Certainly there is a need for mental health parity that was supposedly enacted awhile back. If everyone is seeing what I'm seeing, there are quite a few folks out there who are, how shall I say, bat-shit crazy.
And the people I'm talking about are not in the hood or anyone's ghetto. They are on television and the radio, some of them are actually elected officials. What's possibly worse is that seemingly ordinary-Joes feel compelled to carry some of the most horrendous looking guns I have ever seen to political rallies or meetings.
Unfortunately for us, mental health insurance is as screwed up as health insurance in general. Care for mental disorder or disease really sucks for just about everyone these days as the need for intervention in a disease process goes up and there are fewer people trained to intervene in whatever disease process needs attention.
The number of psychiatric medications sold in 2008 spiked remarkably. A brief check among colleagues told a similar tale of gloom about our collective mental health with which we have been playing far too loose, if you ask me.
Most Prescribed Medicines of 2008
Here is a sampling of the top 20, with discussion to follow:
#1. Hydrocodone (with acetaminophen)
Used to treat pain, especially short-term acute pain like after an injury or surgery. Of course, that is what the physician or other prescribing care-giver would be giving them for, but we all know that is not their only use to patients. This stuff is damned good at blocking pain from consciousness or dulling the conscious to the point where the patient doesn't give a flying hoot anymore. This drug works on psychic pain as well as physical pain and any of us who have ever taken the drug for short-term, acute, physical pain know it.
Is anyone surprised that 121.3 million prescriptions for hydrocodone with acetaminophen were written last year? I know I'm not.
The retail cost of all this pain medication was $5.88 billion. This is no new medication. It has been around for decades. This number doesn't even take into account all the other opiates and synthetic opiates, sedative hypnotics and alcohol that were sold during the same time. They all serve the same purpose; blotting out awareness of pain of some kind. Strong drink is sometimes the only medicine for the medically indigent and so it has been down through the centuries.
Below are other medications that were sold in huge numbers and why.
#2. Lisinopril
Hypertension
69.8 million prescriptions / $686 million retail cost
#3. Simvastatin
High cholesterol
49.0 / $1.45 billion
#4. Levothyroxine
Hypothyroidism
58.6 / $546 million
#5. Amoxicillin
Bacterial infection
52.1 / $439 million
#6. Azithromycin
Bacterial infection
49.3 / $1.28 billion
#7. Lipitor
High cholesterol
49.0 / $5.88 billion
#8. Hydrochlorothiazide
Edema/hypertension
47.1 / $288 million
#9. Alprazolam
Anxiety
43.6 / $468 million
#10. Atenolol
Hypertension
40.9 / $274 million
Here we have the top ten: Five of these drugs may well be what are referred to as life-style drugs, in that it is pretty clear that the chosen lifestyle of the patient plays a significant role in the disease or disorder being treated. Those that are for hypertension, high cholesterol and possibly diabetes type two.
The drugs for bacterial infection are oldies but goodies. People are paying less for antibiotic drugs than they would be if they were paying for the latest and greatest antibiotic. Is this "patient knowledge" at work" Or is it the physician, the pharmacist?
We also find the anxiety drug, Alprazolam. The patent name was Xanax. It is one of the most addictive drugs big pharma has passed out to Americans and others. I can find no reason why this particular drug is still on the market, quite frankly.
That is a personal prejudice, I admit.
However, I can see why it would be a favorite for the highly anxious free-marketeer or the guy who just lost his job and his wife is pregnant with their third child or the woman who can't find a job because she chose to stay at home and raise her three kids 'til they were well into their education years and now finds herself having to be the sole bread-winner for quite sometime if not forever. Her husband has been permanently disabled.
Last 40: Here will will see much of the same. Peruse the list.....
11. Metformin (diabetes)
12. Metoprolol succinate (hypertension)
13. Furosemide (edema, hypertension)
14. Metoprolol tartrate (hypertension)
(if both formulations of metoprolol are considered, it is the 3rd most prescribed)
15. Sertraline (depression)
16. Omeprazole (ulcers, reflux)
17. Zolpidem/Ambien (insomnia)
18. Nexium (refulx, ulcers)
19. Lexapro (depression)
20. Oxycodone (pain)
21. Singulair (asthman, allergies)
22. Ibuprofen (pain, inflammation)
23. Plavix (blood clotting)
24. Prednisone (allergies, inflammation)
25. Fluoxetine (depression)
26. Synthroid (hypothyroidism)
27. Warfarin (blood clotting)
28. Cephalexin (bacterial infection)
29. Lorazepam (anxiety)
30. Clonazepam (anxiety)
31. Citalopram (depression)
32. Tramadol (pain)
33. Gabapentin (epilepsy, pain)
34. Ciprofloxacin (bacterial infection)
35. Propoxyphene-N (pain)
36. Lisinopril (hypertension)
37. Triamterene (edema, hypertension)
38. Amoxicillin with clavulanic acid (bacterial infection)
39. Cyclobenzaprine (muscle injury, spasm)
40. Prevacid (ulcers, reflux)
41. Advair (asthma)
42. Effexor XR (depression)
43. Trazodone (depression, insomnia)
44. Fexofenadine (allergies)
45. Fluticasone nasal spray (allergies)
46. Diovan (hypertension)
47. Paroxetine (depression, anxiety)
48. Lovastatin (hypertension)
49. Crestor (high cholesterol)
50. Trimethoprim (bacterial infection)
The number of prescriptions for Hydrocodone was astronomical enough to average one prescription for every other person in the United States. Of course hydrocodone is very helpful for those suffering pain, but it is also a drug of abuse and addiction that has gained a lot of popular culture attention. Eminem supposedly has a tattoo of Vicodin on his arm. Overdose of the drug has been implicated in many deaths, including celebrities such as Dana Plato and Heath Ledger.
In fact, 9 of the top 50 medicines could be considered addictive, although when used appropriately are helpful in treating pain and anxiety, would be startling news to most people, I believe.
Surprisingly, only 3 of the top 20 medicines by prescription volume are name brands, a reflection of insurance company formularies, patient cost-saving choices, and physician recommendations.
Psychiatric disorders account for the primary indications of 11/50 of the top medicines.
Propoxyphene-N (or Darvon-N, Darvocet-N) racked up 20,400,000 prescriptions and $225,000,000 in sales despite this year’s FDA advisory panel vote to recommend it be pulled from the market.
Propoxyphene’s potency as a pain reliever is about equal to acetaminophen, with added risks of slowly cleared metabolites and possible increased deaths.
Hypertension, high cholesterol, and diabetes are at least treatable and often curable with changes in lifestyle, weight loss and diet. 15 of the top 50 medicines might be reduced with behavioral changes. 2 of the top 3 medicines fall into this category. The Mediterranean diet does seem effective but with a lifestyle changes, not simply a diet. Diets do not work. .
The above list is ranked by total number of prescriptions written. It includes both generic and name brand drugs. The top ten medicines by total retail dollars spent in 2008 are:
1. Lipitor $5.88 billion
2. Nexium 4.79 billion
3. Plavix 3.79
4. Advair Diskus 3.57
5. Prevacid 3.29
6. Seroquel 2.90
7. Singulair 2.89
8. Effexor XR 2.65
9. OxyContin 2.50
10. Actos 2.44
Interesting, me thinks.
What do you think?
No comments:
Post a Comment