Policy Research Brief, Vol. 30, No. 4

Research Issue

Adults with intellectual and developmental disabilities (IDD) are given more medications than the general population. Taking too many medications can cause serious side effects.

The term polypharmacy generally refers to taking five or more medicines. Each state might define polypharmacy in different ways, including how many medicines a person must be taking to be considered overmedicated. There are currently no clear national standards for the administration of medications.

Study Background

This policy analysis was developed as part of an academic collaboration between faculty, staff, and graduate students at the Institute on Community Integration at the University of Minnesota, the University of Michigan College of Pharmacy, and the Institute for Developmental Disabilities at Oklahoma State University. It utilized a qualitative multiple-case design.

Researchers compared agencies in Oklahoma, Georgia, and Connecticut who provide community-based services to people with IDD. Researchers looked at different strategies these states have to help people who are, or may be at risk of, being overmedicated.

A trained interviewer met with representatives from each state’s developmental disabilities services division and asked a series of questions about medication utilization monitoring systems and practices in their state. Data were collected between April 2021 and February 2022.

Policy Recommendations

Laws and policies can motivate states to help people with IDD who take too many pills. We recommend the following policies:

• Require states to share the polypharmacy data they collect with other states. This should include how each state defines polypharmacy.

• Develop national standards on the definition of polypharmacy and the care of people with IDD who are overmedicated. A common definition of polypharmacy is needed.

• States across the US need support teams and medical staff to work together to help people with IDD.

• Provide training to direct support workers and families on identifying cases of overmedication.

• Include people with IDD in discussions about polypharmacy; they need to know about the side effects of taking too many medications.

• Support self-advocacy by people with IDD. Self-advocacy skills are important when people talk to their doctors about medical concerns.

Key Findings

Polypharmacy definitions among persons with IDD vary by state.

In Connecticut, for example, polypharmacy means taking three or more medications in the same family or category. This can mean taking three antipsychotics or three antidepressants at the same time. In Georgia, polypharmacy means taking two or more medications in the same family. In Oklahoma, polypharmacy means taking three or more medications for seizures, two or more for mental illnesses, or five or more for other health problems.

States attempt to regulate polypharmacy with review boards.

Review boards make recommendations to prescribers. Review practices are particularly sensitive to cases when multiple psychotropic medications are prescribed. However, there are limitations in review volume and processing time due to limited resource capacity.

Clipboard with text, check boxes, and a pharmacy icon