Have we become too dependent on medication?

You have a headache. Do you drink some fluids and take a rest? Or do you reach for the painkillers? 

For most of us, the latter is likely to be the first port of call. With our increasingly busy lifestyles, we tend to opt for a quick fix to our ailments, and this often involves a pill of some kind. 

But have we become too reliant on modern medicines? And if so, could this be doing us more harm than good?

Around 81% of adults in the US use over-the-counter drugs as a first response to minor conditions.

A 2010 survey from The Henry J. Kaiser Family Foundation revealed that between 1999 and 2009, the number of prescriptions dispensed in the US increased by 39%, from 2.8 billion to 3.9 billion.

A 2014 survey from the Centers for Disease Control and Prevention (CDC) revealed 48% of us have used at least one prescription drug in the past 30 days - 5% more than in 1999-2000. Around 31% of us have used two or more prescription drugs in the past month, compared with 25% in 1999-2000.

And when it comes to over-the-counter (OTC) medications, 2012 research from the Consumer Healthcare Products Association found that 81% of adults in the US use such drugs as a first response to minor conditions.

Figures such as these indicate that we are more dependent on medication than ever before. But why is this the case?

'It is easier for patients to pop a pill than make lifestyle changes'

Heart disease is responsible for more than 600,000 deaths in the US each year, making it the leading cause of death in the country.

With this in mind, it is no wonder that among the most commonly prescribed drugs in the US include those used to treat conditions associated with heart disease, such as statins - used to reduce cholesterol. According to the CDC, the use of cholesterol-lowering drugs is now six times higher than it was in 1988-94.

It is common knowledge, however, that a number of lifestyle changes - including adopting a healthy diet, avoiding tobacco smoke and increasing physical activity - can help lower cholesterol, as well as blood pressure and other risk factors for heart disease.

For example, a 2013 study published in The BMJ found that for the treatment of stroke, exercise was more effective than medication, while it was as equally as effective for the secondary prevention of both heart disease and diabetes. So why do many of us turn to medication instead?

This is probably easier for patients to pop a pill as opposed to changing their lifestyle, exercising and losing weight. These are difficult changes to make.

While taking a pill may be easier than making lifestyle changes, however, it comes with risks.

Addiction and overdosing

Pain-relieving drugs, such as opioids, are among the most commonly prescribed medications in the US, and their long-term use has led to major health concerns.

In 2013, the Food and Drug Administration (FDA) reported that there had been more than 15,500 deaths in the US in 2009 as a result of patients overdosing on opioids.

The problem with opioids and many other analgesics is that they can become addictive. 

The National Institute on Drug Abuse (NIDA) estimate that in 2012, around 2.1 million people in the US had substance use disorders relating to prescription opioids.

"Opioid medications can produce a sense of well-being and pleasure because these drugs affect brain regions involved in reward," according to NIDA. 

"People who abuse opioids may seek to intensify their experience by taking the drug in ways other than those prescribed."

In 2013, the Food and Drug Administration (FDA) reported that there had been more than 15,500 deaths in the US in 2009 as a result of patients overdosing on opioids - representing a 300% increase in opioid-related deaths over the past 20 years.

Though it is believed many of these deaths are down to illicit opioid use, a 2011 study published in JAMA revealed that individuals regularly taking larger doses of opioids are at increased risk of unintentional death than those on lower doses.

The researchers claim there was a 124% increase in the rate of unintentional overdose death in the US between 1999 and 2007, "largely because of increases in prescription opioid overdoses."

Antibiotic resistance

On a bigger scale, unnecessary prescriptions of antibiotics - another of the most commonly prescribed drugs in the US - has been cited as a major driver of drug-resistant bacteria. This is bacteria that has mutated to develop resistance to drugs that previously killed it.

A 2013 study revealed that the USA has high rates of unnecessary antibiotic prescriptions for sore throats and bronchitis. 

While the national rates of antibiotic prescriptions should be near 0% for bronchitis and 10% for strep throat - the only cause of sore throat that requires antibiotics - the rates were 60% and 73%, respectively.

In the US, more than 2 million people become infected with drug-resistant bacteria each year, and more than 23,000 die from such infections.

In a 2014 feature looking at how antibiotic resistance has become a global threat to public health.

During the last 70 years, bacteria have shown the ability to become resistant to every antibiotic that has been developed. And the more antibiotics are used, the more quickly bacteria develop resistance.

"The use of antibiotics at any time in any setting puts biological pressure on bacteria that promotes the development of resistance.

When antibiotics are needed to prevent or treat disease, they should always be used. But research has shown that as much as 50% of the time, antibiotics are prescribed when they are not needed or they are misused (for example, a patient is given the wrong dose). This inappropriate use of antibiotics unnecessarily promotes antibiotic resistance."

The side effects of long-term, inappropriate and multiple medication use

As reported previously, more than 30% of us have used two or more prescription drugs in the past 30 days. 

Furthermore, more than 10% of us have used five or more prescription drugs during this time. Many of us may even be using OTC drugs alongside these. But do we know what this cocktail of medication is doing to our health?

Talking to CNN in 2011, an associate professor of clinical pharmacy, psychiatry and behavioral sciences at the University of Southern California, said taking multiple drugs can be potentially dangerous for a patient, particularly if they are receiving medications from different clinicians who are not communicating with each other.

A patient could have adverse effects and think the medical condition is getting worse, when in fact it is a side effect of several different medications which are all interacting in a negative way. When you're on more than 20 drugs all at the same time, you'd want to question whether or not that's really necessary.

But you do not need to take multiple drugs to see side effects.

"All medications have side effects. When used correctly in a particular patient, the benefit accrued likely outweighs the risks. However, if used inappropriately in patients who are less likely to benefit, or more likely to have side effects than an average patient, the balance may tilt to causing more harm."

Taking medications for long periods may also cause problems. Concerns have been raised about long-term aspirin use, for example. While the blood-thinning drug - widely available as both a prescription and OTC medication - has been hailed for reducing the risk of heart attack and stroke among high-risk patients, some studies have suggested that long-term use of aspirin may have negative health implications.

In January 2013, a team of researchers reported on a study linking regular aspirin use to age-related macular degeneration, while other studies have associated aspirin use with hearing loss, gastrointestinal bleeding and extracranial bleeding - bleeding in the brain.

Though the Food and Drug Administration (FDA) advised Americans against aspirin use to prevent a first stroke or heart attack last year, a recent study found that more than 10% of patients in the USA are inappropriately receiving low-dose daily aspirin for that reason.

Major coronary events are reduced 18% by aspirin, but at the cost of an increase of 54% of major extracranial bleeding. Each two major coronary events have shown to be prevented by prophylactic aspirin at the cost of one major extracranial bleed. Yet, primary prevention with aspirin is widely applied.

In their study, the research team says it is not clear how much of the identified inappropriate aspirin use is down to patient decisions or physician recommendations. But this begs the bigger question: what is driving the increase in medication use?

Are doctors overprescribing medication?

The aforementioned statistics show that more prescriptions are being dispensed in the US than ever before. Over the past 20 years, spending on prescriptions drugs in the US has increased by $200 billion.

Some health care professionals believe doctors may be overprescribing drugs to patients.

Of course, the aging population plays a part in this. 

Because we are living longer, the rates of lifelong and age-related illnesses are rising, meaning more medications are required. But this is not the sole cause.

Some health care professionals believe doctors may be overprescribing drugs to patients. "

We are concerned that many doctors are prescribing medicines unnecessarily because they do not have enough time to sit with their patients and talk about options other than taking medication.

In fact, there is available data showing that doctors overprescribe medication. But he believes that the implementation of treatment guidelines in the US and an increase in evidence-based medicine are causing a fall in overprescribing.

Also, electronic records should decrease [overprescribing]. Insurance companies, prescribing databases and pharmacies are doing a better job of preventing duplicate prescriptions by different doctors."

Besides the recent changes in Medicare/Medicaid reimbursements, as well as emphasis on quality improvement measures, have moved doctors toward a more conservative approach with medications used more efficiently over procedures.

Drug advertising: influencing both doctors and patients?

Many health care professionals presently believe pharmaceutical companies also play a major role in increasing medication use in the USA.

Since 1985, it has been legal for drug companies to market their products directly to consumers. In a Bulletin of the World Health Organization (WHO), which claims that, claims such advertising helps inform consumers of their treatment options.

Others disagree and claim that, the truth is direct-to-consumer advertising is used to drive choice rather than inform it, noting that consumers are often directed toward expensive brand-name medications.

In addition, this can cause patients to influence the decisions of doctors. In an era of shared decision-making, it's much more likely that general practitioners will just do what the patient asks.

The FDA state that, while direct-to-consumer drug advertising can offer useful information to consumers, the health care provider is the "best source of information about the right medication for you."

What can we do to avoid unnecessary medication?

While we can avoid taking medication for some minor ailments, many of us suffer from more serious conditions whereby medication is required. But how can we ensure we are receiving the correct treatment?

Patients should engage and research their condition as much as possible to get an idea of the medication that is required, and they should ask their health care provider about all available treatment options.

"I would recommend that patients do their best to be informed about their disease and health conditions. Further, all medications and alternative therapies should be disclosed to providers to avoid adverse drug interactions. It is best to discuss questions and medications with their health care providers."

References:

1.     CDC, Therapeutic drug use, accessed 29 January 2015.

2.     CDC news release, accessed 29 January 2015.

3.     CDC, Heart disease facts, accessed 29 January 2015.

4.     CDC, Antimicrobial resistance , accessed 29 January 2015.

5.     FDA, Prescription drug advertising, accessed 29 January 2015.

6.     WHO, Direct-to-consumer advertising under fire, accessed 29 January 2015.

7.     The Henry J. Kaiser Family Foundation, Prescription drug trends, accessed 29 January 2015.

8.     Consumer Healthcare Products Association, Statistics on OTC use, accessed 29 January 2015.

9.     Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study, Huseyin Naci,, et al., The BMJ, doi: http://dx.doi.org/10.1136/bmj.f5577, published 1 October 2013.

10.   Association between opioid prescribing patterns and opioid overdose-related Deaths, Amy S. B. Bohnert, et al., JAMA, doi:10.1001/jama.2011.370, published 6 April 2011.

11.   National Institute on Drug Abuse, America’s addiction to opioids: heroin and prescription drug abuse, accessed 29 January 2015.

12.   CNN, Are you taking too many meds?, accessed 29 January 2015.

        13.   The Telegraph, Amount of drugs prescribed by GPs triples over 15 years, accessed 29 January 2015.