The problem of over-prescribed opiods has received a lot of attention of late—justifiably so—but there is a much bigger drug-prescribing problem that affects just about all of us. The federal government subsidizes much of it, and your doctor, pharmacist and health-insurance company are complicit.
In 2016, the American public spent $374 billion on prescription drugs. That figure is projected to nearly double in the next four years to $610 billion, more than half a trillion dollars.
Why? As demonstrated to us by now-jailbird Martin Skreli, the man without a moral cell in his body, the pharmaceutical industry will charge whatever the market will bear, and that appears to be an awful lot.
This problem, however, is closer to home. You can’t dictate what others in the prescription chain should or will do, but you can reduce your own costs—along with risks of side effects that all drugs have, even aspirin—at least for drugs for treating non-life-threatening conditions. That includes just about all of those opioids.
It’s called pill-splitting, and the beauty of it is that if a quarter of a pill, or half of one, doesn’t do the job for you, you can always return to taking the entire pill as prescribed. But, at least you will find out what dosage is right for your condition.
You may ask that if a quarter of a pill works for your condition, why don’t drug makers make one in that dosage instead of four times as much.
We may attempt to answer.
All drugs sold in the United States must meet the approval of the Food and Drug Administration. It’s one of those regulatory agencies that libertarians and other conservatives love to hate, almost always without realizing the good it produces.
To get FDA approval, a drug maker must put its pills through excruciating clinical trials at great expense, quite often the expense shared by the National Institutes of Health. Understandably, the pharmaceutical company will want to try a dosage big enough to demonstrate early that it is efficacious and that is big enough to justify its production and by-the-way bigger profit margin.
That’s why you rarely will see a pill marketed in a dosage level under five or 10 milligrams. Yet, if you give it a try, again especially with opioids, you may find that 2.5 milligrams or even 1.25 milligrams will do the trick. Do the math. Splitting your pills in half means you save half the cost, by quarters means you save three quarters of the cost.
Why shouldn’t that be a no-brainer? Because no one in the chain of your drug’s distribution tells you so. Obviously, the pharma company isn’t going to tell you because it will lose profits. But, how about your prescribing physician? Is it the fear of getting sued if he or she strays from the well-trodden path and gives you a sane suggestion? Probably not, it’s just habit, perhaps even laziness.
Your pharmacist could tell you, but that would mean interfering with the physician’s prescription, and that could mean lost business. The insurance company, for whom the doctor and the pharmacist often work, could tell you, and that would make all of the sense in the world, because the insurer usually pays more for the pills than you do.
That last part of the prescription chain, we don’t understand. Insurance companies usually have committees of physicians they employ to advise on their formulary, so perhaps it is that old fear of being sued that takes place. We can understand that it also may fear being sued by a patient whose pill-splitting went wrong, but that threat shouldn’t include advising a patient of the option—again, for non-life-threatening drugs only.
But, you can take the situation into your own hands, damn the torpedoes and full speed ahead, and split those pills until you find the least amount of dosage that works for you. Especially if you are taking opioids.
We do add one caveat here. Particularly with habit-forming drugs such as opioids and other pain-killers, you may have been taking them long enough that you have built up a dependence on those dosages, and splitting the pill will not work for you. But, it doesn’t hurt to try it, as long as the condition is not life-threatening.
There is an added reason why you may wish to consider pill-splitting. As we write this the U.S. government is investigating dozens of makers of generic drugs—most generics makers are in India—for likely price-fixing collusion. You may have noticed that some of your generics drugs have gone way up in price recently. Apparently, the government knows why and is taking action.