Last week the latest Health Survey for England revealed that almost half of us are taking prescription medications. The report did not take into account smoking cessation interventions or contraception. Nevertheless, it led (not surprisingly) to headlines along the lines of “ England now nation of ‘pill-poppers’ with 50 per cent taking prescription drugs” . The actual figures from the report were “ 43 per cent of men and 50 per cent of women reported that they had taken at least one prescribed medicine in the last week”. Look a bit further into the report and you find that the proportion of people that fell into this category increased with lowering income, high area deprivation, and BMI. So if you are poor, live in a bad area and are overweight there is a high chance you would have been prescribed something.
I read on with interest. A total of 1 billion community-based prescriptions were issued in the UK in 2013 at an average 18.7 prescription items dispensed per head of population in England. Wow. The reported Net Ingredient Cost (NIC) (the cost of the drug before any NHS discounts) was £8.6 billion. Bear in mind that the allocated funding for the NHS in 2012/2013 was around £108.9 billion (incidentally the 2013/2014 allocation to NHS England to deliver its mandate was £95.6 billion). So nearly 10% of the NHS budget was spent on prescription medications.
By far the single largest class of medication was for managing cardiovascular disease. Not a huge surprise really. However some of the other figures certainly did raise an eyebrow.
The single most commonly prescribed drug was for lowering cholesterol: simvastatin, Amazing that we are still calling into question the evidence for its benefits versus risks of harm yet over 40 million prescriptions were issued in 2013.
After that there were over 65 million prescriptions for pain relief medications, over 50 million for antidepressants and proton pump inhibitors each.
Thinking about that at ground level I can easily see how that can happen. So a patient with chronic pain from low backache is prescribed a different pain relief analgesic. Some time later, the chronic pain leads to low mood and they end up being prescribed an antidepressant. However the antidepressant they are prescribed may interact with the pain relief medication they were given and irritate their stomach, so they get prescribed a third medication, a proton pump inhibitor, to try and protect their stomach.
Is their back pain or mood any better? Probably not (although we can have a whole separate discussion on the appropriate use and efficacy of antidepressants and proton pump inhibitors). Yet, before you know it the patient is on 3 new drugs and we are in the realms of polypharmacy and the risk of adverse events from these drugs increases.
Polypharmacy, lack of evidence, adverse events, cost….surely there must be some good news? Well depends on your view really. Despite all the prescriptions issued, the reality is that we are all generally poor adherers to prescribed drugs with estimates of up to half of all those prescriptions not even being taken .
So for me the headline should be “£8.6 billion spent on prescription drugs: some may not be taken, some may not work”.