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Overdosed: Poor health of Tennesseans, cultural expectations contribute to high prescription use

KEVIN CASTLE • Feb 17, 2007 at 9:00 AM

There is an epidemic in the Volunteer State, and if you don't believe it, take a look at the long lines at the prescription counter of your neighborhood pharmacy.

According to "Inside Tennessee's Medicine Cabinet," a study released earlier this month by Blue Cross Blue Shield, Tennessee still leads the nation in the use of prescription drugs.

The Tri-Cities ranks second only to Memphis in prescription drug use per person per year, with 12.7 prescriptions per resident.

"This is a problem that has been vexing for a number of us in health care," said Dr. Ronald Franks, dean of the Quillen College of Medicine at East Tennessee State University.

"The health of the people of Tennessee is not good overall, placing at number 47 in the nation in those terms. Cases of cancer, obesity, heart disease, diabetes, among other conditions, have gotten us that high. So for that reason, we are requiring more treatment, including prescribing medications. That is probably the most important factor in all of this."

The study also showed the top 10 most prescribed medications in Tennessee.

Hydrocodone tops the list, making up 2.8 percent of total prescriptions filled in the state. Cholesterol drug Lipitor is second, followed by Nexium, a medication for acid reflux; Alprazolam, which treats anxiety and insomnia; and Levothyroxine, a thyroid medication.

"The most important issue is that we require more prescriptions in Tennessee because our health is not that good. The health of the Tennessean is not that of the regular American. The study shows that...

"You have a person come in who's overweight who also has joint pain and is experiencing some kind of depression because of being overweight, and then they have a sleep disorder because of the depression. They may walk out with three or four prescriptions in that case."

Franks attributes part of the problem to a patient's expectation that there's a a pill for what ails them.

"Before I moved to Tennessee, I lived in Minnesota, and it's hard to draw generalities, but more often in Minnesota I would have to spend extra time to convince (a patient) to take medication. In Tennessee, I had to convince them not to take a medication," said Franks.

"I think part of the cultural expectation is if you're sick enough to go to the doctor and you don't walk out with a prescription, you haven't been treated properly."

Antibiotic resistance could also be contributing to the problem. According to the study, "Tennessee has some of the highest rates of antibiotic resistance in the nation," and hard-to-treat infections are common in the throat, sinus, ears, lungs and intestines.

"The patient wants relief, but there is no easy way to diagnose it because it could be bacterial. You give the antibiotic, and that could help acutely, but if you do that too much, the body starts becoming immune. Too few or too many could be the problem," said Franks.

A spin-off problem from high prescription use is accidental poisonings.

Earlier this month, the national Centers for Disease Control and Prevention said drug interactions are the second-leading cause of accidental deaths nationwide. Auto accidents are the first.

In 2004, there were more than 19,800 deaths nationwide from unintentional drug interactions.

And on the horizon for Tennessee may be an increase in teen prescription drug abuse, which is up sharply across the nation, according to a report released this week by White House drug czar John Walters.

According to the Associated Press, the report found that marijuana use among teens is declining, but prescription drug abuse is not.

The AP reported that Walters said "the drug dealer is us."

Teens most often abuse pain medications, which health care officials say are "readily available" thanks to inattentive adults letting old prescriptions fall into the hands of teens.

The Blue Cross Blue Shield study concludes that many groups will have to work together to solve the prescription problem.

Franks said the Quillen College of Medicine is already working on the problem.

"I would say in the last decade there has been renewed effort to educate students and residents to the risks of over-prescribing, to make sure you're not adding additional drugs," he said.

"A third factor in prescribing is a patient may see two or three doctors, and as much as you like the patients to be able to give you a list of medicines they are on, it is surprising how many patients cannot list them because some do not know.

"We are working to develop a electronic medical record database for this region, so that when a patient walks into any clinic or hospital, with the patient's permission, a list can be pulled up to show what medications they are on. This will significantly reduce the amount of medications being given."

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