Trends in Medication Use

The Journal of the American Medical Association contains an article detailing trends in use of prescription drugs.  (JAMA Article)   The data was generated from the National Health and Nutrition Examination Survey from the 1999/2000 to 2011/2012 period.  In 1999/2000, 51% of adults reported use of any prescription drug in the prior 30 days.  By 2011 to 2012 59% made such a report.  The number of adults saying they used five or more medications rose dramatically, from 8.2% in the earlier period to 15% in 2011/2012, including 39% of adults over the age of 65.  Rates of overall use and polypharmacy (five or more drugs) rose for men and women and across all adult age cohorts, but most slowly among the youngest group of adults.  Hispanics showed flatter increases in medication use compared to other races or ethnicities.  Among drug classes, lipid-lowering and high blood pressure medications showed the most rapid growth in prevalence of use, with anti-depressants also showing a significant rise in use.  Diabetes drugs and indigestion pills also incurred over 3% increases in prevalence, while other categories like pain meds, hormones and antibiotics experienced flatter prevalence growth.    Some drug use changes clearly track changes in guidelines or recommendations or FDA warnings.  The rise in polypharmacy, while understandable in light of the increase in the number of older Americans with multiple chronic conditions, is alarming because there is a much greater likelihood of unpleasant interactions among medications when five or more are being taken, as well as a likelihood of adverse effects from any one of the drugs.  Many of these interactions and adverse events are poorly recognized until a drug is in widespread use.  This widespread polypharmacy also creates an opportunity and need for much stronger medication therapy management.