It may seem perfectly obvious. You’ve got a sinus infection. Your doctor writes you a script for amoxicillin. You (in theory) complete the course of the med–viola, all’s well. (Well, that’s not exactly the truth. Usually it’s ‘viola–you’ve still got your sinus infection,’ but let’s just stipulate so we can move on.)
If your sole experience with prescription meds is some infection every five to ten years–you’re really on the outs.
Because Americans like prescription medication. They like it a whole lot. Enough to spend $234.1 billion per year on it (and that was as of 2008).
A Mayo Clinic study published just this year found that almost 70% of Americans takes at least 1 prescription drug, and over 50% takes two. And one in (brace yourself) five takes five or more prescription medications.
Spending on prescription drugs climbed to $250 billion in 2009, accounting for 12 percent of total personal health care expenditures.
But here’s the thing–while we as Americans clearly like our prescription meds a lot–we may not like this corollary: after spending the first hundreds of billions to purchase the meds, Americans then spend an additional $177 billion a year on medications to fix the problems caused by that first batch.
American HealthCare points out that there are over 700,000 ER visits each year due to incorrect use of prescription medication, 120,000 of which will end up resulting in admissions. Hospital costs alone are $3.5 billion per year.
Shocking as these numbers are, for a real shakeup, let us move from misuse to abuse. The Centers for Disease Control note that overdose from prescription painkillers quadrupled in the US from 1999 (4,030 deaths) to 16,651 in 2010. In the first decade of this century, according to Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, 125,000 lives were lost to legal drugs, like Vicodin, OxyContin and methadone.
The CDC also point out that drug overdoses now kill more Americans than do car crashes. Drug overdoses killed over 38,000 people in 2010, totalling 105 deaths per day. Of these, prescription pain killers accounted for 165,000 deaths, or 45 a day.
And (I’m a statistic sucker in general-I know you could never tell–but this one, behind its dreadfulness, kind of tickled me:) there were enough painkillers prescribed in 2010 to medicate every single American adult every four hours for one month.
The CDC was not amused by the misuse OxyContin, Opana, Vicodin and the like, saying in 2011, “Overdoses involving prescription painkillers are at epidemic levels and now kill more Americans than heroin and cocaine combined.”
And then, as if accidental misuse and downright abuse wasn’t enough, there’s. . .sharing. For real.
This one’s truly hard for me to envision. I try to picture it: I see a friend come in, I hang up her coat, offer her a glass of water–no; perhaps a cup of tea? No, not a tea-drinker; would she rather sit on the sofa in the dining room or on the straight-backed chairs in the living room? Oh–need to sit up straight due to back trouble? Fine, fine, ok–Cookie? Yes? Great–and would you like a 300 mg dose of lithium to go with that?
I mean, really.
But crazy and awkward as I may think it is, according to research published in the Journal of Women’s Health, 28.8% of women and 26.5% of men said they had shared or borrowed someone else’s prescription medication during their lifetime.
Just to satisfy your curiosity (if you had any), women were guilty of this far more than men, with the highest offenders aged 18-44, and the most commonly borrowed medications for that group were for: allergies (43.8%), pain (42.6%), and antibiotics (32.3%).
And just to make things more complicated, Medscape found a number of patients follow the (not totally illogical) thought process to its conclusion, thinking, “If 1 pill is good, then 2 pills should be twice as good.” (Apparently it isn’t Medscape alone who’s run into these folks. They showed up as well in “Medication Adherence in America: A National Report Card,” which I particularly enjoyed reading; it shared the illuminating reason–according to survey–for the vast amount of medical non-adherence to medication regimes in this country (this fascinating information is coming up–hang in there): People forget. Americans earned a C+ on this years Report Card.
Anyway, each one has a theme. This year’s is “Be Medicine Smart,” which sounds like something I’d be all for, if I could figure out what in the world it meant. Fortunately we get a little help over here in that the “focus” of the month (and I do not know how that differs from the “theme,” you will have to ask someone else) is improving medication adherence.
NOW you’re talking. I’d love to impress you with my extensive knowledge on this topic, but I think there’s a word for it (what comes to mind is self-plagiarism), since, in my Clark-Kent blogging job I published a piece entitled “The ‘Other’ Drug Problem,” where I discuss precisely this.
I believe no discussion of medication adherence is complete without the profound words of C. Everett Koop, U.S. Surgeon General under President Reagan, who was, as Salon pointed out it, the only Surgeon General to become a household name.
Dr. Koop had something worth saying when it came to medication. While up to now we’ve addressed over-taking medication, taking the wrong medication, or taking your friend’s medication–mis-use of medication includes not taking your prescribed medication. And, said Dr. Koop:
“Drugs don’t work in patients who don’t take them.”
It’s hard to argue the point.
Just a quick look at the scope of the problem:
Among patients with chronic illness, approximately 50% do not take medications as prescribed. Let’s look at the most commonly prescribed meds.
As many as 50% to 80% of those being treated for hypertension fail to adhere to their medication regimens.
How about statins (which can have a great impact on preventing a heart attack)? Within 6-12 months after receiving the script, 25-50% had discontinued them–and at the end of 2 years, nonadherance is as high as 75%.
Prescriptions for mental illness? Magura et al found that, for major depressive disorder, nonadherence is between 28-52% (granted a rather large range), 20-50% for bipolar disorder, and 20-72% for schizophrenia (and I’m really skeptical about that 20%).
So. . . what to do? Frankly, I was shocked by what the National Council on Patient Information and Education (the group that spearheads this month) recommended to become “medicine smart.” I mean, do we as a group really need to be told among 9 important things you can do to make you “Medicine Smart” to:
- Recognize that all medicines have risks?
- Make a list of the meds we’re on–and actually share that with the doctor who is about to prescribe something new?
- Store our medicine in a safe place–where children can’t get to it?
However, they seemed to offer an excellent resource on the Talk About Prescriptions Month site: a link whereby you could take your pack of pills which (does this happen to other people?) wind up all jumbled together in the wrong container, and actually identify which pill you should take for your gall bladder and which is meant to treat your toe fungus.
Maybe by the time this goes out that link will actually work, but right now it seems to have the same illness as all the government health sites.
So. . .I don’t want to leave you hanging with your antibiotics and your mood stabilizers confounded. Take the whole passel to Drugs.com, click on Pill Identifier, type in the imprint on your pill, then the pill’s shape and color–and you can separate your antihypertensives from your metformin.
I wish you the best of luck with that–and, remember, if you have anything to say about your Prozac or your Miralax, well, come right out and say it. This is the month–but your days are numbered.