The Dangers of Big Medication Doses: Understanding Side Effects and Kinetics
Higher doses aren't always optimal doses
One thing Naturopathic physicians always get right is drug dosing. Allopathic physicians should follow their lead.
Drug doses are insane in America and much of the third world (but especially America). It doesn’t matter what drug you’re taking, odds are the dose is far higher than it needs to be. I’m still amazed by the mega-doses of opioids some physicians recommended for years to treat chronic pain.
I won’t say this is wrong, necessarily. Some people have legitimate chronic pain that is only managed with painkillers. Tolerance builds quickly and next thing you know, you’re dependent on massive doses. Once you’re at that level, you’re essentially a fancy heroin dealer. Take away the pills and the patient is in severe pain, plus going through withdrawals.
This problem doesn’t only exist with painkillers. Physicians recommend and prescribe massive doses of a bunch of drugs when smaller doses would work just as well.
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Why such high doses?
There are many causes for the use of high doses. I’ll do my best to cover some of the important ones here.
This one is pretty straightforward. Big Pharma loves when you’re taking a big dose of whatever product they are pushing. Many drugs (opioids, SSRIs, antipsychotics, etc.) require you to slowly increase and decrease the dose. Let’s consider this hypothetical example of a fictional SSRI, Anarchium.
You are diagnosed with depression and the optimal dose of Anarchium is 100mg per day. For safety, your doctor starts you at 25 mg. Since they’re a good doctor they wait 6 weeks before raising the dose to 25 mg twice per day. After another 6 weeks, they increase the dose to 25 mg in the morning and 50 mg at night. Then after another 6 weeks, 50 mg morning and evening.
This is how an SSRI should be titrated. If it’s then sustained at the optimal dose for 6 months you begin the process of tapering off the drug over the same timeframe. The process of adding and then tapering the drug alone adds 36 weeks of drugs, which is about 9 months. That’s 9 months of Big Pharma profits on Anarchium.
There’s also the obvious benefit of Big Pharma selling higher doses. They can charge more. It’s actually more cost-effective for them to make larger quantities of drugs because they can get better deals on resources and manufacturing. So they win on both ends.
Certainly, the doctors are partly to blame. Many docs are happy to jump to high doses because in their mind it solves a problem. If a patient has high blood pressure they get put on a med. When the med doesn’t work they jack it up to the max dose. This covers their butt if the person has a heart attack in the meantime.
And if that doesn’t cover the problem they simply add a different med and jack up the dose to the max again. It’s not uncommon for people with uncontrolled blood pressure to be on 2-4 max dose blood pressure drugs.
Professional medical associations like the American Medical Association (AMA) and their offshoots set guidelines for drug prescriptions. This plays a major role in increased drug doses.
If the standard according to your relevant association is 100 mg for Anarchium but you stop at 50 mg and the person kills themself, you’re on the hook. A sleazy ambulance-chaser lawyer will eat your lunch in no time.
It doesn’t even need to be that dramatic. If a patient has acid reflux and isn’t put on a PPI then they develop esophageal cancer, the doctor is a risk. The standard, according to their association, is to initiate PPI therapy.
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The individual patient shares some of the blame. I can’t tell you how many times I have had to explain that increasing the dose of a particular drug won’t make any difference and will actually make things worse. 90% of the time the response is something along the lines of “Well, my other doctor did it.”
I’m not really blaming the patient. Most times they understand why higher doses aren’t always better when it’s appropriately explained. Sometimes they do it so they can snap the pill in half and make it last longer, sometimes they want to stash some for a rainy day, and sometimes they just don’t understand.
At the end of the day, it’s the doctor’s fault for not explaining their reasoning. However, sometimes a hard-headed patient simply won’t listen. It’s easy enough for them to doctor shop and find someone who will prescribe them what they want.