“Washington is such a strange place. You stand up to say something in Congress, nobody listens and then everybody disagrees.”
Those comments from Will Rogers, made almost 100 years ago, still apply today — except on one subject, prescription drugs.
Politicians and voters agree in overwhelming numbers that the cost of drugs is too high — recent polls show that 80 percent of Americans think the price of prescription medications are “unreasonably” high.
The total bill for prescriptions is well in excess of $300 billion a year, the highest spending rate of any country in the world. That translates to more than $1,200 in out of pocket costs for every citizen.
In addition to cost, the other ugly fact about prescription drugs is that Americans are just taking way too many of them.
The opioid crisis has been well documented: the National Institute of Drug Abuse reports that 130 people die every day from opioid overdose. In terms of dollars, the Centers for Disease Control and Prevention estimates that $78.5 billion a year is spent on healthcare, lost work production, criminal justice proceedings and other opioid related consequences.
But there is another type of drug consumption, lethal and costly as well, which sometimes gets lost in the opioid publicity. Experts call it Polypharmacy, which means taking excessive numbers of prescription drugs.
“The problem has gotten worse because the average American is on a lot more medications than 15 years ago,” says Dr. Rita Redberg of the University of California San Francisco.
Indeed we are — nearly 50 percent of Americans take four or more prescription drugs a day. And as we grow older, the consumption really accelerates. 40 percent of those over the age of 62 take five or more prescriptions a day, while 13 percent take ten or more.
These are not desperate addicts looking for a fix — these are patients with health problems, many of them longstanding conditions.
Teresa Carr, the health journalist who wrote Too Many Meds? America’s Love Affair with Prescription Medicine, points out that not only do we take too many drugs we don’t need, but we also take drugs prematurely — e.g., when non-drug options like exercise or some other lifestyle change might be tried first.
Popping a pill is a lot easier than going to the gym or pushing away from the table.
Polypharmacy is a very easy practice to slide into — it’s almost a natural consequence of multimorbidity (treating two or more healthcare problems).
For example, heart disease and high blood pressure can go hand-in-hand. Combinations of two or three medications in these cases are often required. Treating accompanying symptoms may also require another medication.
Medical researchers underscore the importance of seeing a primary physician on a regular basis — this physician, who is familiar with the patient’s history and prescriptions, is in the best position to perform appropriate medication management.
Without this appropriate management, the impact of ingesting combinations of prescriptions can be quite negative. The interaction of these substances can produce a broad range of serious clinical incidents. In the last decade, 25 million hospital admissions connected to drug management have occurred.
The Aging Research Center, in a study on the impact of Polypharmacy, concluded: “Caring for the growing number of older people with complex drug regimens and multimorbidity presents an important challenge in the coming years.”
The Lown Institute puts it more bluntly: “If nothing is done to change current practices, medication overload will lead to premature deaths of at least 150,000 older people in the U.S. over the next decade and it will reduce the quality of life of millions more.”
In a nation where five billion prescriptions are filled each year, cost containment is clearly imperative — but so is treatment management. Paying close attention to the number of drugs we are taking is not just prudent, it may be lifesaving.