Americans' longstanding love affair with tranquilizers continues to wane, according to a new government report on prescription drug use. At the same time, the report indicated, powerful antibiotics developed in the last two decades are being used too often and too much by doctors when less powerful weapons might fight infection just as effectively.
Tranquilizers like Valium accounted for only 2.9% of the drug costs of inpatients and outpatients combined, according to a newly published survey of 1982 drug prescribing patterns by the U.S. Food and Drug Administration.
New Report The new government report found drugs to control irregular heart rhythms and blood pressure, as well as the powerful new antibiotics, responsible for the greatest proportion of the $3 billion spent by hospitals and $14.5 billion by consumers on prescription drugs of all kinds.
Publicity about the real and potential dangers of excess use of tranquilizers toppled Valium from top position on the FDA's list of the 25 most heavily prescribed drugs about three years ago, and government analysts now say the public has apparently adopted more reasonable expectations for such preparations.
Experts in and out of government say greatly increased public awareness about the dangers of tranquilizers--dating to the mid-1970s--is largely responsible for breaking prescribing patterns influenced heavily by drug company promotion and advertising to doctors.
Experts in pharmacology who reviewed the new FDA listing, however, noted that the positioning of drugs may be as much a commentary on the increasing complexity of medical economics as anything else. They warned of the dangers of trying to assess trends in medicine in the comparative vacuum of drug prescribing patterns alone, but the new FDA analysis seeks to establish the context in which drugs are ordered by doctors as clearly as possible.
The list, prepared annually for the last four years, ranks the often prescribed drugs. This year, for the first time, the report analyzes trends in the amount of money spent for drugs by consumers and hospitals. The greatest sum went to the ulcer drug Tagamet and the most prescriptions were issued for Dyazide, a diuretic widely used in the treatment of high blood pressure.
The new FDA report appeared last week in the Journal of the American Medical Assn.
In all, the government figures indicate, the volume of prescriptions and the amount of money Americans are spending on such drugs reflects about the same increase as the population in general and hikes in the Consumer Price Index. The tabulation does not include over-the-counter remedies, like aspirin, or any illicit drugs.
Commonly Abused Of the 25 substances on the government's listing of those on which the most money was spent, two--Valium and Tranxene (No. 23)--are commonly abused tranquilizers and one, Tylenol with codeine (No. 17), has been widely linked with diversion to the illicit market. A form of Darvon, a painkiller that also has been widely abused, held to the 15th spot in the ratings.
The list of the top 25 drugs in terms of dollar sales focused on specific brand-name preparations. But the government also released rankings of the most heavily sold broad classes of drugs. Mind-altering drugs lagged in third place, responsible for 7.3% of all sales, behind antibiotics of all kinds (13.6%) and drugs for the wide range of heart problems (12.5%).
Among frequently used specific drug types, substances to control irregular heartbeats captured 5.2% of the total drug market; a class of powerful new antibiotics called cephalosporins took 4.9%; a large class of hypertension/heart drugs called beta-blockers accounted for 3.4%, as did oral contraceptives, while minor tranquilizers in general, including Valium and at least a dozen similar preparations, took 2.9%.
The FDA analysis was based on actual sales by a sample group of 1,200 selected drugstores and a similar survey of hospitals. The measures were correlated with such data as the Consumer Price Index, Census reports and reports by doctors of what drugs they prescribed. The blend of figures led the FDA to estimate that 1.5 billion prescriptions were filled by retail pharmacies in 1982--a 5% increase over the previous year. New prescriptions accounted for 51% of the total and refills for the rest.
Increased 12% Both the total of prescriptions and the population of the United States have increased about 12% since 1971, the FDA concluded, but prescribing patterns have been far more erratic. After the number of prescriptions jumped by 38% from 1971 to 1977, it declined from 1977 to 1979, then started to increase again. But prescriptions were essentially unchanged in number in 1981 and 1982.