The U.S. currently sits dead last in a health ranking of affluent countries. This is largely attributed to the fact that less than 3% of Americans meet the basic qualifications of a “healthy lifestyle” and only 37.9% follow a healthy diet. Additionally, the U.S. population is growing more dependent on prescription drugs to stem the side effects that result from declining health—75% of healthcare treatment is for preventable, chronic diseases such as obesity. Making simple lifestyle improvements could save America up to $87 billion annually on healthcare expenditures.
The Mayo Clinic published a study of the prescription drug usage of the entire population of Olmsted County, Minnesota for the year 2009. The idea was to obtain information on drug usage in a population that is very similar to the entire population of the United States. Overall:
- 68.1% of this population received one or more prescriptions;
- 51.6% received 2 or more prescriptions; and
- 21.2% received 5 or more prescriptions.
The most commonly prescribed drugs were penicillin and ?-lactam antibiotics (17%), followed by antidepressants (13%), narcotic pain medications (12%), and lipid-lowering drugs (11%). While prescribing patterns differed by age and sex, vaccines, antibiotics, and anti-asthmatic drugs were most commonly prescribed in those younger than 19 years of age. Antidepressants and pain medication were most commonly prescribed in the middle-aged adults. Cardiovascular drugs were most commonly prescribed in older adults. Women received more prescriptions than men, especially for antidepressants.
A more recent report from the Center for Disease Control and Prevention underscores the increasing use of prescription drugs with the percent of persons using at least one prescription drug in the past 30 days: 48.7%. The most commonly used drugs now are pain medications, lipid-lowering drugs, and anti-depressants. Both of these reports demonstrate the wide-spread use of prescription medication in the U.S.A.
What is the difference between drug use, drug dependence, and drug addiction?
Many people in the U.S.A. take a prescription medication to treat a medical problem and obtain a benefit from the drug. The prescription medication is stopped when the medical problem is no longer present. This is a simple drug use. If the medical problem lasts a long time—months to years—it is a chronic problem requiring drug refills. In this situation, the patient depends upon this drug to treat the chronic medical problem. And in the event the drug is stopped and the medical problem worsens, the patient will depend even more on this drug for relief. This is drug dependence.
Drug dependency occurs in chronic drug use and involves “withdrawal symptoms” which vary from mild to severe discomfort depending upon the specific drug and the specific condition.
Drug addiction involves a drug dependency and chemical changes in the brain that cause compulsive drug seeking behavior despite the potential for harmful consequences.
Addiction is a complex brain disease with frequently overlapping expressions involving nicotine, alcohol, and other drugs. Yet, current healthcare practices, public policies, and national treatment data often exclude nicotine or address its use as completely separate from other forms of substance use and addiction—compromising patients’ health and incurring unnecessary healthcare costs. Effective prevention and treatment require the inclusion of nicotine in a comprehensive approach addressing all manifestations of addiction within healthcare policy and practice.
How much of this drug use is inappropriate?
It is difficult to find objective data for inappropriate drug usage in 2015 or 2016. It is important how a study defines “inappropriate”. One definition that is simple is an adverse drug reaction (ADR) requiring admission to a hospital. In England in 2004, there were 1,225 admissions related to an ADR, giving a prevalence of 6.5%, with the ADR directly leading to the admission in 80% of cases. The median bed stay was eight days, accounting for 4% of the hospital bed capacity. The projected annual cost of such admissions was $847M. The overall fatality was 0.15%. Most reactions were either definitely or possibly avoidable. Drugs most commonly implicated in causing these admissions included low-dose aspirin, diuretics, warfarin, and non-steroidal anti-inflammatory drugs other than aspirin, the most common reaction being gastrointestinal bleeding.
In the United States, there were approximately 99,628 emergency hospitalizations (95% confidence interval for adverse drug events in adults 65 years of age or older. Nearly half of these hospitalizations were among adults 80 years of age or older. Nearly two-thirds of hospitalizations were due to unintentional overdoses. The four most commonly involved medications included: warfarin (33.3%), insulins (13.9%), oral antiplatelet agents (13.3%), and oral hypoglycemic agents (10.7%).
In homebound geriatric adults, one study found a total of 2,193 people—aged 60 to 106—taking an average of 5 drugs. Cardiac drugs and benzodiazepines were the medications most commonly prescribed. The study found 1,152 of the total 11,689 prescriptions (9.9%) to be inappropriate. Eight hundred seventy-one (39.7%) of these 2193 residents had at least one inappropriate prescription, and 230 (10.4%) had two or more. Of particular concern were 285 people prescribed excessive doses of temazepam and zolpidem, 211 people taking first-generation antihistamines, 115 taking doxepin or amitriptyline, 106 taking an ergoloid, 98 taking dipyridamole, and 85 prescribed a long-acting benzodiazepine. Thus a high prevalence of psychotropic medications and inappropriate drug use among older homebound residents.
In 2015, these are the available facts regarding drug usage:
- In 2013, an estimated 24.6 million Americans aged 12 or older—9.4% of the population—had used an illegal drug in the past month. This number is up from 8.3% in 2002. The increase mostly reflects a recent rise in use of marijuana, the most commonly used illicit drug. Today, with the legalization of marijuana in some states, this is a difficult area to discuss.
- In 2013, 6.5 million Americans aged 12 or older (or 2.5%) had used prescription drugs nonmedically in the past month. Prescription drugs include pain relievers, tranquilizers, stimulants, and sedatives. And 1.3 million Americans (0.5%) had used hallucinogens (a category that includes ecstasy and LSD) in the past month.
- Substance Abuse and Mental Health Services Administration (SAMHSA) conducts the annual National Survey on Drug Use and Health (NSDUH), a major source of information on substance use, abuse, and dependence among Americans 12 years and older.
According to a Columbia University study, “40 million Americans age 12 and over meet the clinical criteria for addiction involving nicotine, alcohol or other drugs.” That’s more Americans than those with heart disease, diabetes, or cancer. An estimated additional 80 million people in this country are “risky substance users,” meaning that while not addicted, they “use tobacco, alcohol, and other drugs in ways that threaten public health and safety.” The costs to government coffers alone (not including family, out-of-pocket, and private insurance costs) exceed $468 billion annually. Over 38,000 people died of drug overdoses in the U.S. in 2010, greater than the deaths attributed to motor vehicle accidents, homicides, and suicides. Overdose deaths from opioids (narcotic pills like Oxycontin, Percodan, and Methadone as well as heroin) have become the fastest growing drug problem throughout the U.S., and not just in large urban settings.
Essentially, healthcare expenditures and drug use, addiction, and dependency in the United States is a growing problem—and one that doesn’t seem destined to disappear anytime soon. Rather than relying on prescription drugs to “cure” a problem, in many cases, the better treatment option is making simple lifestyle adjustments such as better eating habits and adding regular exercise to one’s routine.