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Antidepressants overtake painkillers among Erie's Medicaid prescriptions

The most prescribed class of drugs for Medicaid patients in Erie County doesn't treat asthma, heart disease, diabetes or even severe pain.

It treats depression.

Nearly one of every 10 prescriptions filled last year was for either antidepressants or prescription stimulants, according to a new report from the Erie County Medicaid Inspector General's Office.

And the number is growing. Stimulants are often prescribed to treat both acute cases of depression and attention deficit disorder.

"I was not surprised," said Erie County Mental Health Commissioner Michael Ranney of the findings. "Depression is one of the leading health conditions people may have and often struggle with. But we also have to remember it’s treatable."

Medicaid drug data is one of the few publicly available sources of information that can highlight prescribing trends. With more than 250,000 low-income residents throughout Erie County receiving Medicaid benefits, the Medicaid prescribing data is considered fairly reflective of larger drug prescribing trends countywide. More than 3 million Medicaid prescriptions were written in Erie County last year, and more than 2 million through September of this year.

Health advocates are increasingly succeeding in destigmatizing behavioral health issues and educating primary care physicians on the importance of screening for mental health conditions as well as physical ones, Ranney said. So more people are getting properly diagnosed for conditions like depression and anxiety.

Doctors are now more likely to consider whether physical complaints like sleep issues or eating problems have roots in a mental health condition like depression, Ranney said.

"Think of how the mind and body work together," he said. "One in five people in the U.S. have a mental health condition. It’s pretty common."

Antidepressants weren't always a prescription pad pacesetter.

[RELATED: Popular opioid painkiller falls from top ranks of prescribed drugs in Erie County]

In 2010, narcotic painkillers were the No. 1 prescribed group of therapy drugs, and the painkiller hydrocodone-acetaminophen remained the single-most prescribed drug among Medicaid patients through 2015. But tougher prescribing laws and greater awareness among physicians about the highly addictive properties of opioid drugs have led to a decline in these numbers.

The opposite is true for depression-related medication. This group of therapy drugs has seen a 91 percent increase since 2010 and been the most prescribed class of therapy drugs for Medicaid patients since 2011, based on data provided to The Buffalo News. Doctors signed more than 247,000 antidepressant and psychostimulant prescriptions for Erie County Medicaid patients last year alone.

Medicaid Inspector General Michael Szukala said this year was the first year he was could sort prescription drugs by therapy class, not just by individual drug name. That analysis showed that antidepressants/stimulants were, by far, the most prescribed class of drugs. Anti-seizure medication, which can also used to treat pain, came in a distant second, followed by asthma medication.

One reason why antidepressants may be so frequently prescribed is that patients diagnosed with depression often take antidepressants for months or even years at a time. For instance, while far more Erie County Medicaid patients were prescribed antibiotics than antidepressants last year, the number of antidepressant prescriptions filled was at least five times greater.

Ranney said he hopes awareness and treatment of mental health conditions continue to grow. The county has worked with Buffalo Public Schools and Say Yes Buffalo to establish nearly 60 mental health clinics in the city school system and is working to open a few more. It's also supporting an anti-stigma campaign regarding mental health called Let's Talk Stigma, which includes a website with resources and social media presence with the hashtag #LetsTalkStigma and Twitter handle @TalkStigma.

"We can still do better as it relates to primary care and behavioral health," he said.

The analysis of drug prescriptions for Medicaid patients is only one of multiple findings outlined in the new report on Erie County Medicaid data.

Among the findings:

  • As doctors search for less addictive alternatives to addressing severe and chronic pain, more physicians are turning to gabapentin, sold under the brand Neurontin. This anti-seizure drug is also used to address pain related to nerve damage. In 2014, gabapentin ranked 12th among prescribed Medicaid drugs. This year, through September, it has moved up to sixth place. While considered safer and non-addictive, gabapentin can also be prone to misuse and abuse.
  • Hydrocodone-acetaminophen, a combination of opioid painkiller and Tylenol, has fallen from the single most prescribed drug in 2015 to the seventh most prescribed drug in 2017. Medicaid clients prescribed this medication tend to be middle-aged, white, single and female. Narcotic painkillers, as a drug class, have dropped from fourth place to 11th place over that same time period.

Read the full report here:

Medicaid Report 2018 (Text)

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