Kuma magungunan tabin hankali sune na ukun da ke haddasa mutuwa
Yin magani fiye da kima da kwayoyi yana kashe mutane da yawa, kuma adadin masu mutuwa yana karuwa. Don haka abin mamaki ne cewa mun ƙyale wannan annoba ta ƙwaya ta ci gaba da wanzuwa, har ma fiye da haka saboda yawancin mutuwar magungunan ana iya yin rigakafin su cikin sauƙi.
A cikin 2013, na kiyasta cewa magungunan likitancinmu sune na uku da ke haifar da mutuwa bayan cututtukan zuciya da ciwon daji.1 sannan kuma a shekarar 2015, magungunan tabin hankali kadai su ma su ne na uku a sanadin mutuwa.2 Koyaya, a cikin Amurka, galibi ana bayyana cewa magungunan mu “kawai” shine babban sanadin mutuwa na huɗu.3,4 An samo wannan ƙididdigewa daga nazarin meta-bincike na 1998 na nazarin 39 na Amurka inda masu sa ido suka rubuta duk mummunan halayen miyagun ƙwayoyi da suka faru yayin da marasa lafiya ke asibiti, ko kuma waɗanda suka kasance dalilin shigar da asibiti.5
Wannan dabarar tana ƙasƙantar da mutuwar miyagun ƙwayoyi a fili. Yawancin mutanen da magungunansu ke kashewa suna mutuwa a wajen asibitoci, kuma lokacin da mutane ke kwana a asibitoci ya kasance kwanaki 11 kacal a matsakaicin binciken meta-bincike.5 Haka kuma, meta-binciken kawai ya haɗa da marasa lafiya waɗanda suka mutu daga magungunan da aka tsara su yadda ya kamata, ba waɗanda suka mutu sakamakon kurakurai a cikin sarrafa magunguna ba, rashin bin doka, wuce gona da iri, ko shaye-shayen miyagun ƙwayoyi, kuma ba mace-mace ba inda cutar da miyagun ƙwayoyi ta yiwu kawai.5
Mutane da yawa suna mutuwa saboda kurakurai, misali amfani da magungunan da ba a yarda da su a lokaci guda, da kuma yiwuwar mutuwar ƙwayoyi da yawa na gaske ne. Bugu da ƙari, yawancin karatun da aka haɗa sun tsufa sosai, shekara ta bugawa ita ce 1973, kuma mutuwar miyagun ƙwayoyi ya karu sosai a cikin shekaru 50 da suka gabata. Misali, an ba da rahoton mutuwar miyagun ƙwayoyi 37,309 ga FDA a cikin 2006 da 123,927 bayan shekaru goma, wanda shine sau 3.3 da yawa.6
A cikin bayanan asibiti da rahotannin masu bincike, ana ɗaukar mutuwar da ke da alaƙa da magungunan magani a matsayin ta asali ko kuma ba a sani ba. Wannan mummunar fahimta ta zama ruwan dare musamman ga mace-macen da magungunan tabin hankali ke haifarwa.2,7 Ko da a lokacin da matasa masu fama da schizophrenia suka mutu ba zato ba tsammani, ana kiranta mutuwa ta halitta. Amma ba dabi'a ba ne mutuƙar ƙuruciya kuma sananne ne cewa ƙwayoyin cuta na neuroleptics na iya haifar da bugun zuciya mai mutuwa.
Mutane da yawa suna mutuwa daga magungunan da suke sha ba tare da tayar da wani zato ba cewa zai iya zama mummunan tasirin magani. Magungunan damuwa suna kashe mutane da yawa, galibi a cikin tsofaffi, saboda suna iya haifar da hypotension orthostatic, tashin hankali, rudani, da tashin hankali. Magungunan sun ninka haɗarin faɗuwa da karyewar hanji ta hanyar dogaro da kashi,8,9 kuma a cikin shekara guda bayan raunin hip, kusan kashi ɗaya cikin biyar na marasa lafiya za su mutu. Kamar yadda tsofaffi sukan faɗo ta wata hanya, ba zai yiwu a san ko irin wannan mutuwar mutuwar miyagun ƙwayoyi ba ce.
Wani misali na mutuwar miyagun ƙwayoyi da ba a gane ba ana bayar da su ta hanyar magungunan anti-inflammatory marasa steroidal (NSAIDs). Sun kashe dubban daruruwan mutane,1 galibi ta hanyar bugun zuciya da ciwon ciki na zubar jini, amma da wuya a iya sanya wadannan mutuwar a matsayin illar miyagun kwayoyi, domin irin wannan mutuwar na faruwa a cikin marasa lafiya da ba su sha magungunan.
Binciken meta-bincike na 1998 na Amurka ya kiyasta cewa marasa lafiya 106,000 suna mutuwa kowace shekara a asibiti saboda illar miyagun ƙwayoyi (yawan mutuwar kashi 0.32%).5 Wani binciken da aka yi a Norway a hankali ya bincika mutuwar 732 da ta faru a cikin shekaru biyu da suka ƙare a cikin 1995 a sashin likitancin ciki, kuma ya gano cewa akwai mutuwar kwayoyi 9.5 a cikin marasa lafiya 1,000 (kashi 1% na mutuwa).10 Wannan ƙididdigewa ce mafi aminci, saboda mutuwar miyagun ƙwayoyi ta karu sosai. Idan muka yi amfani da wannan ƙididdiga ga Amurka, muna samun mutuwar ƙwayoyi 315,000 kowace shekara a asibitoci. Bita na sababbin bincike guda huɗu, daga 2008 zuwa 2011, an kiyasta cewa akwai fiye da mutuwar kwayoyi 400,000 a asibitocin Amurka.11
Amfani da muggan ƙwayoyi yanzu ya zama ruwan dare wanda za a iya sa ran jarirai a cikin 2019 su sha magungunan magani na kusan rabin rayuwarsu a Amurka.12 Bugu da ƙari, polypharmacy yana ƙaruwa.12
Mutane nawa ne Magungunan tabin hankali Ke Kashe?
Idan muna so mu ƙididdige adadin mutuwar magungunan tabin hankali, mafi tabbataccen shaidar da muke da ita ita ce gwajin bazuwar da ake sarrafa placebo. Amma muna bukatar mu yi la’akari da kasawarsu.
Na farko, yawanci suna gudu na ƴan makonni ko da yake yawancin marasa lafiya suna shan magungunan shekaru da yawa.13,14
Na biyu, kantin magani fiye da ɗaya ya zama ruwan dare a cikin masu tabin hankali, kuma wannan yana ƙara haɗarin mutuwa. A matsayin misali, Hukumar Lafiya ta Danish ta yi gargadin cewa ƙara benzodiazepine zuwa neuroleptic yana ƙaruwa da mace-mace da kashi 50-65%.15
Na uku, rabin duk mutuwar ba a samu ba a cikin rahotannin gwaji da aka buga.16 Ga ciwon hauka, bayanan da aka buga sun nuna cewa ga kowane mutum 100 da aka yi musu magani da sabon neuroleptic na makonni goma, an kashe majiyyaci ɗaya.17 Wannan babban adadin mutuwa ne ga magani, amma bayanan FDA akan gwaje-gwaje iri ɗaya sun nuna ya ninka sau biyu, wato marasa lafiya biyu da aka kashe a cikin 100 bayan makonni goma.18 Kuma idan muka tsawaita lokacin lura, adadin wadanda suka mutu ya karu. Wani bincike na Finnish na 70,718 mazauna al'umma da aka gano da cutar Alzheimer ya ruwaito cewa neuroleptics suna kashe mutane 4-5 a cikin 100 kowace shekara idan aka kwatanta da marasa lafiya da ba a kula da su ba.19
Na huɗu, ƙirar gwajin magungunan tabin hankali yana da son zuciya. A kusan dukkan lokuta, marasa lafiya sun riga sun sami magani kafin su shiga gwajin.2,7 kuma wasu daga cikin waɗanda bazuwar zuwa placebo za su fuskanci sakamakon janyewar da zai ƙara haɗarin mutuwa, misali saboda akathisia. Ba zai yiwu a yi amfani da gwajin sarrafa placebo a cikin schizophrenia don ƙididdige tasirin neuroleptics akan mace-mace ba saboda ƙirar janyewar ƙwayoyi. Yawan kashe kansa a cikin waɗannan gwaje-gwajen marasa da'a ya ninka sau 2-5 fiye da na yau da kullun.20,21 Ɗaya daga cikin kowane marasa lafiya 145 da suka shiga gwajin risperidone, olanzapine, quetiapine, da sertindole sun mutu, amma babu ɗayan waɗannan mutuwar da aka ambata a cikin wallafe-wallafen kimiyya, kuma FDA ba ta yi ba.
suna bukatar a ambace su.
Na biyar, abubuwan da suka faru bayan an dakatar da shari'ar an yi watsi da su. A cikin gwaje-gwajen Pfizer na sertraline a cikin manya, haɗarin kashe kansa da yunƙurin kashe kansa ya kasance 0.52 lokacin da bin diddigin ya kasance awanni 24 kawai, amma 1.47 lokacin da bin bin ya kasance kwanaki 30, watau karuwa a cikin abubuwan kashe kansa.22 Kuma lokacin da masu bincike suka sake nazarin bayanan gwaji na FDA game da magungunan damuwa kuma sun haɗa da lahani da ke faruwa a lokacin biyo baya, sun gano cewa kwayoyi sun ninka adadin kashe kansa a cikin manya idan aka kwatanta da placebo.23,24
A cikin 2013, na kiyasta cewa, a cikin mutane masu shekaru 65 zuwa sama, neuroleptics, benzodiazepines, ko makamantansu, da magungunan baƙin ciki suna kashe mutane 209,000 kowace shekara a Amurka.2 Na yi amfani da ƙididdiga masu ra'ayin mazan jiya, duk da haka, da bayanan amfani daga Denmark, waɗanda suka yi ƙasa da na Amurka. Don haka na sabunta bincike bisa bayanan amfani da Amurka, na sake mai da hankali kan rukunin tsofaffi.
Don neuroleptics, na yi amfani da kimantawar 2% mace-mace daga bayanan FDA.18
Ga benzodiazepines da makamantansu, binciken da aka yi daidai da ƙungiyar ya nuna cewa magungunan sun ninka adadin mutuwar, kodayake matsakaicin shekarun marasa lafiya ya kasance 55 kawai.25 Yawan mutuwa ya kai kusan 1% a kowace shekara. A cikin wani babban, binciken ƙungiyar da ya dace, abin da ke shafi rahoton binciken ya nuna cewa hypnotics ya ninka adadin mutuwa sau huɗu (rabin haɗari 4.5).26 Wadannan marubuta sun kiyasta cewa kwayoyin barci suna kashe tsakanin Amurkawa 320,000 zuwa 507,000 kowace shekara.26 Ƙididdiga mai ma'ana na adadin mutuwa na shekara zai zama 2%.
Ga SSRIs, binciken ƙungiyar Burtaniya na 60,746 masu tawayar marasa lafiya da suka girmi 65 sun nuna cewa sun haifar da faɗuwa kuma magungunan sun kashe 3.6% na marasa lafiya da aka yi wa magani na shekara guda.27 An yi binciken da kyau sosai, misali marasa lafiya sun kasance masu sarrafa kansu a cikin ɗayan nazarin, wanda shine hanya mai kyau don kawar da tasirin rikice-rikice. Amma abin mamaki adadin masu mutuwa ya yi yawa.
Wani bincike na ƙungiyar, na 136,293 mata masu zaman kansu na Amurka (shekaru 50-79) da ke shiga cikin Nazarin Harkokin Kiwon Lafiyar Mata, sun gano cewa kwayoyi masu ciki suna hade da karuwar 32% a cikin duk abin da ke haifar da mace-mace bayan daidaitawa don dalilai masu rikitarwa, wanda ya dace da 0.5% na matan da SSRI suka kashe lokacin da aka bi da su na shekara guda.28 Wataƙila an yi la'akari da adadin mutuwar. Marubutan sun yi gargadin cewa ya kamata a fassara sakamakonsu da taka-tsan-tsan, domin yadda aka gano kamuwa da magungunan kashe-kashe na dauke da babbar kasadar rarrabuwar kawuna, wanda zai sa a samu karuwar mace-mace. Bugu da ari, marasa lafiya sun kasance ƙanana fiye da na binciken Burtaniya, kuma adadin mutuwar ya karu sosai tare da shekaru kuma ya kasance 1.4% ga waɗanda ke da shekaru 70-79. A ƙarshe, matan da aka fallasa da waɗanda ba a bayyana ba sun bambanta don yawancin mahimman abubuwan haɗari na mutuwa da wuri, yayin da mutanen ƙungiyar Burtaniya ke da ikon kansu.
Don waɗannan dalilai, na yanke shawarar yin amfani da matsakaicin ƙididdiga biyu, adadin mutuwar 2% na shekara-shekara.
Waɗannan sakamakona ne na Amurka na waɗannan rukunin magunguna guda uku na mutane aƙalla shekaru 65 (miliyan 58.2; amfani yana cikin marasa lafiya ne kawai):29-32
Iyakance a cikin waɗannan ƙididdiga shi ne cewa za ku iya mutuwa sau ɗaya kawai, kuma mutane da yawa suna karɓar kantin magani. Ba a bayyana yadda ya kamata mu daidaita don wannan ba. A cikin binciken ƙungiyar Burtaniya na masu fama da baƙin ciki, 9% kuma sun ɗauki neuroleptics, kuma 24% sun ɗauki hypnotics/anxiolytics.27
A gefe guda kuma, bayanai kan adadin mace-macen sun fito ne daga binciken da majiyyata da dama suka kasance a kan magungunan masu tabin hankali a cikin rukunin kwatancen, don haka wannan ba zai yiwu ya zama babban iyakance ba idan aka yi la'akari da cewa polypharmacy yana ƙaruwa da mace-mace fiye da abin da ɗayan magungunan ke haifarwa.
Ƙididdiga daga Cibiyoyin Kula da Cututtuka da Cututtuka sun lissafa waɗannan manyan abubuwan da ke haifar da mutuwa:33
Ciwon zuciya: 695,547
Ciwon daji: 605,213
Covid-19: 416,893
Hatsari: 224,935
Mutuwar Covid-19 na raguwa cikin sauri, kuma yawancin irin waɗannan mutuwar ba kwayar cutar ta haifar ba amma sun faru ne a cikin mutanen da suka gwada ingancinta saboda WHO ta ba da shawarar cewa duk mace-mace a cikin mutanen da suka gwada ingancin ya kamata a kira su mutuwar Covid.
Matasa suna da ƙarancin mutuwa fiye da tsofaffi, saboda da wuya su faɗi kuma suna karya kwatangwalo, shi ya sa na mai da hankali kan tsofaffi. Na yi ƙoƙarin zama mai ra'ayin mazan jiya. Ƙidayata ta rasa yawancin mutuwar ƙwayoyi a cikin waɗanda ba su wuce shekaru 65 ba; kawai ya haɗa nau'o'i uku na magungunan tabin hankali; kuma bai hada da mutuwar asibiti ba.
Don haka ba na shakkar cewa magungunan tabin hankali sune na ukun da ke haddasa mutuwa bayan cututtukan zuciya da ciwon daji.
Sauran Kungiyoyin Magunguna da Mutuwar Asibiti
Magungunan analgesics kuma manyan kisa ne. A cikin Amurka, kusan mutane 70,000 ne aka kashe a cikin 2021 ta hanyar wuce gona da iri na opioid roba.34
Hakanan amfani da NSAIDs yana da girma. A Amurka, kashi 26% na manya suna amfani da su akai-akai, 16% daga cikinsu suna samun su ba tare da takardar sayan magani ba35 (mafi yawa ibuprofen da diclofenac).36
Kamar yadda babu wani babban bambance-bambance tsakanin magungunan a cikin karfinsu na haifar da thromboses.37 Za mu iya amfani da bayanai don rofecoxib. Merck da Pfizer ba su ba da rahoton abubuwan da suka faru na thrombotic a cikin gwajin su na rofecoxib da celecoxib, bi da bi, har ya zama zamba.1 amma a cikin gwaji guda ɗaya, na adenomas colorectal, Merck ya kimanta abubuwan da suka faru na thrombotic. Akwai ƙarin lokuta 1.5 na ciwon zuciya na zuciya, mutuwar zuciya ta kwatsam ko bugun jini akan rofecoxib fiye da na placebo a cikin 100 marasa lafiya da aka yi wa magani.38 Kusan kashi 10% na thromboses na mutuwa ne, amma bugun zuciya ba kasafai ba ne a cikin matasa. Ƙuntata bincike ga waɗanda ke da shekaru aƙalla 65, muna samun mutuwar 87,300 kowace shekara.
An kiyasta cewa mutuwar mutane 3,700 na faruwa a kowace shekara a Burtaniya saboda rikice-rikicen cututtukan peptic a cikin masu amfani da NSAID,39 wanda ya yi daidai da mutuwar 20,000 kowace shekara a Amurka. Don haka, jimillar kiyasin mutuwar NSAID kusan 107,000 ne.
Idan muka ƙara kididdigar da ke sama, mutuwar asibitoci 315,000, mutuwar magungunan tabin hankali 390,000, mutuwar opioid roba 70,000, da mutuwar NSAID 107,000, muna samun mutuwar kwayoyi 882,000 a Amurka kowace shekara.
Yawancin magungunan da aka saba amfani da su ban da wadanda aka ambata a sama na iya haifar da dizziness da faduwa, misali magungunan anticholinergic na urination na yoyon fitsari da magungunan dementia, wanda kashi 1% da 0.5% na al'ummar Danish ke amfani da su, bi da bi, duk da cewa ba su da wani tasiri na asibiti.1,2
Yana da wuya a iya sanin hakikanin adadin magungunan da muke kashewa, amma ko shakka babu su ne kan gaba wajen mutuwa. Kuma adadin wadanda suka mutu zai fi haka idan muka hada da mutanen kasa da shekaru 65. Bugu da ƙari, daga adadin adadin mace-mace daga cututtukan zuciya, muna buƙatar rage waɗanda NSAIDs ke haifar da su, da kuma daga hatsarori, mutuwar faɗuwar da magungunan tabin hankali da wasu magunguna da yawa ke haifarwa.
Idan da irin wannan cuta mai saurin kisa da ƙwayoyin cuta ne suka haifar da ita, da mun yi duk abin da za mu iya don shawo kan ta. Abin takaici shi ne cewa za mu iya shawo kan cutar ta mu cikin sauƙi, amma idan 'yan siyasarmu suka yi aiki, yawanci suna daɗa muni. Masana'antar miyagun ƙwayoyi sun shaku da su sosai har ka'idojin miyagun ƙwayoyi sun zama masu halatta fiye da yadda ake yi a baya.40
Yawancin mutuwar kwayoyi ana iya hana su,41 sama da duka saboda yawancin majinyatan da suka mutu ba sa bukatar maganin da ya kashe su. A cikin gwaje-gwajen da aka sarrafa placebo, tasirin neuroleptics da magungunan baƙin ciki sun kasance ƙasa da ƙarancin tasirin da ya dace na asibiti, kuma don baƙin ciki mai tsanani.2,7 Kuma, duk da sunansu, wadanda ba steroidal, anti-inflammatory kwayoyi, NSAIDs ba su da anti-mai kumburi effects,1,42 kuma sake dubawa na tsari sun nuna cewa tasirin analgesic ɗin su yayi kama da na paracetamol (acetaminophen). Duk da haka, yawancin marasa lafiya da ke fama da ciwo ana ba da shawarar su dauki paracetamol da NSAID a kan kantuna. Wannan ba zai ƙara tasirin ba, kawai haɗarin mutuwa.
Mafi yawan abin takaici, manyan likitocin masu tabin hankali a duk faɗin duniya ba su fahimci yadda magungunansu ba su da tasiri da haɗari. Wani likitan hauka na Amurka, Roy Perlis, farfesa a Harvard, yayi jayayya a cikin Afrilu 2024 cewa yakamata a siyar da kwayoyin cutar ta hanyar kan layi saboda suna da "lafiya da inganci."43 Ba su da aminci sosai kuma ba su da tasiri. Perlis ya kuma yi iƙirarin cewa magungunan baƙin ciki ba sa ƙara haɗarin kashe kansa a cikin mutanen da suka girmi 25, wanda kuma ba daidai ba ne. Suna ninka kashe kansa a cikin manya.23,24
Perlis ya rubuta, "Wasu har yanzu suna tambayar tushen ilimin halitta na wannan cuta, duk da gano wasu kwayoyin halitta sama da 100 waɗanda ke haɓaka haɗarin baƙin ciki da binciken neuroimaging da ke nuna bambance-bambance a cikin kwakwalwar mutanen da ke cikin damuwa." Duk waɗannan da'awar ba daidai ba ne. Nazarin ƙungiyar kwayoyin halitta sun taso hannu wofi kuma haka ma nazarin hoton kwakwalwa, waɗanda gabaɗaya suna da nakasu sosai.44 Mutane suna cikin baƙin ciki saboda suna rayuwa mai raɗaɗi, ba saboda wasu cututtukan kwakwalwa ba.
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