Viagra used more, especially by younger men

The use of Viagra increased 84% from 1998 to 2002, with much of the jump accounted for by increases in use among men ages 18 to 55, according to an analysis of an insurance claims database published last month in the International Journal of Impotence Research. Prescriptions for men ages 18 to 45 increased 312%. Those for men 46 to 55 increased 216%.

Researchers expressed concern because this trend may be a burden on the health care system and questioned whether it was a good allocation of resources.

"It's something that the public and insurers should take note of, and, as a society, are we willing to pay for this?" said Thomas Delate, PhD, lead author and director of research for the North American pharmacy benefits manager, Express Scripts.

Positives and negatives

Physicians said the growing use of the drug by younger men was both good and bad. Many doctors credit the marketing of sildenafil and other treatments for erectile dysfunction with convincing more men, traditionally less linked to health care than women, to see a doctor, leading them to receive other health services, too.

"A guy who won't go to an emergency room for chest pain will go to their doctor for erectile dysfunction," said Jean Bonhomme, MD, MPH, a board member of the Men's Health Network and a senior faculty associate in behavioral science and health education at Emory University in Atlanta. "And erectile dysfunction might be more common among young men than we're aware of."

In other words, although the drug was originally marketed to older men, younger men with underlying medical conditions that make them candidates for this drug may be seeking treatment as well.

On the downside, physicians expressed concern that younger men may be asking for the drug simply to enhance sexual performance. And this scenario puts primary care physicians, who write the great majority of sildenafil prescriptions, in the awkward spot of trying to determine what characteristics indicate true medical need.

"When I counsel my patients, I spend more time talking about communication with their partners," said Andrew M. Davis, MD, MPH, an internist and assistant professor of medicine at the University of Chicago. "But the problem is that there are a lot of guys who feel that they need to impress their dates."

The study found that the number of men asking for sildenafil who also had an underlying medical condition declined by more than 10%, and many physicians report anecdotally that younger men are indeed asking for it.

"The issue is not just that it's a younger audience," said Dr. Delate. "But also that this younger audience is showing less of a medical need."

Experts said, however, that while these numbers were intriguing, it was premature to declare that younger men were using the drug recreationally on a large scale.

More age breakdowns needed

This paper lumped men 18 to 45 years old in one group, and critics say more detail is needed to determine if those at the younger end of the spectrum are truly taking this pill more.

"It's not a robust or thorough enough study to make projections on what is happening with younger men using Viagra," said Daniel Watts, spokesman for Pfizer Inc., Viagra's manufacturer. "Our own data show that the average age of someone who receives a prescription is 53 years old, and 84% of prescriptions are for men aged 40 to 69."

Also, the numbers of men with an underlying medical condition were discerned in this study by analyzing prescription records for use of other medications, and not all medical conditions that cause erectile problems would necessarily be captured by that information.

"They can't identify factors like obesity or someone who has a spinal cord injury and isn't on any other meds but who still needs it for medical reasons," said Margaret Nusbaum, DO, MPH, associate professor in the Dept. of Family Medicine at the University of North Carolina. "[This study] definitely raises some questions, but I don't think you can chalk it all up to inappropriate prescribing or usage."

Physicians also said that those who are truly using it recreationally are not coming to them and, therefore, would not have their prescriptions tracked by Express Scripts or paid for by their insurance companies.

"My understanding is that most of the 20- to 45-year-olds are getting it off the street," said Ellen Brull, MD, a family physician from Niles, Ill.