The Causes of Polypharmacy
How did we get to this state of widespread polypharmacy? It will be no surprise to learn that multiple contributing factors have been influencing medication use in the United States for years. Understanding the nature of these influences allows you to appreciate the breadth of the problem and be more prepared to stand up to these forces when feasible.
To begin with, as our population ages, there are more and more persons with multiple chronic conditions. Chronic health conditions go hand-in-hand with medication use. According to the Centers for Medicare and Medicaid Services (CMS), 69 percent of older adults are diagnosed with two or more chronic health conditions and 18 percent have six or more. In contrast, just 27 percent of adults age 18 and older report having more than one chronic health problem. Health conditions common among older adults include high blood pressure, high cholesterol, arthritis, diabetes, and heart disease. The majority of these require drug therapy, and often more than one medication, as described earlier.
Another contributing factor is advances in medicine. As a result of improved medical knowledge, technology, and medications, we are able to survive health events that would have been devastating in the past, such as heart attacks, strokes, and cancer. Subsequently, we are living longer and have the opportunity to acquire other health conditions or ailments that call for drug therapy.
Polypharmacy also is driven by pharmaceutical advancements. Pharmaceutical science has allowed for an increasing number of drug discoveries. We now can treat medical conditions for which we had no drug therapy options in the past. Over the past three decades, the FDA approved an average of thirty-three novel new drugs per year. That amounts to over a thousand new drugs during my career so far as a pharmacist. We also have seen a growth in the number of dietary supplements and over-the-counter (OTC) products on the market. These are multibillion-dollar industries that heavily advertise to consumers.
Advertisements for prescription drugs contribute to polypharmacy trends as well. Since 1997, regulations in the United States have allowed pharmaceutical manufacturers to advertise prescription-only medications directly to consumers, a practice known as direct-to-consumer advertising (DTCA). New Zealand is the only other country where this is legal. The impact of DTCA is complex and not without controversy. One of its benefits is increased awareness of certain health conditions that might be embarrassing for patients to talk about (such as overactive bladder or erectile dysfunction), which promotes physician-patient communication. On the other hand, DTCA is a lucrative opportunity, and drug companies spend about $6 billion annually in advertising to reach consumers. In a 2021 analysis, drugs with the highest DTCA spending were also noted to have the highest Medicare expenditures.
Increased access to health information on the internet also has influenced widespread polypharmacy. As patients seek information about a health condition and its treatment options, they are more apt to self-treat with nonprescription medications or request a prescription from their physicians.
With the wide availability of prescription and nonprescription medications, coupled with high exposure through marketing and the internet, consumers are immersed in the message that pharmaceuticals will treat just about every ailment or symptom. This has contributed to a pill-popping culture, in which individuals tend to prefer a “pill for every ill.” It is far easier to swallow a medication than to invest time and effort in lifestyle changes and other nondrug treatments. Unfortunately, patients often expect a prescription from their physicians when they describe a symptom, and many times physicians will oblige because they are trained to be healers and want to address their patients’ needs.
