More than 4.02 billion prescriptions. written annually
Americans spent $307.4 billion on prescription drugs in 2010, representing more than 4.02 billion prescriptions.
The 10 most-prescribed drugs in the U.S. are:
Hydrocodone (codeine combined with Tylenol) — 131.2 million prescriptions;
Generic Zocor (simvastatin), a cholesterol-lowering drug — 94.1 million prescriptions;
Lisinopril (Prinivil and Zestril), a blood pressure drug — 87.4 million prescriptions;
Generic Synthroid (levothyroxine), synthetic thyroid hormone — 70.5 million prescriptions;
Generic Norvasc (amlodipine), an angina/blood pressure drug — 57.2 million prescriptions;
Generic Prilosec (omeprazole), for esophageal reflux — 53.4 million prescriptions;
Azithromycin (Z-Pak and Zithromax), an antibiotic — 52.6 million prescriptions;
Amoxicillin (various brand names), an antibiotic — 52.3 million prescriptions;
Generic Glucophage (metformin), a diabetes drug — 48.3 million prescriptions;
Hydrochlorothiazide (HCTZ), a water pill used to lower blood pressure — 47.8 million prescriptions.
Seniors use majority of prescriptions
Although senior citizens currently comprise only 13 percent of the general population, they take more than a third of all the prescription drugs. Older Americans also use at least 25 percent of all over the counter (OTC) medications for many common conditions, including arthritis, insomnia, and pain control. That represents 60 million of the 240 million people in the U.S. currently using OTC medicines. This does not include natural or herbal supplements.
When I provide care to seniors it’s not unusual to see multiple pill bottles; some still filled with medications and others empty. Many are outdated and often there are multiple prescriptions with various doses of pills in them. And this is replicated throughout the country by the millions. In fact, nearly 90 percent of people over 60 take at least one prescription drug; 30 percent take five or more. The problem is exacerbated by the fact that multiple physicians may be caring for a patient with no awareness of each other’s treatments.
One of the dangers of specialty medicine referrals and over utilization of medications is “prescribing cascade.” This occurs when a side effect or adverse effect is not recognized for what it is. Patients who do not bring all of their medications to the doctor at each visit risk this potential occurrence. If the healthcare practitioner does not know all of the medications that the patient takes, they cannot make prudent decisions. Patients in turn who do not understand the side effects of a medication may overlook the side effect as a new symptom requiring treatment.
Disposal of drugs taxes healthcare system
Disposal of pharmaceuticals is an enormous problem in this country. Over one billion dollars’ worth of prescription drugs each year are either being stored in medicine cabinets or thrown away. And the majority is disposed of improperly, either in the garbage or flushed down the toilet.
The Associated Press has reported that the health-care industry is currently flushing an estimated 250 million pounds of unused or expired pharmaceuticals a year, creating a significant potential for environmental contamination.
One major source of unused drugs, according to The Pharmaceutical Research and Manufacturers of America (PhRMA), occurs in long-term care facilities, where 7-13 percent (1.5 million pounds) annually goes unused by patients.
The average census for a 120 bed nursing home is 108. If this nursing home generates, on the average, of $2,000 worth of controlled substances to be destroyed on a monthly basis, $24,000 worth of medication is destroyed annually. There are approximately 18,000 nursing homes in the United States. When you multiply these numbers, a staggering $432,000,000 annually is disposed of. These are only the controlled drugs and not all of the other medications that are not ingested. Keep in mind that these numbers do not include Assisted Living organizations. A conservative dollar amount would surpass a half a billion dollars!
Excluded from these numbers are the medications that individuals dispose of in their homes. No one has really captured these costs and the waste inherent in the number of drugs in distribution. Some of these medications are purchased from the local pharmacy while others are ordered from out of area pharmacy providers or even from another country.
While mail ordering medications may be cost effective, it can create other issues. Medications are often delivered in 90-day dose regimens to be cost effective. However, if a prescription or a dosing of a medication is changed, there is now 3 month of medication to dispose of. It is a good idea not to order the 90-day supply of medication until a consistent routine for a medication has been established. Speak to the healthcare provider to assess whether they feel the 90-day regimen is sound advice. The healthcare practitioner may have alternative plans which make the 90 day regimen less cost effective.
Drugs that have been administered are often not totally metabolized and these products are excreted through urine and stool into the environment. This is, of course, a risk that cannot be modified.
One of the inherent problems regarding the number of drugs in use is that patients cannot return prescription drugs once they take possession. No licensed pharmacy is legally permitted to accept returns. Furthermore, the Drug Enforcement Administration (DEA) does not allow the return and reuse of any controlled substance, regardless of the resident’s prescription plan payer.
The two major classes of prescription drugs
All medications need special handling when they are discarded so they aren’t consumed by drug abusers, pets, and unsuspecting children. Two classes of prescription drugs in particular require special care when they are discarded:
• Medications that are regulated as “controlled substances” by the U.S. Drug
Enforcement Administration (DEA) which generally include medications that have a potential for abuse and physical or psychological dependence (i.e., narcotics, stimulants, depressants and sleeping pills.)
• Medications that are made from chemicals that are regulated or considered “hazardous wastes.” Examples of these medications include drugs for cancer called chemotherapeutics.
One class of medication that should not require disposal is antibiotics. When antibiotics are prescribed all of the pills should be consumed, so there should not be any leftover. Unnecessary antibiotics are often prescribed because patients put pressure on their healthcare provider to prescribe them. However, in many instances patients will not take all of their antibiotics because they feel better. These two issues are leading to drug resistant organisms that are not sensitive to any antibiotic on the market.
How can medications be disposed of safely?
A good online resource for safe medication disposal is DisposeMyMeds.org, managed by The National Community Pharmacists Association (NCPA®), which can help you to find medication disposal programs at the local independent community pharmacy near you.
The recommended way to discard of drugs is through your community’s medicine take-back programs where at certain times of the year, the city or county government ‘s household trash and recycling service will pick up out of date, unused or unwanted prescription drugs. Many communities also have a designated location to drop off drugs.
You can contact your local community government office for information, or talk to your pharmacist to see if he or she knows of other medicine disposal programs in your area or visit the U.S. Drug Enforcement Administration’s website for information on National Prescription Drug-Take Back Events.
This country over prescribes medication, and under prepares how to dispose of drugs that are unused. Both pose health risks to everyone.
Mardy Chizek, RN, FNP, BSN, MBA, AAS
President, Charism Eldercare Services, Westmont, Illinois