Psychiatric News September 3, 2004
Volume 39 Number 17
© 2004 American Psychiatric Association
p. 35
9/11 Didn't Produce Jump In Psychoactive Drug Use
Jim Rosack
Despite predictions, for most of the nation, psychotropic medications
were not a significant source of relief following the terrorist attacks of
September 11, 2001.
The widespread distress felt across the United States following the
terrorist attacks of September 11, 2001, was not accompanied by a significant
upward trend in the utilization of psychotropic medications. However, a formal
review of prescription medication data now confirms the conclusions of a
preliminary analysis of the same data by Psychiatric News, which
noted a small but statistically significant increase in the utilization of
psychotropic medications in the New York City area (Psychiatric News,
November 16, 2001).
The results of the formal review, conducted by Benjamin Druss, M.D.,
M.P.H., an associate professor of psychiatry at Emory University in Atlanta,
and Steven Marcus, Ph.D., of the University of Pennsylvania School of Social
Work in Philadelphia, were published in the August American Journal of
Psychiatry. The work was supported by a grant from the National Institute
of Mental Health.
Druss and Marcus used two sources for prescription data "to ensure
both breadth and depth of data about medication use." The first dataset
came from NDCHealth, a national data warehouse that collects information about
more than two-thirds of the prescriptions filled in the United States and then
projects these data to aggregate nationwide, regional, and local estimates of
medication usage. The second dataset came from AdvancePCS, the largest
pharmacy benefits management (PBM) organization in the United States.
AdvancePCS processes more than 450 million pharmacy claims a year.
NDCHealth provided Druss and Marcus with weekly projections of psychotropic
medication utilization nationally and in the New York and Washington, D.C.,
areas. The NDCHealth data represented weekly averages, so the team used them
to provide a comprehensive overview of psychotropic medication use over time
for antidepressants, antipsychotic/antimanic medications, anxiolytics, and
hypnotic medications.
AdvancePCS provided complete data for all prescriptions for psychotropic
medications filled by the PBM between September 2001 and December 2001. Data
from the same period in 2000 were used as a comparison.
The AdvancePCS data represented depersonalized individual prescription
records including not only the date the prescription was filled, the drug
dispensed, and its strength and quantity, but also age, sex, and ZIP code of
the patient and a variable indicating whether the patient had had the same
prescription filled within the prior 365 days.
Druss and Marcus again subdivided the data into the same four major
medication groups as the NDCHealth data.
The researchers found that 156.9 million prescriptions for psychotropics
were filled during the study period. Nationally and in Washington, D.C., the
team found no evidence of any increase in overall psychotropic prescriptions,
the number of new prescriptions, or the dosage of medications. However, in New
York City, there was an increase in the proportion of patients taking
psychotropic medications and who increased their dosages in the 12 weeks
following September 11, compared with the proportion who increased their
dosages during the same 12 weeks in 2000 (13.6 percent). Yet in New York City,
there was still no increase in the number of new psychotropic prescriptions
filled.
"For certain subpopulations—in particular, certain subgroups of
patients already taking psychotropic medications—there was a small but
consistent increase in the use of these medications," Druss and Marcus
concluded. "Taken together, this evidence suggests that initial
predictions of a drastic increase in [psychotropic medication] use after
September 11 were not realized."
Druss and Marcus hypothesized that several reasons could account for a lack
of any apparent effect. First, they said, "it is possible that patients
who needed care failed to obtain access to it." Second, they added,
individuals may have been symptomatic, yet did not see themselves in need of
formal mental health services.
"Finally," the researchers noted, "many people are likely
to have sought help through friends and family, local communities, or
clergy.
Druss and Marcus acknowledged that the study results must be interpreted
with some limitations. "The data sets had considerably more breadth than
depth," they wrote. The data did not include any diagnostic information
or clinical data on treatments other than pharmacotherapy.
The study, "Use of Psychotropic Medications Before and After
Sept. 11, 2001," is posted online at
<http://ajp.psychiatryonline.org/cgi/content/full/161/8/1377>.
Am J Psychiatry 2004 161 1377[Abstract/Free Full Text]
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