By Rebecca Ruiz
Much of the
American South is ailing, with West Virginia the worst off--at
least, if the rate of prescription drug use is any indication. The
state filled 17.7 prescriptions per capita compared to a national
average of 11.5, according to Verispan, a health care information
company.
Alabama, South Carolina,
Tennessee, Arkansas, Louisiana, Kentucky and Missouri also have
prescription drug-use rates well above the national average.
In Depth: America’s Most
Medicated States
Dr. Jane Barlow, vice president of medical strategy and clinical
quality for Medco Health Solutions,
one of the nation's largest pharmacy benefit manager, says
there's a reason these states use more medication: Their rates
of heart disease, obesity and diabetes are higher than the national
average, particularly in West Virginia.
"The growth in
prescription drug use," says Barlow, is driven in part by
"chronic diseases that are largely preventable and are linked
to lifestyle and physical activity."
Behind the
Trends
In 2008, total
sales for prescription drugs reached $291.5 billion, a 1.4%
increase from the previous year. Lipitor, a statin used to control
cholesterol, was the top-selling drug, followed by the acid reflux
medication Nexium, and Plavix, an anti-platelet agent that reduces
the risk of heart attack or stroke. Sales of cardiovascular and
gastroenterology medications, as well as ones that regulate central
nervous system issues like seizures, depression, pain and
Alzheimer's, accounted for half of all drug sales in 2008.
Verispan's data is
gathered from retail pharmacies but exclude those filled by mail
order, which comprised 7% of prescriptions filled in 2007.
The most prescribed drug to
Medicare beneficiaries in West Virginia in 2007, according to the
Centers for Medicare and Medicaid Services, was lisinopril, a
generic drug used to treat high blood pressure. West Virginians
have higher rates of heart-disease death: 237 per 100,000 compared
to a national average of 200.
And their health problems
don't end there. Twelve percent of the population has diabetes,
nearly 4% more than the average rate. Worse yet, almost 70% of West
Virginians are obese or overweight, more than one-quarter smoke and
30% report having poor mental health, according to the Centers for
Disease Control and Prevention.
Mental Wellness
Though physical
inactivity is clearly linked to prescription drug trends, poor
mental health has also influenced usage patterns: Antidepressants
were the third most-popular type of drug dispensed in 2008, with
$9.5 billion in sales.
The percentage of
non-elderly adults who used antidepressants increased from 6% to
10% between 1996 and 2005, according to Dr. Mark Olfson, a
professor of clinical psychiatry at Columbia University Medical
Center who recently analyzed these trends and published the
findings in the Journal of the American Medical
Association.
Olfson and his
co-author, Steven C. Marcus, a professor at the University
Pennsylvania School of Social Policy & Practice, found that the
increase occurred regardless of gender, age, marital status,
educational level and health insurance status.
Despite the increase in
antidepressant use, Olfson says it's unclear if the trend
indicates that more Americans are struggling with mental health
issues. Rather, Olfson cites the growing acceptance of discussing
and treating depression and the use of antidepressants for
conditions like insomnia and back pain as factors for the
increase.
Heightened awareness of
certain drugs and conditions may be another explanation. In 2005,
pharmaceutical companies spent $122 million on direct-to-consumer
antidepressant advertising--almost four times what they spent in
1999. A 2005 study in JAMA found that 55% of participants
who requested a brand-name drug received an antidepressant; only
10% of patients who had similar symptoms but made no request
received an antidepressant.
That seems to be true
regardless of which preventable condition is being treated.
John Law acknowledges that
West Virginia's prescription rate is high, but says the
combination of lifestyle changes and appropriate medication can
only help improve a patient's condition.
"We're working
diligently to turn that around," Law says, referring to the
prevalence of chronic disease in the state. "But you don't
turn that around in a year--it takes a long time."
In Depth: America’s Most
Medicated States
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