Why the Medication Rebellion?

In search of explanations, researchers for a 2009 report by the nonprofit RAND Corp., “A Review of Barriers to Medication Adherence,” combed through 4,660 related articles written between 1998 and 2009. But answers weren’t easy to come by; reasons for noncompliance tend to be individual and the ways of measuring it vary, says lead author Walid Gellad, M.D., adjunct researcher for RAND and an assistant professor of medicine at the University of Pittsburgh. “I think adherence involves several steps: filling the prescription, staying on the prescription and taking it as you’re supposed to.”

Still, three barriers to compliance stood out: cost, the complexity of the medication regimen and beliefs about the medication.         

“If costs are higher, people take their medications less,” says Gellad. “If you’re paying out of pocket and you don’t see results, that has to be incredibly frustrating,” says Fincham.

For some, a challenge to adherence is remembering to take medications throughout the day – or even prioritizing that need. It’s especially challenging if you have other burdens like depression or dementia, or if you’re taking care of someone else, says rheumatologist Robin Dore, MD, clinical professor of medicine at the University of California, Los Angeles. “Some people don’t take their medications because their lives are complicated.”

And many people with arthritis may be taking drugs for other conditions. According to AARP, the average American over 75 takes more than 11 drugs per year.

“People get tired of having a chronic disease,” says DiMatteo. “Maintenance and management take a lot of energy, and it keeps reminding you that you have the disease.”

Having to self-inject medicine, such as certain disease-modifying antirheumatic drugs (DMARDs), adds an additional layer of complications, says Fincham. “It hurts and it’s difficult to do. I don’t blame anyone who would want to take a holiday from that.”

Certain perceptions about medicine can also hinder adherence to a drug regimen, says Gellad. “People may have fears about a medication’s side effects or think it won’t work.”

They might also believe erroneous information they get from friends, family members or the Internet. Or they may simply be cynical about medical care. “If they believe that doctors overprescribe, they could reject what their doctor says,” says DiMatteo.