Pill City

You know your life is changing when the number of prescription medications you take each day begins to inch its way up.

It’s a fact that Americans pop a lot of pills. I recently spent a few minutes researching this issue online and made some rather eye-opening discoveries. A report issued last year by the Kaiser Family Foundation estimated U.S. spending on prescription drugs at $234.1 billion in 2008. According to the report, the number of prescriptions increased 39 percent – from 2.8 billion to 3.9 billion – during the decade between 1999 and 2009.

Here’s the statistic that was really surprising: In 1999 the average number of retail prescriptions was 10.1 per capita. By 2009, this had risen to 12.6 per capita.

Some of these undoubtedly were one-time medications, such as a course of antibiotics, rather than pills being taken 365 days a year. But when you consider that some people get by with one or two prescriptions a year (or perhaps none at all), it’s clear from the math that plenty of others are probably making up for it, and then some, with significant quantities of prescription medications.

A couple more tidbits from the Kaiser Family Foundation report: About 62 percent of American households have at least some prescription drug expenses annually. The likelihood of spending money on prescription medications goes up with age; 58 percent of Americans under age 65 had at least one prescription in 2007, but for those older than 65, it was 90 percent.

Is this a bad thing? Not necessarily. When correctly prescribed and taken, medication undoubtedly helps people manage asthma, allergies, depression, diabetes, high blood pressure, pain and more, allowing them to function and possibly sparing them – or at least reducing their risk – of more serious problems down the road.

But there’s a dark side to all of this. The prevalence of prescription drug use in the U.S. has given rise to polypharmacy, or multiple prescriptions that can increase the risk of unwanted side effects and potentially dangerous drug interactions, especially among the elderly. There’s also “prescribing cascade,” which happens when a prescription medication produces side effects, the doctor prescribes another medication to combat the side effects, which results in yet more side effects, yet another medication and on and on.

Adherence can become an issue as well. It gets complicated when someone takes a dozen prescription medications daily – some once a day, others twice a day, some with food, some without, some that can be taken together, others that can’t. It can be challenging to even remember a regimen like this, let alone stick to it day after day.

For all of the apparent emphasis on pills, many people don’t like taking them. In a study conducted a few years ago, researchers queried older adults about their prescription medication habits and found multiple reasons why these individuals didn’t always take their pills. At the top of the list was cost – but people also often cited concerns about side effects and drug interactions, or didn’t really believe the drug was necessary.

There were some rather strong reactions to a CNN story earlier this year that asked, “Are you taking too many meds?” One person’s comment: “Big pharma is one of the greatest contributors to the wreck and ruination of America.” (I noticed that very few of the commenters addressed the opposite question: Are you not taking meds that would truly benefit your health?)

The truth probably lies somewhere in a gray zone. In recent years there seems to be a trend toward being more thoughtful when prescribing drugs. There’s growing awareness, for instance, that statins to lower cholesterol may not be all that helpful to individuals who have no previous history of heart attack. More recently, the effectiveness of multivitamins for middle-aged women has been called into question. Evidence-based guidelines are forcing more consideration of when a drug is genuinely appropriate.

Most of us are unlikely to get through life without needing a few prescription medications along the way. It’s smart to ask questions to make sure a prescription drug is truly necessary, and smart to take it if the honest answer is yes.

Photo: Wikimedia Commons