Trends in Rx Use Among Adults
Prescription Drug Use Up
Prevalence of use increased in 11 drug classes, among the 18 drug classes used by more than 2.5% of the population. Findings were published in a recent article in JAMA "Trends in Prescription Use Among Adults in the United States From 1999-2012"
Antihypertensive use increased from 20% to 27% with increases seen in most drug classes. The increase in thiazide diuretics is notable given they were recommended as first-line therapy by JNC7. Use of drugs to treat high cholesterol, particularly statins, also increased (6.9-17%). This study preceded the 2013 ACC/AHA recommendations, guidelines which expanded statin use.
Use of antidepressants increased (6.8%–13%) with SSRIs (4.3-–8.5%) and SNRIs (0.4-2.0%) being the most prescribed. The increase may reflect the shifting attitudes regarding depression.
The use of narcotic analgesics increased from 3.8% to 5.7%, although use stabilized after 2003-2004. The flattening trend may be tied to increased awareness of prescription opioid misuse and abuse. COX-2 inhibitor use declined from 1.9% to 0.6%. Overall, prescription pain med use remained stable (11%). Muscle relaxant use increased from 1.2% to 2.5%.
Sex hormone use among women declined (19% to 11%), primarily because of a decline in noncontraceptive hormones (comprised largely of menopausal HRT). This is an interesting finding given conjugated estrogens once were the most commonly used prescription drug.
Antidiabetic drug treatment increased from 4.6% to 8.2%. Increases were seen in biguanides, insulin, and sulfonylureas. Thiazolidinedione use remained unchanged overall. Metformin is now the 5th most commonly used drug.
Proton pump inhibitor use increased from 3.9% to 7.8%.It is unclear how the use of prescription PPIs will be affected by increasing OTC availability.
Use of anticonvulsants increased from 2.3% to 5.5%. Several of these drugs have alternative indications which may account for the increased use.
Use of bronchodilators increased from 3.2% to 5.2%, with a sharp increase in bronchodilator combinations. After 2008, the trend stabilized possibly due to the FDA advisory regarding the use of long-acting beta-adrenergic agonists.
Use of antibiotics decreased from 5.7% to 4.2%.
Why the Increases?
“Eight of the 10 most commonly used drugs in 2011–2012 are used to treat components of the cardiometabolic syndrome, including hypertension, diabetes, and dyslipidemia. Another is a proton-pump inhibitor used for gastroesophageal reflux, a condition more prevalent among individuals who are overweight or obese. Thus, the increase in use of some agents may reflect the growing need for treatment of complications associated with the increase in overweight and obesity,” the authors write.