Unexpected Reasons People Don't Take Their Medications

At one time or another, we've all forgotten to take our medication, skipped a dose of an antibiotic regimen, or ran out of a prescription before remembering to refill it. But, according to a 2011 study published in the Mayo Clinic Proceedings, almost 50% of patients regularly do not take their medications as prescribed. A far more serious issue than the occasional brain lapse, chronic neglect of medication can lead to increased illness, a greater risk of disease, and even death.  

Nonadherence to medication is not only a dangerous problem; it's also a costly one. According to a 2018 study by the Skaggs School of Pharmacy and Pharmaceutical Sciences, nonadherence to medication, not taking medication as directed, or a patient not having the correct information about their prescription costs nearly $530 billion annually in healthcare and insurance costs. This startling number is a good reminder of the importance of taking your medication when you're supposed to and as indicated. However, there are still many people who neglect to do so — and there are many reasons why they make that choice. 

Even people who are diligent about taking their medication are going to ask their doctor what the potential side effects of a particular medication may be. However, in some cases, the answers to those questions, no matter how thorough, aren't good enough, and the fear of what the medication may do can become paralyzing. According to a 2020 study published by Health Psychology Research, fear of medication, or pharmacophobia, is a big reason people do opt to leave their prescription on the shelf.

In some cases, according to Medsafe, those conversations with the doctor about side effects can end up doing more harm than good. This is known as the "nocebo effect," and can happen when patients experience an adverse side effect of a medication after expecting or worrying that they will experience that side effect in advance. In a 2012 study by the Technical University of Munich, researchers concluded that the nocebo effect is common and could present an issue for medical professionals when dealing with anxious patients. 

There is no question that prescriptions can be expensive. In the last nine years alone, the price of prescription medication has increased 35%. According to the Office of the Assistant Secretary for Planning and Evaluation, 2022 saw some drugs rise in cost by $20,000, an almost 500% increase. With numbers like these, it's not surprising that cost can become a factor in people neglecting to take their medication. 

In general, the affordability of medication is an ongoing problem for many patients. A 2023 poll from the Kaiser Family Foundation showed that 37% of people taking four or more prescriptions said that it was difficult to afford their medications. Additionally, households with an income of less than $40,000 were more likely to have trouble paying for their medications. Many people also reported opting for a less expensive over-the-counter medication to treat an illness rather than having to deal with the cost of a prescription. 

When people don't understand how long they should be taking a medication, the dosage, or even the proper way to take it, they can opt out of taking it altogether. According to a 2018 study published in PLOS ONE, less than half of the patients who receive instructions on how to take their medication remember those instructions after the fact. A 2005 study published in Therapeutics and Clinical Risk Management painted a similarly worrying picture. That study showed that 42% of patients profiled misunderstood the directions for taking their medication without having eaten first. 

Literacy and language barriers can play a role in misunderstanding instructions for medication. A 2006 study published in the Journal of General Internal Medicine showed that patients with low levels of literacy were three times less likely to correctly interpret warning labels on prescription medication bottles. According to Adult Meducation, close to 90 million people are at a literacy level below that of an eighth grader. For those people, it's advisable to be honest with their healthcare professional about their ability to understand what is needed for their prescription, and for their doctor to also take these factors into account when presenting information.  

Having multiple prescriptions, sometimes even more than are medically necessary, can create a problem for certain patients, particularly elderly patients who are not yet in nursing homes, according to U.S. Pharmacist. A situation in which five or more medications are prescribed at any given time is known as polypharmacy, and it can be an issue if not addressed. Close to half of men and more than half of women over the age of 65 take more than five prescriptions each week. Issues like forgetfulness, vision issues, and dexterity can all factor into older patients not taking their medication properly. 

A complicated dosing schedule can also be a problem for patients who are struggling to stay on track with their medications. According to a 2017 study published in BMC Geriatrics, 56% of patients could not identify the purpose of at least one of their medications. Moreover, only two-thirds knew their correct dosage regimen. 

Medical mistrust is a growing problem, as evidenced by a 2017 survey conducted by ReviveHealth and shared in the American Journal of Managed Care. According to that survey, trust in the healthcare system had reached its lowest level in more than a decade. On a scale of 100 points, the survey showed that the level of trust in health plans among consumers was at 68. Additionally, the survey showed that healthcare consumers who had changed their plans in the past year were four times more likely to believe that the change was not for the better. 

Among Black Americans, trust in the healthcare system is an ongoing issue, according to the Commonwealth Fund. Because of mistreatment of Black patients in the past, many in the Black community are hesitant to seek treatment, with just 42% of Black Americans saying they were willing to receive the COVID-19 vaccine. A 2012 study published in Pain Medicine showed that Black patients were often mistreated for pain far more than any other ethnic group. This kind of mistrust can most definitely lead to patients not taking their prescriptions properly.

If a person does not feel symptoms of a certain condition or if the symptoms they do experience clear up after taking medication for a bit, they may decide to stop it altogether. 

According to Drugs.com, certain conditions such as hypertension or high cholesterol do not present with symptoms, leading some people to believe that they don't have a problem and neglect taking any medication. In other cases, such as people who are suffering from depression, patients may suddenly begin feeling better and think they no longer need it. However, suddenly discontinuing your medication can cause a host of unpleasant side effects and actually make your symptoms worse. 

For conditions such as high blood pressure, it can be tempting to go off your medication when you get a good reading. But HealthMatch notes that going cold turkey when you have a condition such as high blood pressure can be dangerous and even deadly. Your blood pressure can spike and cause artery damage, increase your risk of aneurysms, damage your optic nerve, and even cause sexual dysfunction. In any situation where you think you can safely stop taking your medication, you should only do so after talking with your doctor and following his or her advice.  

Many people with mental illnesses such as schizophrenia and bipolar disorder neglect to take their medications. According to a 2016 study published in the World Journal of Psychiatry, nearly half of patients who are diagnosed with bipolar disorder eventually stopped taking their medication over the long term. 

In some cases, these rates of nonadherence could climb as high as 70%. A 2000 study published in the Journal of Affective Disorders cited a few reasons for nonadherence in cases of mental illness, including fear of hospitalization, concerns about the perception of other people, and dissatisfaction with available services and treatment.

In addition, there can be other, more surprising factors at work when it comes to nonadherence. According to a 2001 study published in Health Services Research, 55% of people profiled didn't take their medications because they didn't believe that they were sick. This condition is known as anosognosia, and can be a major roadblock for patients with mental illness and their medication routine. The Treatment Advocacy Center cites anosognosia as the largest impediment to patients with schizophrenia and bipolar disorder taking their medication.  

Forgetting to take one's medication is a common cause of nonadherence. A 2011 study published in Patient Education and Counseling showed that, of the 50% of patients on chronic medications who are nonadherent, 30% cited forgetfulness as their primary reason. This can cause problems over time, according to WebMD, as certain medications rely on a particular window of time to be effective. You can also experience withdrawal symptoms, or not complete your treatment successfully. 

If you have a tendency to forget to take your medications, the University of Queensland offers a few suggestions, including pill boxes, mobile apps, and setting an alarm to remind you when it's time for another dose. If you have forgotten a dose, Medsafe says that, in most cases, you should simply make sure to take your next dose at the normal time. Do not try to double the dosage as a means of catching up. If you are concerned about having missed your medication, you can always check with your doctor to determine the next best steps.  

For some people with strong religious convictions, taking medication or receiving certain treatments may not be an option. in 2007, American Family Physician reported the case of a patient from Africa who suffered from urinary issues. The physician in charge of the examination feared the patient may have bladder cancer and requested a pelvic examination. According to the report, the patient's religious beliefs did not permit such an examination. Additionally, a 2013 study published in BioPsychoSocial Medicine showed that patients with a high degree of spirituality were almost three times more likely to be nonadherent than those who were not as spiritual. 

Religious beliefs can factor heavily into a patient's nonadherence, which Archives of Disease in Childhood says should be taken into account when prescribing treatment. For example, Jehovah's Witnesses can choose to avoid blood-derived products, while Jewish law forbids medications containing glycerol, stearates, lactose, and porcine products. These are a few examples of cultural sensitivities that can impact certain religious groups' treatment.