Some days it’s hard to remember life before pills. Every day, you face a sometimes confusing calendar of when to take what pills, and sometimes you wonder, when you stare at your empty pocketbook or feel the side effects kicking in, if you wouldn’t be better just chucking the drugs – or at least taking a break from them.

You have plenty of company. According to two studies of adherence rates at the MD Anderson Cancer Center in Houston, which were presented at the American College of Rheumatology 2010 Annual Scientific Meeting, sticking to a medication regimen is tough. In one study of 110 people with rheumatoid arthritis, RA, prescribed disease-modifying antirheumatic drugs, DMARDs, the adherence rate was 59 percent. For the second study, of 74 patients with lupus who were prescribed prednisone, the adherence was 64 percent. And in both groups, only one in five people took their drugs as prescribed at least 80 percent of the time.

The Cost of Skimping on Meds

As former U.S. Surgeon General C. Everett Koop once said: Drugs don’t work in patients who don’t take them.

The result for people with arthritis? “A worsening of disease and an increase in healthcare and hospitalizations,” says rheumatologist Leslie R. Harrold, MD, an associate professor at the University of Massachusetts Medical School in Worcester, who studies medication adherence in rheumatic patients, particularly those with gout. Failure to treat these conditions leads to further joint damage. “The consequences are [less function] and more pain, and an [inability] to be independent and to go to work,” he says.

“If you look at conditions such as rheumatoid arthritis, the drugs are not curative,” says Jack E. Fincham, PhD, professor of pharmacy practice and administration in the School of Pharmacy at the University of Missouri – Kansas City. “If patients don’t take the meds as they should, they’re going to see a progression of symptoms, more falls and a decreased ability to carry on the activities they’re interested in. And if you can’t move and can’t participate in life, then you’re going to have depression.”

In the MD Anderson Cancer Center lupus study, depression was associated with lower adherence. Those with better mental health were more likely to follow their treatment plans.

M. Robin DiMatteo, Distinguished Professor of Psychology at the University of California, Riverside, and co-author of Health Behavior Change and Treatment Adherence (Oxford University Press, 2010), has studied patient-doctor interactions and medication adherence. She says that better communication could improve adherence rates. “Doctors usually don’t know that patients are non-adherent,” she says. “The patients act as if they’re adherent because they don’t want to disappoint the doctor, and doctors don't provide the opportunity for the patients to be honest.”