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 β-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.