Overprescribing

Overprescribing refers to the practice of prescribing medications or ordering diagnostic tests in situations where the expected benefits do not outweigh the risks, or where safer or less intensive options would suffice. It can involve excessive dose, duration, or frequency, and may occur across medical specialties.

The term is commonly discussed in relation to antibiotics, opioids and other controlled substances, benzodiazepines, and imaging or laboratory testing. In antibiotics, overprescribing contributes to antimicrobial resistance; in opioids, it increases the risk of dependence and adverse events; in imaging, unnecessary studies expose patients to radiation and can lead to incidental findings that require further workup.

Causes include patient expectations, time pressures in primary care, defensive medicine, fragmented care, financial and reimbursement incentives, pharmaceutical marketing, and limited access to non-drug therapies or to up-to-date guidelines.

Consequences include adverse drug events and drug interactions, polypharmacy, increased healthcare costs, antimicrobial resistance in the case of antibiotics, waste of resources, and potential harm to patients from unnecessary exposure.

Responses include stewardship programs, adherence to evidence-based guidelines, dose optimization and deprescribing protocols, clinical decision support, prescription monitoring programs, professional education, and patient engagement to set appropriate expectations.

From a public health perspective, the goal is to preserve access to necessary medications while reducing unnecessary exposure. Measurement relies on prescribing rates, duration of therapy, and appropriateness indicators, with audits and feedback driving practice change.