Boston — Drug-prescribing practices in America appear to be undergoing a significant change.
After years of unchecked increases, studies indicate that the use of all prescription drugs in the United States is declining. And the use of tranquilizers and sleeping pills appears to be down even more markedly.
Statistics compiled by the National Institute of Mental Health (NIMH) and the California-based Institute for Social Behavior show a 4 percent drop-off among all types of retail prescription drugs since the mid-1970s. In 1980 alone, 100 million fewer prescriptions were being filled than in 1974, despite increased numbers of drugs on the market. And the decline in the use of psychotherapeutic (mood altering drugs used under medical supervision) drugs has been even sharper.
Psychotherapeutic drugs include tranquilizers, sleeping pills, and sedatives. Doctors are now prescribing one-third less of these drugs than they were in the mid-'70s. And the use of specific drugs, such as the tranquilizer Valium and sleeping pills, is down by more than half.
''Each class of drugs has its own trend, and the psychotherapeutics have dropped significantly faster than any other group,'' says Dr. Mitchell Balter, chief of the health practices program at NIMH.
There appears to be two key reasons for this decline. One is concern over the health risks associated with mind-altering drugs. Dr. Balter says the decline in psychotherapeutic drugs began in the mid-1970s when physicians began to encounter some negative side effects. ''The perception of the risks involved with those drugs increased,'' he says. ''And that's a perception that is connected to the larger consumer concern regarding the benefit and risks of drug-taking in general.''
Other observers see the decline in psychotherapeutic drugs as the result of a sharpening moral focus. ''There is no question that large numbers of patients and doctors believe the use of these drugs is a sign of weakness,'' says Dr. Eliot Heiman of the University of Arizona. ''A lot of people don't want to take drugs to solve their problems. They don't want to depend upon drugs instead of their own characters. There is a very strong moral component involved.'' In a recent study, Dr. Heiman says he found that 25 percent of doctors polled said they would never prescribe tranquilizers, ''anytime.''
Such a decline, say observers, reflects a substantial change on the part of patients and physicians in drug prescribing practices.
''The old school of thought said that a patient won't be truly happy unless he leaves his physician's office with a prescription in hand. That is no longer the case,'' says Dr. Steve Wartman, director of internal medicine at Brown University and Rhode Island Hospital, who has studied prescribing practices. ''Every year it seems as if some new drug has been withdrawn from the market. And physicians today feel much less pressure to prescribe.''
NIMH survey data indicate that the percentage of the US population between 18 and 74 years of age who are using psychotherapeutic drugs has declined from 18 to 16 percent. Tranquilizer prescriptions have fallen off from 104.5 million in 1973 to 70.8 million in 1981. And the tranquilizer Valium, once the most popular prescription drug in the US, has dropped over 50 percent from its peak of 62 million prescriptions in 1975.
Sleeping pill prescriptions have also dropped by more than half from 40 million in 1973 to 21 million in 1980. And daytime sedatives have declined from 21 million prescribed annually in the mid-1970s to a new low of just over 9 million in 1980. Such declines, experts say, are largely due to the increased perception of the risks of drug-taking on the part of patients and physicians.
''Unlike the late 1960s and early '70s when people just automatically reached for a Valium, today there is a big fear of addiction,'' says Bradley Wulf, director of research at the College of Pharmacy at the University of Nebraska. ''Patients don't really want to take that many drugs, and physicians are trying not to prescribe haphazardly.''
Because of the adverse publicity and the fear of addiction involving the psychotherapeutic drugs, many physicians now recommend drug-free alternatives for patients.
Despite the falloff in psychotherapeutic drugs, the prescription drug industry has yet to show a decline in profits. In fact, according to industry analysts, most prescription drug companies are growing. ''It's a question of product upgrade,'' says Dick Vietor, an analyst with Drexel Burnham Lambert Inc. ''The decline in use of old products has been more than offset with new products.''