Common Pain Relievers Lead US Medication Use Trends

New national survey data show that over-the-counter (OTC) and prescription medication use are nearly identical in prevalence, with common pain relievers leading the list, as well as that nearly two-thirds of US adults report taking at least 1 OTC or prescription medication in a given week, underscoring the central role medications play in everyday health management. The findings provide updated, medication-specific prevalence estimates that can inform regulatory policy, pharmacoeconomic research, and public health surveillance.

These results appeared online today in JAMA Network Open.¹

“There is no ongoing data source that monitors prevalence of actual medication usage,” the study authors wrote. “Point-of-sale data for OTC medications and pharmacy dispensing records for prescription medications are useful in understanding the types and amounts of medications obtained by patients but do not measure actual usage.”

Snapshot of Medication Use

The study analyzed data from 21,000 US adults who completed an online survey between June 2023 and April 2024. Their mean (SD) age was 47.9 (17.5) years, with participants aged 55 to 64 years comprising the largest individual age group (18.0%), and most (53.2%) of the overall cohort were female individuals. Medical history encompassed listing health conditions, lifetime history, and current status. The MedHAT method^2,3 was used to gather medication use.

Overall, 62.3% (n = 13,073) reported using at least 1 OTC or prescription medication within the past 7 days. Usage of 5 or more medications in the past week was reported by 16.3% (n = 3425), and use of 10 or more medications was reported by 3.3% (n = 690). These participants also reported 3 principal methods of health care coverage: employer-sponsored insurance (37.9%; n = 7956), Medicare (23.9%; n = 5020), and Medicaid or other government assistance (21.9%; n = 4602). The top 3 conditions they were most likely to treat at study participation were hypertension (n = 4610/6309; 73.1%), diabetes (n = 1855/2605; 71.2%), and anxiety or panic disorders (n = 2702/6220; 43.4%). Further, medication use was more common among female than male participants (66.6% vs 57.3%).

The authors wrote that the findings “demonstrate the magnitude of US reliance on these important therapies and highlight the importance of accessibility.”

One of the study’s most striking findings was the near parity between OTC and prescription medication use. Past 7-day prevalence of any OTC medication use was 46.0% (n = 9657) compared with 46.3% (n = 9719 participants) for any prescription medication.

“This mix certainly underscores an important reality: health care is not an either-or proposition. It is a continuum in which consumers combine self-care and clinician-guided treatment to meet their needs,” said lead study author Jody L. Green, PhD, Chief Scientific Officer, Uprise Health, in an interview with The American Journal of Managed Care^®. “Each comes with different trade-offs between access and cost. The increase in utilization of medications that have gone through the Rx-to-OTC switch would suggest this process is a critical policy, assuming the benefit-risk evaluation is appropriate.”

Overall use also increased with age at similar rates among the male and female survey participants, topping out at 79.2% and 81.9%, respectively, for those 65 years and older, but was higher at most individual age groupings (18-44, 45-64, 65-74, and 75-84 years) for the female cohort. Drilling down to type, however, showed prescription medication use increased to a greater degree vs OTC medication use and much more sharply among older adults.

Most Commonly Used Medications

Six of the 10 most commonly used medications were available OTC—acetaminophen (29.4%), ibuprofen (22.3%), aspirin (15.8%), naproxen (6.9%), diphenhydramine (5.2%), and omeprazole (4.6%)—underscoring the central role of nonprescription therapies in routine care. The remaining 4 were atorvastatin (6.4%), lisinopril (5.5%), levothyroxine (5.2%), and amlodipine (4.6%).

The top 3 medications from the past 7 days also were all analgesics: acetaminophen, ibuprofen, and aspirin. Female vs male participants reported greater use of acetaminophen (33.4% vs 24.9%) and ibuprofen (25.1% vs 19.2%) but less use of aspirin (14.5% vs 17.3). Of the remaining top 10, females reported greater use of naproxen (7.2% vs 6.6%), levothyroxine (7.5% vs 2.6%), diphenhydramine (6.1% vs 41%), and omeprazole (4.8% vs 4.4%), and males reported greater use of atorvastatin (7.6% vs 5.3%), lisinopril (6.4% vs 4.7%), and amlodipine (5.0% vs 4.3%).

The authors also evaluated treatment for the top 30 medical conditions, and the top 5 reported substantial treatment rates among those experiencing symptoms:

• Hypertension: 73.1% of the 14.1% experiencing symptoms
• Diabetes: 71.2% of 21.6%
• Anxiety or panic disorders: 43.3% of 33.1%
• Depression: 40.7% of 31.4%
• Allergies: 39.9% of 20.8%

Changes Since the Slone Survey

The previous most comprehensive US assessment of medication use was the Slone Survey, which analyzed data collected from February 1998 through December 1999.⁴ At that time, acetaminophen, ibuprofen, and aspirin were also the top 3 medications, and since then, use of acetaminophen and ibuprofen has increased from 23.0% to 29.4% and from 17.0% to 22.3%, respectively, whereas aspirin use fell from 17.0% to 15.8%

Overall shifts appear to reflect regulatory and market changes. After the Combat Methamphetamine Epidemic Act became effective in 2006,⁵ there was a dramatic drop in pseudoephedrine use: from 8.1% and #4 rank in the Slone Survey to 1.4% and #34 rank in the present study. Several medications also transitioned to OTC status after being prescription only during the Slone Survey; the authors highlighted cetirizine and omeprazole, which the FDA approved for OTC use in 2007⁶ and 2003,⁷ respectively. Omeprazole is also 1 of 4 medications that is now a top 20 drug, along with amlodipine, metformin, and sertraline.

When asked what might have driven these changes, Green explained, “It is difficult to measure direct causality; however, the temporal relationships between the utilization before and after an Rx-to-OTC switch suggest these types of regulatory decisions are impactful. The broader clinical trends are still reliant upon regulatory decisions and product approvals, considering all medications in our study were approved for OTC and/or prescription use.”

Implications: Policy, Economic, Monitoring

The authors emphasize that medication prevalence estimates are essential for regulatory science and pharmacoeconomic modeling because the data help characterize baseline utilization, identify high-use populations, and inform postmarketing safety monitoring, in an era of evolving drug markets, regulatory reforms, and shifting patterns of chronic disease. OTC medications have additional economic implications. Approximately 8.0% of the US population is uninsured, and 36.3% rely on public insurance programs such as Medicare or Medicaid, the authors explained. OTC availability may reduce the need for clinician visits and associated costs.

However, evaluating the full public health impact of regulatory changes requires accurate prevalence data, the authors added, and their study did not assess the safety or appropriateness of specific medications, evaluate outcomes of regulatory pathways, include topical medications, or conduct a winter data collection. Their results are also subject to recall bias because of their self-reported nature; for higher recall accuracy, the authors chose to focus on past 7-day use and excluded low-confidence entries. Despite these limitations, the authors conclude that the findings offer critical contemporary data.

“With the recent FDA rule outlining additional conditions for nonprescription use, it will be important to measure pre- and postapproval utilization, as well as measures of benefit and risk,” Green stated. “Access is a measure of benefit but should be weighed in relation to risk for any medication when studying the larger public health benefit.”

References

1. Green JL, Dailey-Govoni T, Kalidindi SD, Vosburg SK. Prevalence of over-the-counter and prescription medication use in the US. JAMA Netw Open. 2026;9(2):e2559479. doi:10.1001/jamanetworkopen.2025.59479
2. Green JL, Anderson V, Dart RC, Heard K. Medication history assessment in research: a randomized controlled trial comparing tablet-based (eMedHAT) versus structured interview (MedHAT). Pharmacoepidemiol Drug Saf. 2018;27(12):1356-1360. doi:10.1002/pds.4665
3. Heard K, Anderson VE, Dart RC, Green JL. Accuracy of the structured medication history assessment tool (MedHAT) compared with recorded real-time medication use. Pharmacotherapy. 2016;36(5):496-504. doi:10.1002/phar.1750
4. Kaufman DW, Kelly JP, Rosenberg L, Anderson TE, Mitchell AA. Recent patterns of medication use in the ambulatory adult population of the United States: the Slone Survey. JAMA. 2002;287;(3):337-344. doi:10.1001/jama.287.3.337
5. General information regarding the Combat Methamphetamine Epidemic Act of 2005 (Title VII of Public Law 109-177). U.S. Department of Justice Drug Enforcement Administration Diversion Control Division. Accessed February 14, 2026. https://www.deadiversion.usdoj.gov/meth/cma2005.html
6. Cetirizine or levocetirizine: drug safety communication - FDA warns about risk of severe itching after discontinuation of long-term use of allergy medicines. FDA. May 23, 2025. Accessed February 14, 2026. https://www.fda.gov/safety/medical-product-safety-information/cetirizine-or-levocetirizine-drug-safety-communication-fda-warns-about-risk-severe-itching-after
7. Pray WS, Pray GE. Recent Rx-to-OTC product switches. U.S. Pharmacist. October 20, 2010. Accessed February 14, 2026. https://www.uspharmacist.com/article/recent-rx-to-otc-product-switches