For more than two decades, Jane (not her real name) — a woman in her early 70s — took the same white pill each night to sleep. It had been prescribed when menopause first disrupted her sleep. She tried to stop taking it more than once, but each time her insomnia came rushing back. It wasn’t that she needed the drug — her body had become dependent on it. With the help of Stacy D’Angelo, a Toronto pharmacist who specializes in helping people get off medication, Jane tapered off the pill over a 6-month period. She adopted a consistent sleep schedule, got morning light, and adjusted her bedroom to be cooler and darker. For the first time in more than 20 years, Jane slept through the night — all without a pill. Like many Americans, Jane stayed on a medication longer than intended. It may have had non-drug alternatives or been meant for short-term use, but continued for years without reassessment. The process of safely reducing or stopping medications that may no longer help or be necessary is rarely taught in medical school or pharmacy training. Unfortunately, the consequences can be serious. An estimated 750 older adults in the United States are hospitalized each day because of medication-related harm. Every medication has a timeline, but they don’t announce when they’ve outlived that timeline. The signs appear instead as a fall, morning brain fog, a racing heart, or even a hospital visit for a symptom that seems unrelated but traces back to a drug. To get off the so-called “pill train,” make a list of every medication you take, including over-the counter drugs and supplements. Then schedule an appointment with your primary care doctor, focused solely on medications, and take the list for review. The conversation can begin simply: “I’d like to go through my medications one by one and understand whether I still need each of them.” Your physician will look over the medications and decide how to safely reduce or stop one or more of them. The brain adapts to having medication, and when you remove it too quickly, the system doesn't have time to adjust, and that can cause problems. If stopping feels worse, it doesn’t always mean you need the medication, it may mean you need a slower plan. Medications are tools, not permanent fixtures. They serve a purpose, can be adjusted as circumstances change, and sometimes set aside when they no longer fit. For many doctors, medication review begins only when patients ask.
