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Still, there's little doubt about how debilitating a B12 deficiency can be. Silverstein also said he didn't know if over-prescription was a problem in other provinces. said to me, 'I don't know how you're standing on your feet. His study could not determine why family physicians were prescribing it inappropriately - including whether it was initiated by the doctor or at the request of the patient. Silverstein said he decided to investigate the over-prescribing of B12 shots, because "as an internal medicine resident, I have seen many patients come into the emergency department, and they were getting B12 injections without having a really good reason for it." She has since switched to over-the-counter tablets that doctors say are just as effective. Kema Dwarka, 79, used to receive vitamin B12 shots after being diagnosed with a deficiency. Long-term deficiency can lead to cognitive problems. People who don't get enough of the essential vitamin can experience nausea, fatigue, dizziness or depression among other symptoms. Over-the-counter B12 tablets are a fraction of the cost of shots, and have been shown in a British-Canadian study to work just as well for most people, although some people with digestive conditions may have difficulty absorbing the vitamin in tablet form.ī12 is found in animal-based sources such as meat, fish, poultry, eggs, and dairy products. Silverstein and his colleagues calculated the inappropriately prescribed shots needlessly cost the province's health-care system $45.6 million annually. "But we were quite surprised that it was the number was as high as it was." William Silverstein of the University of Toronto. "We know that's a lot of inappropriate care that happens in Canada," said study co-author Dr. Of those, 93,615 (64 per cent) either had tests confirm they already had normal B12 levels, or they weren't tested at all. The study used databases at the Toronto-based Institute for Clinical Evaluative Sciences to review the patient records of 146,850 residents of the province aged 65 or over who were prescribed regular vitamin B12 shot between January 2011 and October 2015. Almost two-thirds of Ontario seniors who received vitamin B12 shots had no evidence of a B12 deficiency, according to a study published in the medical journal JAMA Internal Medicine.