe it&#39;s working.

What happens when you don&#39;t take your meds 
Since medication is prescribed to cure a temporary medical issue (like the flu or an&nbsp;ear infection), manage a chronic condition (like diabetes) or prevent a recurrence of a significant health event (such as a heart attack or&nbsp;stroke), poor adherence could result in complications, disease progression and even death. For example, when it comes to cardiovascular disease&mdash;the leading cause of death among men and women of all ethnicities in the US&mdash;the American Heart Association states that patients who do not take heart meds as prescribed may be faced with &ldquo;serious consequences,&rdquo; including up to a 40 percent increased risk of a hospital stay, and a 50 to 80 percent increased risk of mortality.

&ldquo;The sheer act of stopping particular medications without soliciting the advice of your doctor&mdash;that in and of itself can cause harm,&rdquo; adds Caudle. The reason: it could result in other health complications (aside from not treating the chronic condition), as well as adverse side effects. &ldquo;There are certain blood pressure meds, for example, that if stopped abruptly could worsen blood pressure, among other things. We don&rsquo;t want to stop anti-depressants abruptly, either.&rdquo;

Again, Caudle stresses the importance of having an open dialogue with your doctor. &ldquo;I always tell my patients, &lsquo;It&rsquo;s okay that you want to stop a medication&mdash;but what I ask you to do is talk to me, let me know what you&rsquo;re thinking and what your concerns are, so we can come up with a plan that works for you,&rsquo;&rdquo; she says. &ldquo;Even if someone can&rsquo;t afford the medication, I want to know so I can try to help them navigate this problem.&rdquo;

Tips for taking your meds 
One of the most common reasons people&nbsp;take their meds incorrectly? According to a survey, they simply forget. That&#39;s why Caudle is &quot;a big fan&quot; of pill boxes. &ldquo;They&rsquo;re great for keeping meds organized and you can easily see if you&rsquo;ve taken your pills that day or not.&rdquo; She suggests keeping the meds in a place you visit at least once a day as part of your routine, like next to your toothbrush.

&ldquo;Then there&rsquo;s technology&mdash;a number of apps can remind us to take our meds each day and to refill the prescription before we&rsquo;re down to the last pill,&rdquo; concludes Caudle. &ldquo;After all, forgetting to call in time for a refill can result in days without meds, as well.&rdquo; Try Sharecare for&nbsp;<a href="https://itunes.apple.com/us/app/sharecare/id964313779?mt=8">iOS&nbsp;</a>or&nbsp;<a href="https://play.google.com/store/apps/details?id=com.sharecare.realgreen&amp;hl=en">Android</a>, which includes an easy-to-use medication tracker.

Remember, too, that communication with your doctor is key; they can share strategies to improve your medication adherence and work with you to make sure your needs are being addressed. In the end, your health is worth it.

Medically reviewed in July 2018.

Skipping Your Meds? Here's Why That's a Bad Idea

Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are some of the most commonly used medications, with more than 30 billion doses taken annually in the US alone. Unfortunately, NSAIDs aren&rsquo;t just widely used: they&rsquo;re also widely abused, with nearly one out of seven users going over the daily limit, according to a January 2018 study from the Boston University School of Medicine.

That may not seem like a big deal, but NSAIDs can have serious side effects&mdash;even when taken as prescribed, says <a href="https://www.sharecare.com/doctor/dr-charan-k-cheema">Charan K. Cheema, DO</a>, a family medicine physician with <a href="https://www.sharecare.com/group/saint-joseph-mercy-health-system">Saint Joseph Mercy Health System</a> in Saline, Michigan. And because side effects are dose-related, overdoing it makes them even more likely, leading to bigger problems than the aches, pain and fever you originally took the meds for.

Who overdoses and why 
The recommended daily limit of NSAIDs varies from drug to drug. For ibuprofen, the most popular NSAID, it&rsquo;s 1200 mg for over-the-counter (OTC) drugs and 3200 mg for prescription meds, divided into three or four doses over a 24-hour period. Study participants, who kept a daily diary of their NSAID use for one week, exceeded the limit in several ways:

<ul>
	<li>They took too much of a single NSAID at one time. This was more likely when people used meds calling for a one-pill dose versus the more common two-pill dose.</li>
	<li>They took two different NSAIDs at the same time.</li>
	<li>They failed to wait long enough before taking another dose.</li>
</ul>

Most participants in the study only took OTC meds. But those using prescription NSAIDs complied significantly better with the maximum dosage&mdash;only 2 percent exceeded the daily limit. This highlights the concern about the lack of medical oversight with OTC meds. &ldquo;People often think that these drugs are safe, even at higher doses, because they&rsquo;re available over the counter,&rdquo; says Cheema.

A poor understanding of dosing recommendations was common among study participants who took too much medicine, as were the attitudes that they could choose what dose to take and that it wasn&rsquo;t necessary to start with a low dose to see if it would do the trick. People who exceeded the limit also were more likely to have ongoing pain and poor physical function.

How too many NSAIDs can affect you 
NSAIDs can be hard on the stomach, causing minor troubles, such as indigestion and stomach ache, or more serious problems like irritation of the stomach lining, ulcers and bleeding in the stomach or bowel. Gastrointestinal (GI) issues are more likely if you&rsquo;re older because your stomach lining weakens with age, but even younger people who are predisposed to it can experience irritation with these types of medications, says Dr. Cheema.

Except for aspirin, which is a type of NSAID, these drugs are also linked to a greater risk for heart attacks and strokes. In fact, one 2017 systematic review and meta-analysis found that taking any dose of NSAIDs for one week, one month or more than a month was associated with a 20 to 50 percent increased risk of heart attack compared with not using these drugs&mdash;though the risk was greatest with higher doses and during the first month of use.

&ldquo;You really have to be careful when prescribing these types of medications to people who&rsquo;ve had a heart attack or are at increased risk of heart disease,&rdquo; Cheema cautions. In these cases, she says <a href="https://www.sharecare.com/health/acetaminophen/what-is-acetaminophen">acetaminophen</a>, which works differently than NSAIDs and doesn&rsquo;t increase the risk of heart attacks, may be a safer option.

<a href="https://www.sharecare.com/health/kidney-disease/article/high-blood-pressure-diabetes-watch-out">Kidneys</a> may be affected, as well. &ldquo;Over time, NSAIDs can reduce blood flow to the kidneys,&rdquo; says Cheema. For people with normal kidneys, taking too many NSAIDs for too long can result in chronic interstitial nephritis, a disease contributing to renal failure. Those with kidney function problems should use lower doses or shouldn&#39;t take NSAIDs at all.

Using NSAIDs safely 
To avoid side effects, take the lowest effective dose for the shortest amount of time. &ldquo;The longer you&rsquo;re on them, the higher the risks,&rdquo; says Cheema. While there&rsquo;s no dose that completely avoids all these risks, Cheema advises using NSAIDs no more than two to three times a week.

If you need to take these drugs for long periods, talk to your doctor for advice about how to reduce the risk of side effects. For instance, Cheema sometimes switches things up by having patients substitute a dose of acetaminophen instead of taking ibuprofen or naproxen (another NSAID) every time.

Another option: topical anti-inflammatories, which work well for localized pain near the surface of the skin, like joint pain from arthritis. Compared to pills, only a little of the drug from these creams, gels, liquids and patches makes it into your bloodstream; also, topicals don&#39;t cause GI stress, and may be a safer bet when it comes to heart health. In an October 2017 study published in the Journal of the American Heart Association, people who used topical NSAIDs&mdash;even those who already had heart disease&mdash;had fewer heart attacks and strokes than those who took oral NSAIDs.

Alternatives to NSAIDs 
When it comes to easing pain, medication isn&#39;t the only game in town.

<ul>
	<li>Heat, which relaxes muscles and boosts blood flow, and ice, which reduces swelling, can help. So can wearing a brace or elastic bandage to support the area that&rsquo;s hurting.</li>
	<li>Exercise and physical therapy may improve strength, function and range of motion to reduce pain, and boost energy and mood, as well.</li>
	<li>The <a href="https://www.sharecare.com/health/pain-management/slideshow/natural-ways-manage-pain">mindful breathing</a> done during meditation and yoga are also proven to help alleviate pain.</li>
</ul>

Other potentially effective non-drug therapies include <a href="https://www.sharecare.com/health/acupuncture/how-does-acupuncture-treat-pain">acupuncture</a> and <a href="https://www.sharecare.com/health/mind-body-therapies/how-biofeedback-therapy-works">biofeedback</a>; speak to your doctor if you&#39;re interested in these options for chronic pain.

Medically reviewed in March 2018.

How Much is Too Much Ibuprofen?

If you&rsquo;ve got a fever and you&rsquo;re coughing, congested or battling a sore throat, chances are you&rsquo;re also missing work, losing sleep&mdash;and running out of patience. It&rsquo;s natural to want to feel better as quickly as possible. Many people with flu-like symptoms think antibiotics are a quick-fix for their misery. But in most cases, antibiotics are not the answer.

Antibiotics are powerful drugs, but they aren&rsquo;t a cure-all. They specifically target bacteria, killing these microscopic organisms or preventing them from reproducing. But most chest colds and other illnesses are not caused by bacteria.

&ldquo;The vast majority of respiratory illnesses are viral,&rdquo; explains <a href="https://www.sharecare.com/doctor/dr-r-r-brown">Rush Brown, MD</a>, a primary care physician affiliated with <a href="https://www.sharecare.com/group/memorial-health">Memorial Health</a> in Savannah, Georgia. &ldquo;Antibiotics will not do anything to a virus. They will not help at all.&rdquo;

Bacteria vs. virus: What&rsquo;s the difference? 
Bacteria are ubiquitous. These one-celled microscopic organisms can be found just about everywhere in the environment&mdash;even in the human body. Different types of bacteria live on your skin, inside your mouth and along your digestive tract.

Many of these microbes actually help you stay healthy. Only certain species of bacteria, including some that are normally found on the body, have the potential to make people sick, including Streptococcus, Staphylococcus and E. coli. These and other types of bacteria are responsible for some common illnesses, like strep throat, bacterial pneumonia and urinary tract infections (UTIs). The immune system can usually fight harmful bacteria on its own. More serious infections, however, are treated with antibiotics.

Antibiotics often work quickly. Even though these drugs may need to be taken for a week or more, people usually start feeling better and are no longer considered to be contagious after about 24 hours. Although antibiotics are highly effective against bacteria, they are useless against viruses&mdash;the culprits responsible for the common cold, the flu and other viral illnesses that cause similar symptoms.

Unlike bacteria, viruses need a living host to replicate. These tiny germs consist of genetic material wrapped in protein. Antibiotics won&rsquo;t clear a viral infection, help you feel better or prevent you from spreading the illness to others.

In fact, there is no specific treatment for most viral illnesses. If taken right away, some anti-viral medications can reduce the severity and duration of the flu, according to Dr. Brown. But in most cases, people with a cold or other virus must rely on rest, fluids and other supportive care until they recover on their own in about one to two weeks.

&ldquo;The reality of the matter is we cannot make them well overnight,&rdquo; he says. &ldquo;It just takes time.&rdquo;

The risks of antibiotic misuse 
Since the symptoms of flu-like viruses are similar to the warning signs of a bacterial infection, it&rsquo;s often tough to tell the difference. Feeling uncertain or frustrated, some people urge their doctor to prescribe them an antibiotic without knowing whether or not they really need it.

&ldquo;For many years, unfortunately, my colleagues handed them out to make patients happier, maybe before we had as much data and before we were tracking these things as well as we do now,&rdquo; Brown says. &ldquo;We&#39;re certainly trying to reeducate everyone.&rdquo;

Every year in the United States, about 30 percent of antibiotics&mdash;some 47 million prescriptions&mdash;are still prescribed unnecessarily. This is not only unwarranted but also risky for two reasons:

1. The number of drug-resistant germs is increasing as the arsenal of effective antibiotics is dwindling. Before penicillin was discovered in 1928, people more often died of bacterial infections, such as pneumonia and tuberculosis, than from heart disease, cancer and other non-contagious diseases. In the following decades, as more life-saving antibiotics were developed, the average life expectancy of Americans jumped from about 50 years of age to nearly 80.

Every time antibiotics are used, however, bacteria have a chance to adapt and become resistant to them. Overusing or misusing antibiotics (not taking them as prescribed, skipping doses or not completing the entire course of treatment) allows more bacteria to develop resistance, making them stronger and more difficult to kill.

&ldquo;The more you use an antibiotic, the less effective it may become in the future,&rdquo; Brown explains. &ldquo;That certainly holds true for individuals, but also for the community.&rdquo;

With few new antibiotics under development, scientists are concerned that the rise of antibiotic-resistant bacteria will undo progress that has been made against bacterial infections over the past 70 years. Eventually, the increased risk for tough-to-treat infections may complicate common injuries and routine surgeries, like joint replacements.

Each year in the United States, some two million people develop infections that are caused by drug-resistant bacteria. These so-called superbugs claim at least 23,000 lives, the U.S. Centers for Disease Control and Prevention reports. That number is on track to reach 30,000 by 2050, according to a November 2018 report from the Organization for Economic Cooperation and Development (OECD). If left unchecked, it&rsquo;s also estimated that drug-resistant infections could drain $100 trillion from the world economy over the next 32 years.

2. Like all medications, antibiotics may cause allergic reactions or other unwanted side effects. Taking these drugs unnecessarily exposes you to these risks without offering a potential benefit. Side effects from antibiotics may include:

<ul>
	<li>Rash</li>
	<li>Dizziness</li>
	<li>Nausea</li>
	<li>Diarrhea</li>
	<li>Secondary yeast or bacterial infections</li>
	<li>Irregular heartbeat</li>
	<li>Tendonitis, or increased risk for tendon injuries</li>
</ul>

Things you can do 
If you&rsquo;re suffering from a range of symptoms, including a runny nose, cough, low-grade fever, sore throat and other flu-like symptoms, you may have a virus. If so, antibiotics won&rsquo;t help, but there are some things you can do to ease your discomfort, including:

<ul>
	<li>Rest</li>
	<li>Drink plenty of fluids</li>
	<li>Gargle with saltwater for temporary relief of a sore throat</li>
	<li>Ask your doctor about over-the-counter pain and fever reducers, such as acetaminophen or ibuprofen</li>
	<li>Use a cool mist vaporizer or humidifier to reduce congestion</li>
</ul>

You can also try over-the-counter cough remedies or saline nasal sprays to get temporary symptom relief. These should be taken only as directed. Some of these products contain more than one active ingredient. Read all labels to ensure you&rsquo;re not taking too much of any one medication.

Viruses usually clear up in a week or two. If your symptoms persist for more than 10 days without improvement, you could have a bacterial infection or another health issue that may need treatment and you should see your doctor.

Some other warning signs and symptoms that should be evaluated by a doctor:

<ul>
	<li>You have a persistent high fever and chills.</li>
	<li>Your fever or other symptoms gradually worsen over time, or improve initially but then get worse.</li>
	<li>You feel short of breath.</li>
	<li>Your sore throat develops very suddenly, and you have tiny red spots on the roof of your mouth.</li>
</ul>

Your doctor can perform a physical exam and tests to determine if you have a bacterial infection or another health issue that requires treatment. Sometimes a blood or urine test may also be needed to confirm or rule out a diagnosis.

&ldquo;I would say a temperature above 100.5 [Fahrenheit] for more than 48 hours that&rsquo;s just not getting better should certainly prompt somebody to get checked out,&rdquo; advises Brown. &ldquo;Let somebody look at you so that we can try and figure out if there&#39;s something else going on or something we need to treat.&rdquo;

Seek immediate medical attention if you&rsquo;re having trouble breathing, are in severe pain or if you&rsquo;re confused or disoriented. These may be symptoms of a life-threatening infection or other medical emergency.

Do I Need an Antibiotic?

The U.S. Food and Drug Administration (FDA) is now requiring stronger warnings on the labels and medication guides for a class of commonly prescribed antibiotics called fluoroquinolones, including Cipro (ciprofloxacin) and Levaquin (levofloxacin).

They&rsquo;ve concluded that for patients with sinusitis, bronchitis or less severe urinary tract infections (UTIs), the risk of serious side effects associated with these drugs generally outweighs their benefits&mdash;especially if other treatments are available.

Why the new warnings? 
After conducting a safety review, the FDA found that this class of antibiotics could cause disabling and potentially permanent side effects involving the tendons, muscles, joints and nervous system.

And it&rsquo;s not the first time questions have been raised about fluoroquinolones&rsquo; safety.

Back in 2008, the FDA linked these antibiotics to tendon rupture and tendinitis in some patients. And in 2013, the FDA issued a follow-up, warning against the drugs&rsquo; potential to cause permanent nerve damage, or <a href="https://www.sharecare.com/health/pain-conditions/what-is-peripheral-neuropathy" style="line-height: 1.6em;">peripheral neuropathy</a>.&nbsp;

Studies have also linked fluoroquinolones to potentially fatal aortic tears and <a href="https://www.sharecare.com/health/aneurysms/is-an-aortic-aneurysm-how-soon-do-i-need-surgery" style="line-height: 1.6em;">aortic aneurysm</a>.

Doctors prescribe these antibiotics to over 26 million Americans each year.

What if I&rsquo;m currently taking these drugs? 
&ldquo;It&#39;s important for patients to be aware of side effects and symptoms, and report any to their doctors,&rdquo; says <a href="https://www.sharecare.com/user/dr-darria-longgillespie">Darria Long Gillespie, MD, MBA, FACEP</a>, emergency room physician and senior vice president of clinical strategy at Sharecare. &ldquo;But I also don&rsquo;t want people to stop taking these medications without telling anyone.&rdquo;

That&rsquo;s because while there are serious side effects associated with these antibiotics, taking an incomplete course of any antibiotic &ldquo;is the perfect set-up for an antibiotic-resistant infection,&rdquo; she says.

Talking to your doctor 
If you are taking this type of antibiotic and begin to experience muscle, joint or nerve pain, confusion or cloudy thinking, hallucinations, tingling, prickling or a pins-and-needles feeling in your hands and feet, it&rsquo;s important to talk to your doctor right away, even if you&rsquo;ve stopped taking the medication.

If your doctor does prescribe a fluoroquinolone antibiotic for sinusitis, bronchitis or a UTI, ask about alternative treatment options, and be open about your concerns.

&ldquo;The main lesson here,&rdquo; says Dr. Long Gillespie, &ldquo;is that every medication has side effects, and that includes our most common antibiotics. Antibiotics are wonderful, life-saving medications, but they do not prevent infections and they don&rsquo;t treat viral infections. It&rsquo;s crucial that we only prescribe them when needed.&rdquo;

Medically reviewed in March 2018.

FDA Issues Stronger Warning for Common Antibiotics

When it comes to a lingering case of the sniffles, your first instinct may still be to run to the family doctor for an antibiotic to knock them out.

The truth is, though, antibiotics aren&rsquo;t a one-size-fits-all solution when you aren&rsquo;t feeling well. And when you take them for the wrong reason, they can actually do more harm than good.

What Happens When I Take an Antibiotic I Don&rsquo;t Need? 
A doctor prescribes an antibiotic when bacteria, rather than a virus, causes the illness in question. This means if you&rsquo;ve got a cold, the flu, or even something like mono, an antibiotic isn&rsquo;t going to make you feel better.

They could also bring on some not-so-pleasant side effects, like an allergic reaction or upset stomach. Overuse and misuse of antibiotics also contribute to <a href="https://www.sharecare.com/health/superbugs/article/have-antibiotics-reached-their-expiration-date" style="line-height: 1.6em;">antibiotic resistance</a>, which is what happens when the bacteria adapt and make the medication ineffective. This means longer, more severe infections.

When Are Antibiotics the Right Choice? 
There are times when an antibiotic is still the best bet for getting you back on your feet, though, and if you have symptoms of these six illnesses, it could be time to head to your doctor for a prescription.

Bacterial sinus infection - may set in after a cold, but also can be hard to distinguish from a cold

<ul>
	<li>Symptoms: Cloudy or discolored nasal drainage is the big clue, along with headaches, facial tenderness, congestion, bad breath, fever and fatigue. Symptoms that last more than 10 days, or get better then worse again, suggest a bacterial infection.</li>
</ul>

Whooping cough - a serious bacterial respiratory infection that mainly affects infants younger than six months old, kids who haven&rsquo;t been immunized and older children and adults whose immunity is wearing off&nbsp;

<ul>
	<li>Symptoms: Early symptoms include runny nose, mild cough, low-grade fever and sneezing. After one to two weeks, severe coughing fits often appear. They can last over a minute, followed by a &ldquo;whooping&rdquo; sound, vomiting and exhaustion.&nbsp;&nbsp;</li>
</ul>

Strep throat -&nbsp;a contagious sore throat infection caused by Streptococcus bacteria, more common in children than adults

<ul>
	<li>Symptoms: A severe sore throat may be accompanied by a fever of 101&deg;F or above, swollen tonsils (sometimes with white patches), red spots on the roof of the mouth, headache, nausea, vomiting, swollen lymph nodes and a rash.</li>
</ul>

Bacterial ear infection - occurs when germs cause fluid buildup in the middle ear; it can also cause the tubes in the ear to become blocked or swollen

<ul>
	<li>Symptoms: Most ear infections, viral and bacterial, share common symptoms such as fever, headaches, ear pain, pressure in the ear, drainage, reduced hearing and dizziness.&nbsp;</li>
</ul>

Urinary tract infection (UTI) - an infection of the urinary tract&mdash;including the urethra, bladder and kidneys&mdash;most commonly caused by bacteria; affects more women than men.

<ul>
	<li>Symptoms: Symptoms of a UTI vary by age, but most commonly include an intense need to use the restroom, burning or pain during urination and cloudy or dark urine. In older adults, symptoms can be vague and include weakness, fatigue, muscle aches and abdominal pain.&nbsp;</li>
</ul>

Bacterial pneumonia - A serious bacterial infection in the lungs; often a complication of the flu

<ul>
	<li>Symptoms: Bacterial pneumonia often causes very high fever, sweating, increased heart rate and rapid breathing, along with a cough, shortness of breath, sharp chest pain, headache, loss of appetite and, in older adults, confusion.</li>
</ul>

Medically reviewed in March 2018.

6 Ailments That Call for an Antibiotic

You know bisphenol A (BPA) is nasty stuff. Unfortunately, the bad news about this toxin just keeps on coming. A pair of just-released studies links BPA with heart disease, obesity, and diabetes risk.

BPA is an organic compound that&#39;s used in plastics, such as water bottles, the lining of canned goods, and thermal receipts. Problem is, BPA mimics estrogen in your body and is thought to disrupt hormone function. BPA is linked to a host of potential health problems, from fertility trouble to cancer to developmental delays in kids. <a href="https://www.sharecare.com/health/breast-cancer/how-toxins-contribute-breast-cancer" target="_blank">Learn more about the link between breast cancer, BPA, and other toxins</a>.

Reasons to seek BPA-free products 
A new study from Britain links high urinary concentrations of BPA in healthy men and women to a higher risk of heart disease 10 years later. In another new study, Chinese researchers linked high concentrations of BPA to obesity -- especially belly fat -- and insulin resistance (a forerunner of diabetes) in middle-aged and elderly people. American researchers have found a similar connection between BPA and type 2 diabetes. <a href="https://www.sharecare.com/health/diabetes-complications/prevent-diabetes-high-blood-pressure" target="_blank">Discover ways to help prevent diabetes</a>.

With that kind of news, you certainly don&#39;t want a side order of BPA every time you eat or drink. Simple changes can limit your exposure to BPA and possibly prevent diabetes, heart disease, obesity, and other health-related problems.

<ul>
	<li>Opt for fresh food. One study found that a diet of organic fresh food can reduce urinary levels of BPA and DEHP (a type of phthalate chemical that&#39;s also a hormone disruptor) by more than 50% in just 3 days.</li>
	<li>Look for BPA-free containers. When you do buy packaged foods, choose those in glass jars, aseptic packaging, and BPA-free cans.</li>
	<li>Store food in glass, ceramic, or stainless-steel containers. You can find plastic containers that are free of BPA, but some researchers have found traces of BPA in those, too.</li>
	<li>Shop for dry goods at the bulk bins. Pick up flour, rice, beans, dried fruit, cereal, and pasta at the bulk bins at health-food stores. Sure, you&#39;ll put bulk-bin finds into plastic bags, but you can transfer them to BPA-free containers as soon as you get home.</li>
	<li>Avoid microwaving food in plastic containers. The heat causes BPA and other chemicals to leach into food. Similarly, don&#39;t put plastic containers in the dishwasher.</li>
	<li>Don&#39;t handle thermal receipts. These are those carbonless receipts you collect everywhere you go, from the grocery store to the gas station to the ATM. Yep, they have BPA. Refuse receipts if you have the option. If you don&#39;t, wash your hands after handling them. BPA in thermal receipts can be absorbed through your skin, as well as ingested with food.</li>
</ul>

Medically reviewed in April 2018.

3 Reasons to Worry About Toxic BPA

Think of the name of an aspirin brand you know. If you thought &ldquo;Bayer,&rdquo; you&rsquo;re probably not alone. But what about the store-brand aspirin that often sits side-by-side with name-brand options on the drugstore shelf? You may be wondering if they&rsquo;re the same.

The short answer to that question is yes.

If a chemist analyzed pills from the two bottles, the results would match up. They&rsquo;d both contain acetylsalicylic acid&mdash;the active ingredient in aspirin&mdash;at the same dose. There might be some differences in inactive ingredients, but these wouldn&rsquo;t have any effect on how the medicine works.

The main difference is in the price: The generic or store-brand version will usually be much cheaper than the name brand.

One study published in 2016 in the Journal of Pharmaceutical Policy and Practice suggests that pharmacists see these options as directly interchangeable&mdash;so much so, in fact, that when it comes to over-the-counter medications, more than 90 percent of the time, they&rsquo;ll pick the generic over the brand for themselves.

Why are they cheaper? 
You may be wondering if &ldquo;cheaper&rdquo; means &ldquo;not as good.&rdquo; Here&rsquo;s why generics tend to be less expensive.

By the time a generic drug hits the pharmacy shelves, the brand version has been around for years. The company that gained approval for the brand-name drug put in years of costly research, testing it in increasingly strict clinical trials. This groundwork and the expense of seeking approval for a new drug increase the costs of brand-name drugs.

A generic doesn&rsquo;t have to go through this process of proving a drug&rsquo;s safety and effectiveness. The active ingredient and how it&rsquo;s formulated have already been tested and approved.

That doesn&rsquo;t mean that generics have no regulation, though. Their manufacturers have to go through their own approval process, showing that their active ingredient and effects are exactly like those of the brand name in everything but name only.

Meanwhile, because several generic manufacturers typically receive approval to sell the same generic drug, the competition between those companies often has the effect of lowering the generic cost further.

Are generics regulated like brand name drugs? 
The U.S. Food and Drug Administration (FDA) has specific requirements for generic drugs. They have to match up with the name-brand versions in several ways. The dose size, how it&rsquo;s taken, dosage level, reasons for use, shelf life and safety all have to be the same. The medicine, says the FDA, has to work just like the brand-name drug does and it has to offer the same clinical benefits.

These requirements are crucial because, according to the FDA, 9 in 10 drug prescriptions that are filled are for generics. So it&rsquo;s vital for consumers that they get what they&rsquo;re supposed to get.

The FDA cautions that any batch of drugs, branded or not, can show some &ldquo;natural variability.&rdquo; From batch to batch, little things can change that don&rsquo;t alter the medical outcome of taking the drug. The FDA has limits on just how much these factors, such as size or purity, can vary.

The process seems to work. One large study published in 2009 in the journal Annals of Pharmacotherapy looked at 12 years of data covering 2,070 studies that compared generic and branded drugs. The authors found no impressive differences between generic and branded drugs in how people absorbed them in their bodies, which is an important factor in how well a drug works.

These comparisons of how the body absorbs the generic and brand versions of a drug are known as &ldquo;bioequivalence studies.&rdquo; Generics can be compared to brand-name versions in other ways. They can be compared for &ldquo;pharmaceutical equivalence,&rdquo; which means how well they match for active ingredient, dose and how they&rsquo;re administered.

Together, bioequivalence (how similarly the body uses the two comparison drugs) and pharmaceutical equivalence (how similar the active ingredient is between the drugs) add up to the &ldquo;therapeutic equivalence.&rdquo; A generic drug that is therapeutically equivalent to its brand-name counterpart will show pharmaceutical equivalence and bioequivalence with it. It will have the same effect and same safety profile as the brand-name drug. FDA-approved generic drugs are expected to show this therapeutic equivalence.

Why doesn&rsquo;t the generic look like my drug? 
One way that branded and generic versions of a drug will definitely differ is in their appearance. Legal rules call for the color or shape of the medications to be different. The active ingredient, however, must be the same.

Are there ever mistakes? 
Like brand-name drugs, generic drugs are monitored on an ongoing basis. The FDA keeps an eye on everything from how a drug is made and packaged to any reports of problems from people taking the drugs.

This post-approval monitoring has helped the agency identify cases in which a generic violates the requirement of therapeutic equivalence. One such example is with an antidepressant called bupropion, also known by the brand name Wellbutrin. After a generic version of this drug was approved, some concerning reports started coming in. People were saying that one specific dose and type of the generic version was not having the usual effects of the drug.

The FDA became concerned enough to conduct its own study of how the body used the two versions of the drug. They found that one of the generics from one of several manufacturers was not therapeutically equivalent to the brand-name version. The manufacturer voluntarily pulled that generic from the market.

Is my drug available as a generic? 
Although an FDA-approved generic drug is anticipated to be functionally the same as a brand-name drug, it&rsquo;s still important to consult with your doctor before switching the manufacturer of any drugs you&rsquo;re taking, such as from a brand-name drug to a generic.

Once you get the green light from your healthcare provider, your pharmacist will be able to help you determine whether your drug is available as a generic. You also can search on the FDA&rsquo;s site through its &ldquo;<a href="https://www.accessdata.fda.gov/scripts/cder/ob/index.cfm" target="_blank">Orange Book</a>&rdquo; database or its <a href="https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm" target="_blank">Drugs@FDA</a> tool. A search on the drug you&rsquo;re looking for will list the manufacturers of the brand name and any generics that are therapeutic equivalents.

5 Essential Facts About Generic Drugs

The U.S. Food and Drug Administration (FDA) is warning consumers about fraudulent letters sent to people who have purchased medicines online or over the phone from illegal pharmacies. The agency is concerned that these fake letters, which look similar to official FDA correspondence, are part of an international extortion scam.

Printed on what appears to be FDA letterhead, the letters follow the format of other documents sent by the agency. They alert recipients that their packages have been reviewed and allude to drug violations stemming from their purchases. They ask for a written reply within 15 days, providing a valid FDA address.

So far, approximately three dozen letters have been reported. Mysteriously, thus far none appear to have included a request for money.

While the FDA routinely sends warning letters to companies manufacturing and distributing illegal drugs, individual consumers purchasing from these pharmacies typically are not targeted.

It&rsquo;s unclear how the names and addresses of the recipients were obtained or how the senders knew who made the purchases. The FDA has warned that many of these websites&mdash;which allow people to buy drugs without a valid prescription and often at steep discounts&mdash;offer no fraud protection, thereby potentially enabling personal and credit card information to get into the hands of scammers. Some consumers may not even realize they are ordering from illegitimate websites.

&ldquo;Many of these illegal websites appear legitimate, and it can be hard to tell the difference between a legally operating online pharmacy and a rogue website,&rdquo; said FDA Commissioner Scott Gottlieb in a statement.

There are other dangers to making purchases from illegal pharmacies that go beyond scams. There is no guarantee that the medicine sent is exactly what was ordered. And many of these drugs are counterfeit, expired, unapproved or contaminated.

The best way for anyone to safeguard against receiving unsafe medication or being exposed to consumer fraud is to only buy from U.S.-licensed pharmacies that require a prescription. The FDA also advises consumers to follow certain <a href="https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm048396.htm" target="_blank">guidelines when shopping for drugs online</a>.

Meanwhile, anyone who receives a fraudulent letter is asked to email <a href="https://mailto:FDAInternetPharmacyTaskForce-CDER@fda.hhs.gov">FDAInternetPharmacyTaskForce-CDER@fda.hhs.gov</a> with as much information as possible, including photos of the envelope and scanned copies of the document to help the FDA investigate the scam.

Medically reviewed in July 2018.

News: FDA Warns Online Drug Buyers About Fake Letter Scam

For the eleventh year in a row, law enforcement agencies are teaming up with the United States Drug Enforcement Administration (DEA) for National Prescription Drug Take Back Day. On Saturday, October 23, around 5,000 locations across the country will be accepting prescription drugs for disposal. Collection sites will be open from 10 a.m. local time.

Nationwide, 839,543 pounds&mdash;more than 420 tons&mdash;of expired, unused, or unwanted prescription drugs were gathered during the last collection, held in April 2021. Since the first collection in 2010, the DEA has collected 14,524,391 pounds&mdash;7,262 tons&mdash;of prescription drugs.

A 2017 survey found that roughly 6 million Americans abused controlled prescription medication, with a majority of pills obtained from family members and friends. These drugs often come from home medicine cabinets. Disposing of drugs at events like the National Prescription Drug Take Back Day is a good way to keep prescription opioids and other medications out of the wrong hands and to help prevent drug addiction, overdose, and accidental poisoning. Disposal is always free of charge and anonymous.

You can visit the DEA&rsquo;s website to <a href="https://takebackday.dea.gov/" style="color:#0563c1; text-decoration:underline" target="_blank">find a drop-off location near you</a>, learn more about this year&#39;s event, and get information about treatment for substance abuse. Google has also launched their own <a href="https://recovertogether.withgoogle.com/prevention/" style="color:#0563c1; text-decoration:underline" target="_blank">locator tool</a> to make finding your nearest collection site simple.

If you can&#39;t participate in this year&#39;s take back, there are other ways to safely remove medications from your home.

<ul>
	<li>Hand off unwanted medication at a DEA-authorized <a href="https://apps2.deadiversion.usdoj.gov/pubdispsearch/spring/main;jsessionid=rxqv6oz8if0BowbSpLvpupNVoNS4o8Z0N9cg3d-p.web2?execution=e1s1" style="color:#0563c1; text-decoration:underline" target="_blank">controlled substance public disposal location</a>. Authorized collection sites may include pharmacies, hospitals, and law enforcement buildings.</li>
	<li>In a sealed bag, mix pills with dirt, used coffee grounds, or kitty litter. Toss out with your household trash.</li>
	<li>Certain medications can be flushed down the toilet, but it&rsquo;s best to check the <a href="https://www.fda.gov/drugs/disposal-unused-medicines-what-you-should-know/drug-disposal-fdas-flush-list-certain-medicines#FlushList" style="color:#0563c1; text-decoration:underline" target="_blank">U.S. Food and Drug Administration&rsquo;s</a> list of approved medications before heading to the bathroom.</li>
</ul>

There&rsquo;s never a bad time to get rid of unwanted medication. <a href="https://takebackday.dea.gov/" style="color:#0563c1; text-decoration:underline" target="_blank">National Prescription Drug Take Back Day</a> occurs twice a year, usually in April and October.

Sources:

U.S. Drug Enforcement Administration. &ldquo;Take Back Day.&rdquo; 2021. Accessed October 21, 2021. 
U.S. Food &amp; Drug Administration. &ldquo;Disposal of Unused Medicines: What You Should Know.&rdquo; October 1, 2020. Accessed October 21, 2021.

Trash Your Old Pills on National Prescription Drug Take Back Day

From vitamin store oils to online foot creams, cannabidiol (CBD) can be found just about everywhere these days, in a stunning array of products&mdash;and millions of people are getting in on the trend. Based on a January 2019 survey, Consumer Reports estimated that about 64 million Americans tried CBD during the two years prior, often to treat health conditions like insomnia, anxiety or pain.

The problem is, while people take CBD for a multitude of medical issues, there is currently little scientific evidence it actually helps. In some cases, it may even pose safety risks. That&rsquo;s why healthcare providers (HCP) must be careful about the information they relay to patients&mdash;and patients should let their HCPs know if they&rsquo;re taking CBD.

&ldquo;Patients are nervous sometimes to tell their physicians that they&#39;re using these products, so I encourage them to have that open dialogue with me and I thank them for sharing,&rdquo; says Tulisa LaRocca, MD, an internist affiliated with <a href="https://www.sharecare.com/group/jfk-medical-center">JFK Medical Center</a> in Atlantis, Florida. &ldquo;I urge patients and other healthcare providers to retain their clinical curiosity about CBD, but also a healthy skepticism.&rdquo;

So, what is CBD, exactly? Do the purported health perks really live up to the hype? And what potential problems with CBD should patients keep in mind?&nbsp;

The basics of CBD 
CBD is a cannabinoid, a chemical compound that comes from the cannabis plant. There are more than 100 known cannabinoids, including CBD and tetrahydrocannabinol (THC), the substance that creates a high when you use marijuana. Unlike THC, CBD has no psychoactive effect, which is part of its appeal.&nbsp;

Certain varieties of the cannabis plant have lower amounts of THC and higher amounts of CBD. These types are commonly known as hemp, and they&rsquo;re often used to make CBD products, including oils, sprays, creams and pills.

Currently, the legal status of these and other CBD products is extremely complicated. Though the 2018 Farm Bill legalized hemp on a federal level, state and local regulations vary widely, meaning what&rsquo;s readily available in Colorado may be unlawful in next-door Nebraska.&nbsp;

The U.S. Food and Drug Administration (FDA) also restricts how CBD can be advertised and sold. It&rsquo;s against the law to market CBD in food or as a supplement, for example, and to peddle it across state lines. Importantly, it&rsquo;s also illegal to push a CBD product as a prevention, treatment or cure for any disease without FDA approval.&nbsp;

That said, the general enforcement of CBD rules is somewhat lax, and the substance remains widely accessible in much of the U.S., especially once online retailers are taken into account. In many states, there are even brick-and-mortar stores dedicated entirely to CBD goods. &ldquo;I drive around my area, and I see at least four or five CBD stores on the way to work,&rdquo; says Dr. LaRocca.

Does CBD really have health benefits? 
People take CBD for a wide variety of problems, often without the recommendation of a HCP. &ldquo;A lot of our patients are using CBD on their own without consulting physicians,&rdquo; says LaRocca. &ldquo;The biggest use I hear about is for <a href="https://www.sharecare.com/health/pain-management/slideshow/natural-ways-manage-pain">chronic pain</a>. The second most common would be for anxiety, and the third most common reported to me is for insomnia.&rdquo;&nbsp;

Some research hints that CBD has potential for treating these, and perhaps other, health problems. For example, a Neuropsychopharmacology review published online in 2017 found overwhelming evidence that cannabinoids helped block inflammation and pain in rodents. Other small human studies have found that CBD may curb the urge to use heroin, suggesting it could help treat opioid abuse.&nbsp;

In addition to promising research, there&rsquo;s also widespread anecdotal support for CBD. No matter the illness, many people report that taking CBD simply helps them feel better. This may be true for some, and it may hint at a possible placebo effect for others&mdash;the idea that if people believe something works, it just might help.&nbsp;

That said, much more CBD research is needed, and there&rsquo;s currently little concrete scientific proof that it&rsquo;s an effective therapy for most conditions. In fact, the FDA has approved just one medication containing CBD for the treatment of disease: Epidiolex, for people with Dravet syndrome or Lennox-Gastaut syndrome. &ldquo;They&#39;re rare childhood seizure disorders where children can have multiple seizures in a day,&rdquo; says LaRocca. &ldquo;[Epidiolex] has reduced the frequency of seizures.&rdquo;&nbsp;

On occasion, a company will market CBD specifically as a cure for serious chronic health problems, including illnesses like cancer and <a href="https://www.sharecare.com/health/alzheimers-disease/article/what-need-know-about-alzheimers-disease">Alzheimer&rsquo;s disease</a>. But patients must understand that it will not prevent, treat or cure these conditions.&nbsp;

&ldquo;If a patient tells me that they&#39;ve been on the website or spoke to a company that touts CBD as being a cure for any disease&mdash;cancer, neurodegenerative, whatever&mdash;I tell them to beware,&rdquo; says LaRocca. Companies making these claims put patient lives at risk, since sick people may use CBD instead of seeking proven medical care.&nbsp;

Other possible downsides of CBD 
In general, CBD is considered safe to use in the short-term for most people, and there&rsquo;s little evidence you can abuse or become dependent on it. However, there are risks of side effects, including nausea, fatigue, irritability, low blood pressure, sleepiness, dry mouth and lightheadedness.&nbsp;

CBD may also interact negatively with other medications, supplements and even foods; fattier meals and snacks can increase its absorption and effects. What&rsquo;s more, not much is known about how CBD affects certain populations, including pregnant women, children and older adults. The FDA strongly advises pregnant and nursing women to avoid CBD.

That&rsquo;s not all. Due in large part to its relative newness, many experts have unresolved questions and concerns about the compound, including its:

<ul>
	<li>Long-term safety: CBD&rsquo;s effects over time remain unclear. For instance, there are some indications it can lead to liver injury in certain people.&nbsp;</li>
	<li>Lack of dosing guidelines: There&rsquo;s little professional medical guidance regarding how much CBD to take for any given condition, and how the amount might vary depending on the form of CBD. &ldquo;One dose is not a one-dose-fits-all,&rdquo; says LaRocca. &ldquo;It&#39;s very different dosages for different conditions and for each individual.&rdquo;</li>
	<li>Labeling inaccuracies: Since the FDA doesn&rsquo;t generally police the purity and safety of CBD products, labels aren&rsquo;t guaranteed to be accurate. There may be unlisted additional ingredients, including THC, or the listed amount of CBD may be incorrect. &ldquo;There have been a lot of companies that will sell CBD, and then when the patients have had it analyzed by a third party, there&#39;s very little CBD in there,&rdquo; says LaRocca.</li>
</ul>

Despite these risks, many people decide to go ahead with CBD anyway. In these cases, LaRocca advises patients to exercise caution and take a conservative approach. When her patients use CBD, she recommends starting with a low dose, slowly working up to a dose that&rsquo;s effective, and monitoring progress.&nbsp;

&ldquo;If you&#39;re taking it for pain, see how you feel with your pain,&rdquo; she says. &ldquo;Keep a log and document how you feel. If you&#39;re using it for <a href="https://www.sharecare.com/health/sleep-health/slideshow/simple-habits-sleep-soundly">sleep</a>, document how many hours you&#39;re sleeping. If you&#39;re using it for anxiety, document how you&#39;re feeling with your anxiety.&rdquo;

To avoid issues with labeling errors, she also recommends asking product manufacturers to provide a third-party evaluation of CBD content. &ldquo;A reputable company should have no problem showing you that,&rdquo; she explains.

Ultimately, CBD requires plenty of additional research before we more fully understand its capabilities and drawbacks. For these reasons, it&rsquo;s always best to speak with an HCP before trying a CBD product. Until then, as LaRocca says, be curious, be skeptical&mdash;and go to your provider with questions.&nbsp;

Medically reviewed in October 2019.

Sources: 
Gill, Lisa. &ldquo;CBD Goes Mainstream.&rdquo; Consumer Reports. April 2019. 
UCLA Health. &ldquo;Cannabis and its Compounds.&rdquo; 
Harvard Health Publishing&rdquo; &ldquo;Cannabidiol (CBD) &mdash; what we know and what we don&rsquo;t.&rdquo; 
National Cancer Institute. &ldquo;Cannabis and Cannabinoids (PDQ&reg;)&ndash;Patient Version.&rdquo; 
Medline Plus. &ldquo;Cannabidiol (CBD).&rdquo; 
Oregon State University Extension Service. &ldquo;What is Industrial Hemp?&rdquo; 
U.S Food and Drug Administration (FDA). &ldquo;Regulation of Cannabis and Cannabis-Derived Products, Including Cannabidiol (CBD),&rdquo; &ldquo;What You Need to Know (And What We&rsquo;re Working to Find Out) About Products Containing Cannabis or Cannabis-derived Compounds, Including CBD,&rdquo; &ldquo;FDA Regulation of Cannabidiol (CBD) Products,&rdquo; &ldquo;Statement from FDA Commissioner Scott Gottlieb, M.D., on signing of the Agriculture Improvement Act and the agency&rsquo;s regulation of products containing cannabis and cannabis-derived compounds,&rdquo; &ldquo;FDA is Committed to Sound, Science-based Policy on CBD,&rdquo; &ldquo;What You Should Know About Using Cannabis, Including CBD, When Pregnant or Breastfeeding,&rdquo; &ldquo;Warning Letters and Test Results for Cannabidiol-Related Products.&rdquo; 
VanDolah, Harrison J. et al. Clinicians&rsquo; Guide to Cannabidiol and Hemp Oils. Mayo Clinic Proceedings. Volume 94, Issue 9, 1840 &ndash; 1851. 
Donvito G, Nass SR. et al. The Endogenous Cannabinoid System: A Budding Source of Targets for Treating Inflammatory and Neuropathic Pain. Neuropsychopharmacology. 2018 Jan;43(1):52-79. 
UpToDate.com. &ldquo;Seizures and epilepsy in children: Refractory seizures and prognosis.&rdquo; 
Bonn-Miller MO, Loflin MJE, Thomas BF, Marcu JP, Hyke T, Vandrey R. Labeling Accuracy of Cannabidiol Extracts Sold Online. JAMA. 2017;318(17):1708&ndash;1709.

What Is CBD and Why Are so Many People Using It?

According to the Centers for Disease Control and Prevention (CDC), about 115 Americans die daily from an overdose of opioids, a class of drugs that includes prescription opioids, heroin and fentanyl. More than 42,000 people died of an opioid overdose in 2016, and about 40 percent of those deaths included a prescribed opioid.

Used appropriately, prescription opioids are powerful painkillers. They are also highly addictive and dangerous. Opioids make you feel euphoric and change the way nerve cells work, creating a physical dependence. They also depress your respiratory system, which is what causes a fatal overdose.

Experts believe the liberal use of opioids to treat chronic, non-cancer <a href="https://www.sharecare.com/chronic-pain/pain-management/opioid-free-ways-beat-pain">pain</a> has lead to the current public health crisis, and it&#39;s prompted an exploration as to whether medical marijuana (cannabis) might help reduce the number of opioid overdoses. Marijuana is believed by many patients to be an effective pain reliever, and is typically far less hazardous and addictive than opioids. &ldquo;Cannabis, and cannabis-derived compounds, deserve further study as non-opioid treatments for chronic pain,&rdquo; says <a href="https://med.nyu.edu/faculty/joshua-d-lee" target="_blank">Joshua D Lee, MD, MSc</a>, an associate professor in the Department of Population Health at NYU Langone Health.

What is medical marijuana? 
Marijuana comes from the Cannabis sativa or Cannabis indica plant, and in the United States, it&#39;s used more than any other illicit drug. Users inhale smoke, add it to foods (edibles) or use it in a vaporizer. The active ingredients enter the bloodstream and alter your senses, change your mood and impair your cognitive abilities. It&#39;s thought that between 9 and 30 percent of marijuana users may develop a disorder related to that use.

When people use marijuana for health issues, it&#39;s often to ease chronic or severe pain stemming from injuries and illnesses&mdash;and many find it to be effective. However, the Food and Drug Administration (FDA) has not approved marijuana as a medicine (though it has approved synthetic cannabinoids), and the US government classifies marijuana as a Schedule 1 drug, meaning it&#39;s illegal on a federal level. Still, a growing number of states allow it for medical purposes. Doctors can recommend it, and patients can pick it up at a dispensary or grow it at home.

How medical marijuana could curb opioid use 
Chronic pain is common, and the number of people being prescribed opioids rose sharply in the 2000s. While prescription rates have fallen since then, many are still given the drugs to treat their pain. Several studies suggest that using marijuana to treat that pain&mdash;instead of opioids&mdash;might be linked to a lower rate of opioid overdoses and deaths.

For example, an analysis of death certificates between 1999 and 2010 found that states with medical cannabis laws had lower average rates of opioid overdose deaths. In another study, researchers looked at state-level hospitalization data between 1997 and 2014 and found significant reductions in opioid-related hospitalizations coinciding with the implementation of medical marijuana policies.

The potential problems 
&ldquo;There may be benefits [of using medical marijuana], but the research to date has been mostly observational, ecological and has important limitations,&rdquo; says Lee.&nbsp;&ldquo;Lower rates of overdoses, for instance, may have to do with factors other than cannabis reforms.&rdquo; For example, he says, rates of fentanyl, street heroin and counterfeit opioid pills have varied widely state by state. Over the last five years, it&#39;s been fentanyl that has largely driven the acceleration of overdose death rates.

What&#39;s more, some research suggests medical marijuana may not be as effective as hoped, and may have certain drawbacks. According to the National Institute on Drug Abuse (NIDA), there is a lack of large clinical trials showing that the benefits of marijuana outweigh the risks. Some studies of people with chronic pain show that cannabis users don&#39;t lower their doses of opioids, either, compared to people who use opioids and don&#39;t use marijuana. And finally, other research shows using cannabis may actually increase the odds of non-prescription opioid use or addiction. That said, NIDA does accept that many studies show medical marijuana could play a role in opioid reduction.

Lee takes care to mention that any interventions which are safer and effective alternatives to chronic opioid pain treatments are urgently needed. &quot;Medical marijuana (by prescription), cannabis-derived compounds (like cannabidiol), and casual recreational cannabis use may or may not prove to help,&quot; he says. &quot;The studies to date have not yet adequately answered these questions.&rdquo;

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