Q&A: "Are People Better Or Worse Off With All The Prescription Drugs We Have These Days?"
Q&A: "Are People Better Or Worse Off With All The Prescription Drugs We Have These Days?"
Contains Subjective Input/Opinion
Originally January 15, 2019
Immunity To Morphine
http://sciencenordic.com/genetic-defect-makes-some-nearly-immune-morphine
Codeine Immunity, Some Stats
https://www.dailymail.co.uk/health/article-2531361/Why-codeine-painkillers-dont-work-millions-harm-health.html
OxyContin Lawsuit
https://www.reuters.com/article/us-usa-opioids-purduepharma/new-york-sues-oxycontin-maker-purdue-pharma-over-opioids-idUSKBN1KZ1WZ
Contains Subjective Input/Opinion
Originally January 15, 2019
A lot of people have to think hard about this question, citing all the possible side effects of any given Rx as reason alone to criticize the scope of prescription drugs in the United States and elsewhere. Also, Big Pharma has some fairly shady marketing practices at times. Many believe that these companies made up disorders like Restless Leg Syndrome and ADHD just to sell pills, when the medical community clearly recognizes these as legitimate syndromes with particular treatments. Again, the marketing strategies employed by Big Pharma cross into shady territory all too often, but they don’t belong to some grand conspiracy that makes up mental illnesses in order to drug different-minded people into submission to the status quo…
Before going off on some tangents that explore America's obsession with pharmaceuticals and a few negative observations mainly regarding Big Pharma, the question must be directly addressed. Overall, weighing both the pros and cons, having so many diverse medicines available does an extreme amount of good for society. Diabetics didn't have access to insulin years ago. Those with high blood pressure probably had heart attacks and died in their 40s. Painkillers allow otherwise immobilized individuals to get up and move around. By treating such a variety of ailment from such a variety of angles (since different drugs exist to treat the same conditions), the life expectancy and quality of that life has increased dramatically over the last 100 years, owing a portion of its thanks to pharmaceuticals.
Now, to look at the broader subject a bit more. First of all, whatever way you try to spin it, America has a humungous pharmaceutical industry. According to CNBC, the U.S. spent $610 billion on their Rx purchases in 2016. Countries like Poland, Sweden, and Argentina don't even have that much money in their entire economy. This number continues to climb each year at a rate which outpaces general economic growth: from 2015–16 the GDP increased by 3.40% whereas the Rx drug industry expanded by 5.8%. The year 2018 saw 4.18 billion separate prescription bottles filled in this country.
Meanwhile, more than 70% of Americans took at least one prescription drug regularly; 1 in 5 consume more than 5 prescription drugs on a daily basis. Plenty of people get overmedicated for sure; even so, a large number of people suffer from more than one medical condition and thus may require more than one medicine.
What does America take drugs for? Well, 5 of the 10 most prescribed drugs in one quarter of 2016 have applications in treating high blood pressure. Lipitor—or atorvastatin calcium—tops the list, sold to lower cholesterol and reduce the risk of stroke and heart attack.
At number 2, Synthroid (levothyroxine) mainly treats hypothyroidism. Prilosec (omeprazole) ranks #4—people take that for acid reflux. Glucophage (metformin) comes next, helping those with Diabetes Type 2 to control their blood sugar levels. The next 5 most frequently prescribed drugs all treat either high blood pressure or high cholesterol; all except #8, a spot held by Vicodin (hydrocodone/acetaminophen mix).
The volume of painkiller prescriptions in America poses a troubling dilemma. Limit the ease with which doctors and patients write and fill scripts for opioids, and you theoretically decrease their illicit diversion and addiction; then again, this might mean that a number of people in legitimate pain cannot get the drugs or dosage that they need to have the quality of life that they deserve and could have if the doctor would only write for it. The other way around makes it easier for people with real pain to find relief, though then more pills get illegally diverted, abused, and cause addiction.
Surprisingly, the next 40 most widely prescribed drugs after the top 10 consist largely of mental health medications:
#12 Ambien (zolpidem), for insomnia; #17 Neurontin (gabapentin), sometimes used off-label for anxiety.
Also on the list were Zoloft (sertraline), antidepressant and sometimes anxiety; Ultram (tramadol), painkiller (not quite a psych med, but opioids sort of lump in with that category); Lexapro (escitalopram), antidepressant, also anxiety; Xanax (alprazolam), anxiety; Wellbutrin (bupropion), antidepressant and occasionally used off-label for ADHD; Celexa (citalopram), antidepressant, also anxiety sometimes; Cymbalta (duloxetine), antidepressant; Prozac (fluoxetine), antidepressant, also anxiety sometimes; Effexor (venlafexine), antidepressant; Adderall (mixed amphetamine salts), ADHD; Oleptro (trazodone), sleep aid, antidepressant, anxiety.
The Top 50 list contains at least 5 drugs known to cause addiction and/or dependence: Vicodin and Ultram, being painkillers, get diverted and abused for the euphoria and sedation they induce (Ultram doesn't usually wow users as much as other opioids though); Ambien, which more or less functions like a benzodiazepine, causes a sedating high which some find pleasant; Xanax, forming a physical dependence in its regular users, can decrease inhibitions and make the person feel carefree; and Adderall, prescribed for ADHD but used illicitly in a number of settings, most commonly at school or work as a performance enhancer.
That doesn’t mean that these pharmacists shouldn’t fill scripts for these drugs, no; more so just a notable observation. If a law went into effect today that would ban pharmacists from filling scripts, then illegal versions of these drugs would trickle into society. The only differences: they'd cost more and have a lower quality. Water always finds its way around a dam.
Despite that, overall having Rx drugs plus more Rx drugs means that patients have a wider selection of potential treatments for any given ailment. Look at the plethora of antidepressants on the market today. Less than a century ago, very few drugs existed for the specific purpose of treating depression. Nowadays, doctors can try depressed patients on any number of SSRIs, NDRIs, TCAs, MAOIs, etc. If one fails to provide relief (and often it does fail) then doctors can try another class of meds which target entirely different receptors in the brain or work differently.
Another prime example: more than 100 years ago, the only painkillers in use came directly from the opium poppy plant: codeine, morphine, heroin (aka diacetylmorphine), and the like. However, a sliver of the general population for one reason or another simply cannot feel the effects of traditional opiates like codeine via their inability to process it properly inside the body; this effects 7 to 10% of the population in Britain, deriving from a mutation which leads the liver to produce less CYP2D6--an enzyme responsible for (among other things) converting codeine to morphine.
Nowadays, synthetic opioids exist which do not need to undergo that conversion in order to take effect. Thus, a chunk of the population that wouldn’t have had any options for severe pain relief back then can receive treatment, using newer synthetics like fentanyl or methadone.
An even smaller group doesn’t even respond to any opioid whatsoever; these people can benefit from alternative ways to treat pain: marijuana maybe (which, ok, that did exist long before the birth of Big Pharma), or ketamine, or something else that probably didn’t exist a century ago; if it did, it existed in isolated laboratories rather than mass produced and sold across the globe.
Marketing newer painkillers specifically has certainly led to extremely far-reaching ramifications.
Purdue Pharma pushed Oxycontin as a non-addictive painkiller beginning in 1996, a move which many trace the current American Opioid Epidemic to. They knew that oxycodone effected opiate receptors just like morphine, eased pain just like morphine, and created a physical dependency just like morphine. But the public and even FDA believed their lie for some time, during which thousands found themselves unintentionally addicted. Eventually, a slew of massive law suits mounted against Purdue Pharma, forcing them to pay hundreds of millions of dollars in damages. In one court case from 2007 alone, the court had them cough up over $600 million after pleading guilty to misbranding their product. To date, from individuals to entire states, more lawsuits against the company continue to be filed. And yet, despite all the lawsuits and payouts, they still make a hefty profit: they sold $1.7 billion worth of those pills in 2017 alone.
However, the way that pharmaceutical companies push doctors to write scripts for their new brand name drugs has an element of sleaze to it, although it ranks as understandable for a business to promote their newest products.
Take a look at the history of Adderall, a treatment for ADHD. Amphetamines existed on the market for 50+ years before its debut, but Shire cooked up Adderall using four slightly different variations of the amphetamine molecule and combining them in a particular ratio, making it just different enough than its predecessor Obetrol to get a patent. When that expired, Shire released Adderall XR, a capsule containing two doses of Adderall inside, releasing the second dose several hours after ingestion. Because small beads encapsulated the amphetamines and due to its longer duration, Shire boasted it had less abusable properties. Then when that patent passed, they launched Vyvanse: a once-daily formulation of amphetamine with even less abuse liability because an extra molecule makes it so that the user can only feel its effects by swallowing it, preventing anyone from snorting the drug. After that, they launched Mydayis, an extended release pill more similar to the original ratio found in Adderall rather than that of Vyvanse.
Extended release pills certainly provide some benefits. For example, children and teens taking that particular medication can take one pill before school rather than one before and one during school. In some cases extended releases hinder treatment though. For example if a patient taking stimulants wakes up late, they have to choose between not taking their ADHD meds or potentially not sleeping that night because the amphetamine continues at full blast when the nighttime comes. As a generalization, the new drugs which contain pre-existing chemicals usually offer very little novelty and prove no more efficacious than the original pill. Coming out with a pill, waiting for the patent to expire, and then releasing the extended release version seems to be a favorite among these manufacturers.
As a note about ADHD (Attention Deficit Hyperactivity Disorder), the affliction certainly does exist; all accredited medical bodies in the United States agree on that. However, they probably do over-diagnose the disorder in children seeing as 6.4 million American juveniles, more than 1 in 10 in that population according to Psychology Today, have at some point received that diagnosis. That equates to a 42% increase in the rate of childhood ADHD in just a decade. Some attribute this to better diagnostics and awareness about it, but chances are far too many people get this label and then take stimulants which can have intense effects for those without ADHD. Nonetheless, the disorder does exist and brain scans can show the deficiencies in neurochemicals like dopamine and glutamate that true ADHD sufferers have compared to neurotypical brains. ADHD has far-reaching negative consequences that go into adulthood, seeing as 2/3 of children with it still exhibit symptoms into adulthood. Yet adult ADHD receives extremely little attention. Many doctors will readily put a 7 year old on watered-down speed (e.g. Adderall, Ritalin) yet hesitate to give it to a 30 year old man for whatever reason, probably fearing that the adult will abuse the drug.
Another criticism of the Rx status quo today must be brought up when companies keep releasing new drugs of a class to which a pre-existing drug on the market belongs. Not to keep going to the opioid painkillers, but when meds like oxycodone hit the market, they usually boast some sort of advantage over the already prevalent sister drugs. They’ll claim it has less side effects, lower abuse profile (for addictive ones), works faster, works longer, and things like that which either have no basis in reality or an isolated clinical study conducted by the company will show that their drug is 4% less likely to cause a headache than the current drug within that class on the market. And yet, some people require shorter-acting drugs and others may benefit more from longer-acting ones depending on the condition for which they receive the medication. In anxiety disorders, people with panic attacks take fast-acting benzodiazepines with a short duration; the drug takes effect within minutes and leaves the body not too long after that. Meanwhile, for [chronic] Generalized Anxiety Disorder, doctors usually go to a longer-acting drug such as Klonopin (clonazepam) because that will provide a long period of relief for the patient.
Companies market their medications for off-label use as well. It takes a long time for the FDA to approve a drug’s effectiveness in treating even one condition, let alone several others. Yet many medications may have a number of applications. Adderall, for example, usually gets prescribed to people with ADHD, but it can also go to those with narcolepsy; in the past, doctors also gave amphetamines for obesity, depression, even as a nasal decongestant. Pharmaceutical marketers take things too far too often though, and end up dispensing drugs to people who probably don’t need it.
A prime example of this practice can be seen with the way they sold Neurontin, or its chemical name, gabapentin. In 2000, Parke-Davis got the green light to sell the pill for use in treating epileptics: by some unknown mechanism, the chemical likely indirectly interacts with GABA in the brain, suppressing seizures, along with another number of effects. In the coming years, through aggressive marketing, the company would convince the medical field en masse that their drug could help treat among any of the following: mood swings in bipolar disorder (which experiments have since disproven and yet in 2019 a handful of doctors still dole it out for this purpose); almost any anxiety disorder (for which it actually shows some promise); fibromyalgia; Restless Leg Syndrome (RLS); alcohol dependence, to help through early recovery; pruritus (aka generalized itchiness); Irritable Bowel Syndrome (IBS); hot flashes during menopause in women; migraines…the list literally goes on regarding what at least some doctors do prescribe gabapentin for, almost 2 decades later, despite any empirical evidence from clinical trials or FDA approval. That helped make gabapentin (now available as a generic) among the most frequently prescribed medications in America. Doctors definitely should have the power to write off-label prescriptions, but doing so with a new and relatively untested drug just doesn’t seem like good practice.
Another case of overly promoting off-label use involves Seroquel, or chemically called quetiapine. This drug debuted as an anti-psychotic medication, approved for the treatment of psychosis in Bipolar 1 Disorder and Schizophrenia. Yet somehow, it became common practice for psych doctors and physicians to prescribe the drug in lower doses than those used for mania/psychosis so as to treat insomnia, anxiety disorders, and similar afflictions. The manufacturers must’ve targeted prisons and institutions specifically, because by the mid-2010s this pill had become a major drug of abuse among prison inmates. Granted, nobody would use Seroquel that way on the streets or if given access to ‘real’ drugs, but in prisons, inmates enjoy the fact that it can make you sleep a whole day away as well as the very minor “messed up” grogginess experienced at its onset. Drug and alcohol rehabs also handed out scripts to this drug liberally.
Skeptics think that psychiatric community did this to subtly dull out “undesirables” like prisoners and drug addicts; by putting them on an anti-psychotic drug, they’ll think less and do less and therefore do less harm to the greater society. In reality, they probably just had a great marketing campaign and a strategy that involved hitting institutions. Since 2016, the local jail as well as the state’s Department of Corrections in Pennsylvania has stopped prescribing Seroquel to inmates; gabapentin also fell off the roster of drugs which prison psychiatrists can prescribe—at least at the local jail.
The fact that Rx drugs are just that—prescriptions, available only by a doctor’s signature—kind of stinks in a number of ways. Yet this system serves as a happy medium for the time being between total, unrestricted access to any and all drugs versus extremely strict limitations on who gets what and why which renders much of the population untreated. It’d be nice if patients had a bit more leeway to choose similar drugs to the ones that their doctors picked; for example, if a doctor gave the patient a script for a new, brand-name SSRI, he could tell the pharmacist that he instead would like Zoloft (sertraline). Both medications work the same way essentially, though with different pharmacological profiles. Of course, patients would have to educate themselves about all this…which probably will never happen extensively among the general population.
The prices patients without insurance must pay for drugs in the United States falls nothing short of absurd. For example, recovering opioid addicts taking buprenorphine for maintenance usually have prescriptions for Suboxone, the brand-name formulation from Reckitt-Benckiser. Generic drugs which contain buprenorphine exist, as does Suboxone (which has naloxone as an added ingredient) in pill form. Yet these doctors insist on writing for the more expensive Suboxone strips because that patent has yet to expire. Sometimes costing as little as $7 per dosage unit, in many places that cost can shoot to upwards of close to $10 apiece at the pharmacy without insurance. Plenty of discount cards can be found to help once or twice; otherwise, the patient will probably find Suboxone for a cheaper price on the street. In that case, the patient would benefit from asking the doctor to write for a generic formulation of a buprenorphine containing drug, since in reality the strips don’t have a dramatic advantage over other meds that contain the same thing.
Luckily, with insurance, refills on medications comes out to cost something more affordable for most people: $10, maybe $30, or as little as $1–5 depending on the plan. In Pennsylvania, people insured by the state pay $1 for most refills—less than those who have private insurance plans! Access to healthcare has gotten somewhat easier in the last decade, and yet still so many Americans cannot afford the meds that they need. Nonetheless, the healthcare infrastructure in the United States allows for the huge volume of prescription drugs sold and consumed. Of course all industrialized and even less fortunate countries have healthcare systems in which they can receive prescriptions for various ailments. Debating which systems work best doesn’t belong here right now. At any rate, Americans will pay sometimes 10x what a patient in the third world might pay. Rightfully so—those in squalid poverty should probably have the opportunity to obtain medication at a price closer to their means.
As this post has made abundantly clear, pharmaceutical giants play some dirty games to get their drugs in your body. Billions and billions of dollars go into the industry each year, and Americans consume a ton of prescription medications. Many may cite this as excessive, commercialized, social control, and more. However, even with its ills, the fact that in society today a person who has a problem with their heart beating too fast, depression, some disease, or whatever can go to a doctor and usually receive something that might help make the problem go away, or at least mitigate its harm. Life expectancy in the last century has skyrocketed, in part because of people taking some medications: if nothing else, they act as preventative measures that keep people out of the hospital. Somebody with high blood pressure can take a pill each day to keep that in check versus do nothing and have a heart attack, end up in the E.R., getting expensive surgery, and that type of thing. Vaccines have nearly eradicated once deadly and highly prevalent diseases. So overall, the prevalence of prescription drugs in society has benefited it as a whole along with literally millions of individuals.
Works Cited:
Before going off on some tangents that explore America's obsession with pharmaceuticals and a few negative observations mainly regarding Big Pharma, the question must be directly addressed. Overall, weighing both the pros and cons, having so many diverse medicines available does an extreme amount of good for society. Diabetics didn't have access to insulin years ago. Those with high blood pressure probably had heart attacks and died in their 40s. Painkillers allow otherwise immobilized individuals to get up and move around. By treating such a variety of ailment from such a variety of angles (since different drugs exist to treat the same conditions), the life expectancy and quality of that life has increased dramatically over the last 100 years, owing a portion of its thanks to pharmaceuticals.
Now, to look at the broader subject a bit more. First of all, whatever way you try to spin it, America has a humungous pharmaceutical industry. According to CNBC, the U.S. spent $610 billion on their Rx purchases in 2016. Countries like Poland, Sweden, and Argentina don't even have that much money in their entire economy. This number continues to climb each year at a rate which outpaces general economic growth: from 2015–16 the GDP increased by 3.40% whereas the Rx drug industry expanded by 5.8%. The year 2018 saw 4.18 billion separate prescription bottles filled in this country.
Meanwhile, more than 70% of Americans took at least one prescription drug regularly; 1 in 5 consume more than 5 prescription drugs on a daily basis. Plenty of people get overmedicated for sure; even so, a large number of people suffer from more than one medical condition and thus may require more than one medicine.
What does America take drugs for? Well, 5 of the 10 most prescribed drugs in one quarter of 2016 have applications in treating high blood pressure. Lipitor—or atorvastatin calcium—tops the list, sold to lower cholesterol and reduce the risk of stroke and heart attack.
At number 2, Synthroid (levothyroxine) mainly treats hypothyroidism. Prilosec (omeprazole) ranks #4—people take that for acid reflux. Glucophage (metformin) comes next, helping those with Diabetes Type 2 to control their blood sugar levels. The next 5 most frequently prescribed drugs all treat either high blood pressure or high cholesterol; all except #8, a spot held by Vicodin (hydrocodone/acetaminophen mix).
The volume of painkiller prescriptions in America poses a troubling dilemma. Limit the ease with which doctors and patients write and fill scripts for opioids, and you theoretically decrease their illicit diversion and addiction; then again, this might mean that a number of people in legitimate pain cannot get the drugs or dosage that they need to have the quality of life that they deserve and could have if the doctor would only write for it. The other way around makes it easier for people with real pain to find relief, though then more pills get illegally diverted, abused, and cause addiction.
Surprisingly, the next 40 most widely prescribed drugs after the top 10 consist largely of mental health medications:
#12 Ambien (zolpidem), for insomnia; #17 Neurontin (gabapentin), sometimes used off-label for anxiety.
Also on the list were Zoloft (sertraline), antidepressant and sometimes anxiety; Ultram (tramadol), painkiller (not quite a psych med, but opioids sort of lump in with that category); Lexapro (escitalopram), antidepressant, also anxiety; Xanax (alprazolam), anxiety; Wellbutrin (bupropion), antidepressant and occasionally used off-label for ADHD; Celexa (citalopram), antidepressant, also anxiety sometimes; Cymbalta (duloxetine), antidepressant; Prozac (fluoxetine), antidepressant, also anxiety sometimes; Effexor (venlafexine), antidepressant; Adderall (mixed amphetamine salts), ADHD; Oleptro (trazodone), sleep aid, antidepressant, anxiety.
The Top 50 list contains at least 5 drugs known to cause addiction and/or dependence: Vicodin and Ultram, being painkillers, get diverted and abused for the euphoria and sedation they induce (Ultram doesn't usually wow users as much as other opioids though); Ambien, which more or less functions like a benzodiazepine, causes a sedating high which some find pleasant; Xanax, forming a physical dependence in its regular users, can decrease inhibitions and make the person feel carefree; and Adderall, prescribed for ADHD but used illicitly in a number of settings, most commonly at school or work as a performance enhancer.
That doesn’t mean that these pharmacists shouldn’t fill scripts for these drugs, no; more so just a notable observation. If a law went into effect today that would ban pharmacists from filling scripts, then illegal versions of these drugs would trickle into society. The only differences: they'd cost more and have a lower quality. Water always finds its way around a dam.
Despite that, overall having Rx drugs plus more Rx drugs means that patients have a wider selection of potential treatments for any given ailment. Look at the plethora of antidepressants on the market today. Less than a century ago, very few drugs existed for the specific purpose of treating depression. Nowadays, doctors can try depressed patients on any number of SSRIs, NDRIs, TCAs, MAOIs, etc. If one fails to provide relief (and often it does fail) then doctors can try another class of meds which target entirely different receptors in the brain or work differently.
Another prime example: more than 100 years ago, the only painkillers in use came directly from the opium poppy plant: codeine, morphine, heroin (aka diacetylmorphine), and the like. However, a sliver of the general population for one reason or another simply cannot feel the effects of traditional opiates like codeine via their inability to process it properly inside the body; this effects 7 to 10% of the population in Britain, deriving from a mutation which leads the liver to produce less CYP2D6--an enzyme responsible for (among other things) converting codeine to morphine.
Nowadays, synthetic opioids exist which do not need to undergo that conversion in order to take effect. Thus, a chunk of the population that wouldn’t have had any options for severe pain relief back then can receive treatment, using newer synthetics like fentanyl or methadone.
An even smaller group doesn’t even respond to any opioid whatsoever; these people can benefit from alternative ways to treat pain: marijuana maybe (which, ok, that did exist long before the birth of Big Pharma), or ketamine, or something else that probably didn’t exist a century ago; if it did, it existed in isolated laboratories rather than mass produced and sold across the globe.
Marketing newer painkillers specifically has certainly led to extremely far-reaching ramifications.
Purdue Pharma pushed Oxycontin as a non-addictive painkiller beginning in 1996, a move which many trace the current American Opioid Epidemic to. They knew that oxycodone effected opiate receptors just like morphine, eased pain just like morphine, and created a physical dependency just like morphine. But the public and even FDA believed their lie for some time, during which thousands found themselves unintentionally addicted. Eventually, a slew of massive law suits mounted against Purdue Pharma, forcing them to pay hundreds of millions of dollars in damages. In one court case from 2007 alone, the court had them cough up over $600 million after pleading guilty to misbranding their product. To date, from individuals to entire states, more lawsuits against the company continue to be filed. And yet, despite all the lawsuits and payouts, they still make a hefty profit: they sold $1.7 billion worth of those pills in 2017 alone.
However, the way that pharmaceutical companies push doctors to write scripts for their new brand name drugs has an element of sleaze to it, although it ranks as understandable for a business to promote their newest products.
Take a look at the history of Adderall, a treatment for ADHD. Amphetamines existed on the market for 50+ years before its debut, but Shire cooked up Adderall using four slightly different variations of the amphetamine molecule and combining them in a particular ratio, making it just different enough than its predecessor Obetrol to get a patent. When that expired, Shire released Adderall XR, a capsule containing two doses of Adderall inside, releasing the second dose several hours after ingestion. Because small beads encapsulated the amphetamines and due to its longer duration, Shire boasted it had less abusable properties. Then when that patent passed, they launched Vyvanse: a once-daily formulation of amphetamine with even less abuse liability because an extra molecule makes it so that the user can only feel its effects by swallowing it, preventing anyone from snorting the drug. After that, they launched Mydayis, an extended release pill more similar to the original ratio found in Adderall rather than that of Vyvanse.
Extended release pills certainly provide some benefits. For example, children and teens taking that particular medication can take one pill before school rather than one before and one during school. In some cases extended releases hinder treatment though. For example if a patient taking stimulants wakes up late, they have to choose between not taking their ADHD meds or potentially not sleeping that night because the amphetamine continues at full blast when the nighttime comes. As a generalization, the new drugs which contain pre-existing chemicals usually offer very little novelty and prove no more efficacious than the original pill. Coming out with a pill, waiting for the patent to expire, and then releasing the extended release version seems to be a favorite among these manufacturers.
As a note about ADHD (Attention Deficit Hyperactivity Disorder), the affliction certainly does exist; all accredited medical bodies in the United States agree on that. However, they probably do over-diagnose the disorder in children seeing as 6.4 million American juveniles, more than 1 in 10 in that population according to Psychology Today, have at some point received that diagnosis. That equates to a 42% increase in the rate of childhood ADHD in just a decade. Some attribute this to better diagnostics and awareness about it, but chances are far too many people get this label and then take stimulants which can have intense effects for those without ADHD. Nonetheless, the disorder does exist and brain scans can show the deficiencies in neurochemicals like dopamine and glutamate that true ADHD sufferers have compared to neurotypical brains. ADHD has far-reaching negative consequences that go into adulthood, seeing as 2/3 of children with it still exhibit symptoms into adulthood. Yet adult ADHD receives extremely little attention. Many doctors will readily put a 7 year old on watered-down speed (e.g. Adderall, Ritalin) yet hesitate to give it to a 30 year old man for whatever reason, probably fearing that the adult will abuse the drug.
Another criticism of the Rx status quo today must be brought up when companies keep releasing new drugs of a class to which a pre-existing drug on the market belongs. Not to keep going to the opioid painkillers, but when meds like oxycodone hit the market, they usually boast some sort of advantage over the already prevalent sister drugs. They’ll claim it has less side effects, lower abuse profile (for addictive ones), works faster, works longer, and things like that which either have no basis in reality or an isolated clinical study conducted by the company will show that their drug is 4% less likely to cause a headache than the current drug within that class on the market. And yet, some people require shorter-acting drugs and others may benefit more from longer-acting ones depending on the condition for which they receive the medication. In anxiety disorders, people with panic attacks take fast-acting benzodiazepines with a short duration; the drug takes effect within minutes and leaves the body not too long after that. Meanwhile, for [chronic] Generalized Anxiety Disorder, doctors usually go to a longer-acting drug such as Klonopin (clonazepam) because that will provide a long period of relief for the patient.
Companies market their medications for off-label use as well. It takes a long time for the FDA to approve a drug’s effectiveness in treating even one condition, let alone several others. Yet many medications may have a number of applications. Adderall, for example, usually gets prescribed to people with ADHD, but it can also go to those with narcolepsy; in the past, doctors also gave amphetamines for obesity, depression, even as a nasal decongestant. Pharmaceutical marketers take things too far too often though, and end up dispensing drugs to people who probably don’t need it.
A prime example of this practice can be seen with the way they sold Neurontin, or its chemical name, gabapentin. In 2000, Parke-Davis got the green light to sell the pill for use in treating epileptics: by some unknown mechanism, the chemical likely indirectly interacts with GABA in the brain, suppressing seizures, along with another number of effects. In the coming years, through aggressive marketing, the company would convince the medical field en masse that their drug could help treat among any of the following: mood swings in bipolar disorder (which experiments have since disproven and yet in 2019 a handful of doctors still dole it out for this purpose); almost any anxiety disorder (for which it actually shows some promise); fibromyalgia; Restless Leg Syndrome (RLS); alcohol dependence, to help through early recovery; pruritus (aka generalized itchiness); Irritable Bowel Syndrome (IBS); hot flashes during menopause in women; migraines…the list literally goes on regarding what at least some doctors do prescribe gabapentin for, almost 2 decades later, despite any empirical evidence from clinical trials or FDA approval. That helped make gabapentin (now available as a generic) among the most frequently prescribed medications in America. Doctors definitely should have the power to write off-label prescriptions, but doing so with a new and relatively untested drug just doesn’t seem like good practice.
Another case of overly promoting off-label use involves Seroquel, or chemically called quetiapine. This drug debuted as an anti-psychotic medication, approved for the treatment of psychosis in Bipolar 1 Disorder and Schizophrenia. Yet somehow, it became common practice for psych doctors and physicians to prescribe the drug in lower doses than those used for mania/psychosis so as to treat insomnia, anxiety disorders, and similar afflictions. The manufacturers must’ve targeted prisons and institutions specifically, because by the mid-2010s this pill had become a major drug of abuse among prison inmates. Granted, nobody would use Seroquel that way on the streets or if given access to ‘real’ drugs, but in prisons, inmates enjoy the fact that it can make you sleep a whole day away as well as the very minor “messed up” grogginess experienced at its onset. Drug and alcohol rehabs also handed out scripts to this drug liberally.
Skeptics think that psychiatric community did this to subtly dull out “undesirables” like prisoners and drug addicts; by putting them on an anti-psychotic drug, they’ll think less and do less and therefore do less harm to the greater society. In reality, they probably just had a great marketing campaign and a strategy that involved hitting institutions. Since 2016, the local jail as well as the state’s Department of Corrections in Pennsylvania has stopped prescribing Seroquel to inmates; gabapentin also fell off the roster of drugs which prison psychiatrists can prescribe—at least at the local jail.
The fact that Rx drugs are just that—prescriptions, available only by a doctor’s signature—kind of stinks in a number of ways. Yet this system serves as a happy medium for the time being between total, unrestricted access to any and all drugs versus extremely strict limitations on who gets what and why which renders much of the population untreated. It’d be nice if patients had a bit more leeway to choose similar drugs to the ones that their doctors picked; for example, if a doctor gave the patient a script for a new, brand-name SSRI, he could tell the pharmacist that he instead would like Zoloft (sertraline). Both medications work the same way essentially, though with different pharmacological profiles. Of course, patients would have to educate themselves about all this…which probably will never happen extensively among the general population.
The prices patients without insurance must pay for drugs in the United States falls nothing short of absurd. For example, recovering opioid addicts taking buprenorphine for maintenance usually have prescriptions for Suboxone, the brand-name formulation from Reckitt-Benckiser. Generic drugs which contain buprenorphine exist, as does Suboxone (which has naloxone as an added ingredient) in pill form. Yet these doctors insist on writing for the more expensive Suboxone strips because that patent has yet to expire. Sometimes costing as little as $7 per dosage unit, in many places that cost can shoot to upwards of close to $10 apiece at the pharmacy without insurance. Plenty of discount cards can be found to help once or twice; otherwise, the patient will probably find Suboxone for a cheaper price on the street. In that case, the patient would benefit from asking the doctor to write for a generic formulation of a buprenorphine containing drug, since in reality the strips don’t have a dramatic advantage over other meds that contain the same thing.
Luckily, with insurance, refills on medications comes out to cost something more affordable for most people: $10, maybe $30, or as little as $1–5 depending on the plan. In Pennsylvania, people insured by the state pay $1 for most refills—less than those who have private insurance plans! Access to healthcare has gotten somewhat easier in the last decade, and yet still so many Americans cannot afford the meds that they need. Nonetheless, the healthcare infrastructure in the United States allows for the huge volume of prescription drugs sold and consumed. Of course all industrialized and even less fortunate countries have healthcare systems in which they can receive prescriptions for various ailments. Debating which systems work best doesn’t belong here right now. At any rate, Americans will pay sometimes 10x what a patient in the third world might pay. Rightfully so—those in squalid poverty should probably have the opportunity to obtain medication at a price closer to their means.
As this post has made abundantly clear, pharmaceutical giants play some dirty games to get their drugs in your body. Billions and billions of dollars go into the industry each year, and Americans consume a ton of prescription medications. Many may cite this as excessive, commercialized, social control, and more. However, even with its ills, the fact that in society today a person who has a problem with their heart beating too fast, depression, some disease, or whatever can go to a doctor and usually receive something that might help make the problem go away, or at least mitigate its harm. Life expectancy in the last century has skyrocketed, in part because of people taking some medications: if nothing else, they act as preventative measures that keep people out of the hospital. Somebody with high blood pressure can take a pill each day to keep that in check versus do nothing and have a heart attack, end up in the E.R., getting expensive surgery, and that type of thing. Vaccines have nearly eradicated once deadly and highly prevalent diseases. So overall, the prevalence of prescription drugs in society has benefited it as a whole along with literally millions of individuals.
Works Cited:
Immunity To Morphine
http://sciencenordic.com/genetic-defect-makes-some-nearly-immune-morphine
Codeine Immunity, Some Stats
https://www.dailymail.co.uk/health/article-2531361/Why-codeine-painkillers-dont-work-millions-harm-health.html
OxyContin Lawsuit
https://www.reuters.com/article/us-usa-opioids-purduepharma/new-york-sues-oxycontin-maker-purdue-pharma-over-opioids-idUSKBN1KZ1WZ
Prevalence Of ADHD Today; Possible Over-Diagnosis https://www.psychologytoday.com/us/blog/side-effects/201509/dramatic-rise-in-adhd-diagnoses
Gabapentin History
https://www.emedexpert.com/facts/gabapentin-facts.shtml
Suboxone Price, No Insurance
https://www.rxgo.com/drug/suboxone-coupon
https://www.emedexpert.com/facts/gabapentin-facts.shtml
Suboxone Price, No Insurance
https://www.rxgo.com/drug/suboxone-coupon
Volume of US Rx Industry:
https://www.cnbc.com/2017/05/04/us-prescription-drug-spending-as-high-as-610-billion-by-2021-report.html
https://www.cnbc.com/2017/05/04/us-prescription-drug-spending-as-high-as-610-billion-by-2021-report.html
US GDP Growth
http://www.multpl.com/us-gdp-growth-rate/table/by-year
http://www.multpl.com/us-gdp-growth-rate/table/by-year
Prescriptions Filled In the US
https://www.statista.com/statistics/261303/total-number-of-retail-prescriptions-filled-annually-in-the-us/
https://www.statista.com/statistics/261303/total-number-of-retail-prescriptions-filled-annually-in-the-us/
Prescription Drug Use Stats
https://www.cheatsheet.com/health-fitness/how-many-rx-meds-does-the-average-american-take.html/
Top 50 Rx Drugs
https://www.lowestmed.com/top-50-prescription-drugs-filled/
https://www.cheatsheet.com/health-fitness/how-many-rx-meds-does-the-average-american-take.html/
Top 50 Rx Drugs
https://www.lowestmed.com/top-50-prescription-drugs-filled/
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