Pill Poppin People
The US has the highest prescription drug usage rate in the world. From statins to SSRIs, Americans are overmedicated it's taking it's toll, as we are still one of the least healthy populations.
The use of prescription medications dates back to ancient times, with records as early as 1820 BCE when Egyptian physicians prepared and prescribed drugs. In the early 1900s, opium, morphine, heroin, and cocaine were widely used in over-the-counter medicines, leading to addiction and subsequent regulation. The early 1900s saw several legislative acts passed to regulate these substances as the pharmaceutical industry began to take off.
After WWII the pharmaceutical industry saw a revolution in therapeutics, with significant discoveries and the development of new drugs like aspirin and barbiturates. The 1980s and 1990s saw a movement to expand the role of pharmacists in clinical settings, culminating in the Medicare Prescription Drug Improvement and Modernization Act of 2003. Even with increased regulatory oversight, prescription drugs have become a staple in American culture over the past few decades. The late 1990s to mid-2000s saw a dramatic rise in prescription drug abuse, leading to an epidemic level of misuse. By 2020, the U.S. filled approximately 6.3 billion prescriptions, with an average of 19 prescriptions per American, while spending on prescription drugs reached over $600B by 2022, with high costs affecting access and compliance. It’s almost difficult these days to find people who are not on one or even multiple prescription drugs at a time.
The United States is the epicenter for prescription drug use and abuse. A number of factors have led to this including the aging population of Boomers, given prescription drug use increases with age, with 85% of adults ages 65+ using prescription drugs. The increase in chronic disease prevalence, such as diabetes, heart disease, and arthritis, in the US is also a huge contributing factor along with higher rates of mental health issues. Statins for cholesterol, metformin for diabetes, SSRIs for depression and anxiety, and even amoxicillin for bacterial infections are now more accessible than ever. More than half of Americans take one or more prescription drugs daily. While prescription drugs provide significant health benefits and have become integral to the US healthcare system, we have also encountered many challenges related to abuse, cost, and access from their widespread adoption.
Abuse:
Prescription drug misuse is one of the most commonly used illicit drugs in the country. From opioids to depressants, Americans are addicted and dependent often after being legally prescribed these drugs in a medical setting. The accessibility and availability of prescription drugs have led to higher usage rates, sometimes resulting in misuse, Prescription Drug Misuse (PMD), and addiction. This coupled with direct-to-consumer marketing of these substances by pharmaceutical companies has led to a society dependent on prescription drugs.
Opioids seem to be the biggest culprit due to their highly addictive nature. Since the 1990s opioids usage has been surging, both from illegal black markets and the push from many pharmaceutical companies and incentives for doctors to prescribe them. One of the biggest scandals of the industry revolved around Purdue Pharma and the Sackler family, which was heavily responsible for the manufacturing and marketing of Oxycontin since 1999. Many other cases have been brought against pharmaceutical companies and even doctors who were being incentivized to push these types of opioids to their patients given the rapid increase in deaths from these drugs in recent decades. In 2022 there were over 100,000 drug overdose deaths in the US, with opioids being a major contributor. Nearly 40% of opioid-related deaths are from prescription opioids. The widespread availability and prescription of opioids for pain management have contributed to their misuse.
Beyond deaths related to prescription drugs, there are many adverse side effects that have emerged from commonly used medications. SSRIs or antidepressants have also come under fire for their side effects such as emotional blunting, cognitive dysfunction, sexual dysfunction, weight gain, fatigue, and more, reducing quality of life and increasing overall healthcare costs for patients. Since the COVID-19 pandemic, rates of SSRI use have skyrocketed with younger and younger populations being put on these drugs and a 46% YoY increase in antidepressant fills in 2022.
Company Highlight: Outro is aiming to battle the overprescription of these drugs by digitizing safe and effective, evidence-based tapering protocols for these drugs.
“Overtreatment with drugs kills many people, and the death rate is increasing. It is therefore strange that we have allowed this long-lasting drug pandemic to continue, and even more so because most of the drug deaths are easily preventable”
Cost:
The U.S. stands out for its high prescription drug prices compared to other high-income countries, which contributes to increased spending and usage. The US lacks many regulatory mechanisms that other developed countries have to cap and negotiate drug prices leading to weakened bargaining power and allowing pharma companies to set prices at their discretion. The pharmaceutical industry also has significant lobbying efforts which has historically influenced policies that favor high drug prices. Although these companies set out to help treat patients struggling with disease, they are, at the end of the day, for profit entities who need to make money for their shareholders, therefore they are not incentivized to make these substances more affordable given the populations willingness to pay.
Company Highlight: Mark Cuban’s Cost Plus Drugs is focused on improving accessibility and price transparency of drugs through lowering prices by removing middlemen, working directly with manufacturers, and moving to a cost-plus pricing strategy.
Access:
The access piece here is twofold: while on one hand, there are certain prescription drugs that have been difficult to get for those who need them whether it be due to shortages or price, but on the other hand, drugs like opioids, SSRIs, and stimulants have become shockingly easy to access and have been prescribed willy nilly to many from children to the elderly. While there isn’t an easy way to fix the overprescribing issue, digital tools and streamlined authorization and medication management can help alleviate some of the bottlenecks that keep patients from getting the drugs they need.
Certain policy interventions such as the Inflation Reduction Act, have aimed to reduce prescription drug costs and improve access by allowing Medicare to negotiate drug prices and lower costs for consumers. Insurance coverage has also expanded for many, helping alleviate access issues. Through increased telemedicine and prescribing flexibility and financial incentives from pharmaceutical companies, doctors have also been increasing their rates of prescribing.
On the flip side, there has been a significant increase in drug shortages due to supply chain and manufacturing issues as well as some increased restrictions on drugs from insurers. High costs remain a barrier for many, despite policy efforts, which many insurers not always covering the full cost of drugs, leading to high out-of-pocket costs. Access to prescription drugs in the U.S. has seen mixed trends. While policy interventions have improved affordability and coverage for some, ongoing challenges continue to hinder access.
Company Highlight: Photon Health is building modern prescribing tools to transform prescription ordering and fulfillment while giving patients agency over their drugs to help alleviate issues with high drug prices, shortages, and poor patient experiences.
What does this mean for our country? Well, in short, we need to make sure regulators and insurers are allowing those who medically need these drugs have access to them in a safe and tempered way. Secondly, we must hold our pharmaceutical companies and doctors accountable for pill pushing and irresponsibly prescribing these compounds. A crack down of “pill mills” through licensing, inspections, and ensuring clinic owners are legal prescribers has helped ease some of these issues. Implementing strict rules around refills and prescription, enhancing support and resources for addiction and abuse, and encouraging companies to establish transparent pricing, monitored and efficient access, and safe and effective patient experiences. And lastly, but arguably most importantly, educating the public about the harmful effects of these drugs and long-term consequences of their use whether that be social, financial, or physical. By educating the patient, we can hope they are informed about their alternative options, understand the potential side effects, and are aware of the costs of these medications.