Michael Steinman, MD

4150 Clement St Box 181G

San Francisco CA 94121 mike.steinman@ucsf.edu

Fax 415.750.6641

Tel 415.221.4810 x23677

There is much to celebrate about deprescribing research. The past decade has seen an explosion of interest in the topic.¹Recent scholarship has revealed key barriers and facilitators to deprescribing, elucidated effective communication strategies, and developed new measures. Moreover, it has demonstrated the potential for deprescribing to improve outcomes, with meta-analyses finding that intensive deprescribing interventions may reduce mortality and falls in nursing homes by approximately 25%, and that comprehensive medical review may yield similar reductions in mortality among older adults in ambulatory settings.^2,3

Yet, challenges abound. Many interventions which seemed promising have had disappointing results, and we have gained appreciation of how difficult deprescribing can be. In clinical practice, many people are reluctant to stop medications they were previously told they needed, and clinicians often lack incentive, willingness, or adequate time to make proactive efforts to deprescribe. Even when successful, real-world translation of interventions remains limited, and the push for aggressive medication therapy remains deeply embedded in health systems. Reducing medication count, a common outcome of studies, is not necessarily a win for patients if the discontinued medications were not bothersome or costly to them or their caregivers.

Deprescribing research is thus at a crossroads. While we celebrate initial successes, the easiest work is behind us. As we look ahead, I offer 6 recommendations for how the field can continue to grow, developed from my own reflections, conversations with leaders in the field, and past literature⁴ and initially presented as a talk at the first International Conference on Deprescribing in September 2022.