Prescription drug abuse… in older adults?

 

Drug abuse affects people from all walks of life. But when you hear about drug abuse, you tend to think of teens or young adults, not older adults. Unfortunately, drug abuse in older adults is also a serious problem. It occurs most often when the elderly misuse or abuse their own prescription medicines or when they intentionally take medicines prescribed for other people.

 

For example, people may take their prescription medicines with alcohol or other drugs to enhance their effects. Or, they may take more medicine than prescribed or continue to take it when they no longer need it. In a recent survey of older adults between the ages of 50 and 80, only half reported switching from a powerful opioid pain medicine to an over-the-counter (OTC) pain medicine as soon as possible.1 About 1 in 20 participants admitted to taking an opioid pain medicine more often and in higher doses than prescribed. Most of the older adults said they kept leftover opioid pain medicine in case they needed it later. Unused opioid pain medicines that linger in homes are one of the primary causes of prescription drug abuse and dependence.1

The causes

Age-related physical and emotional changes are linked to the most common reasons an older adult may abuse prescription medicines (or alcohol). These age-related changes may lead to boredom, anxiety, depression, a fear of getting old, financial loss, health concerns, and chronic pain.2 More than 100 million Americans live with daily pain.1 Health problems that result in pain, such as arthritis, nerve damage, or cancer, are more common as people age. Older adults are also more likely to have mobility issues, sleep pattern disturbances, and to undergo painful surgical procedures, such as joint replacements.1,2 They may experience loneliness, social isolation, and anxiety from a life event such as loss of employment or family problems, and are prone to grief and depression because of the loss of a spouse. As these age-related changes occur, doctors often prescribe medicines intended to improve the elderly person’s quality of life. However, these medicines can also be the source of prescription drug abuse in older adults.

Medicines most likely to be abused

Older adult prescription drug abuse usually involves a “controlled substance.”3 Controlled substances are a category of addictive medicines whose possession and use is restricted by law. Examples include opioids and benzodiazepines.

Opioids are used to treat moderate to severe pain. Some examples include:

  • oxycodone (OxyContin and others)
  • oxycodone combined with acetaminophen (Percocet and others)
  • hydrocodone combined with acetaminophen (Vicodin and others)

Benzodiazepines (tranquilizers) are used to treat anxiety, panic attacks, and sleep disorders. Some examples include:

  • diazepam (Valium)
  • alprazolam (Xanax)
  • clonazepam (Klonopin)
  • lorazepam (Ativan)

Long-term use of opioids or benzodiazepines can result in several problems. The person may develop a tolerance for the drug, meaning they gradually need to increase the amount they take to control their pain, anxiety, or other symptoms. They may also find that the drug makes them feel happy, euphoric, sedated, or numb.3 To maintain or increase this effect, they may start to abuse the drug—by continuing to take it when they no longer need it or by taking it in larger doses than prescribed. Ultimately, they may become addicted, and then fear stopping the drug because withdrawal symptoms are severe.

Signs and symptoms

It can be very difficult to identify prescription drug abuse in older adults. We are more familiar with identifying drug abuse in younger people when they are unable to fulfill their work and family commitments. Older adults may have fewer of those commitments, making it harder to identify the signs of drug abuse.2 Also, some of the more noticeable symptoms of drug abuse in older adults are changes in appearance, behavior, or health that mimic symptoms of other problems that are commonly associated with aging:4

• Frequent falls and unexplained bruises
• Nausea and loss of appetite
• Sudden weight loss or weight gain
• Change in sleep patterns
• Drowsiness
• Confusion
• Slurred speech
• Impaired coordination
• Unexplained change in personality or attitude
• Becoming defensive or agitated
• Deterioration of physical appearance, personal grooming habits
• Becoming withdrawn or losing interest in activities they once enjoyed

 

Other behavioral clues of prescription drug abuse are more closely linked to how the medicines are obtained and taken:2-4

• Getting the same prescription from different doctors
• Using more than one pharmacy to fill prescriptions
• Afraid to go anywhere without taking their medicine
• Sneaking or hiding the medicine

Here’s what you can do: Learning to recognize the physical and behavioral signs of prescription drug abuse can help prevent the problem from progressing further and causing serious harm. If you suspect an older family member or friend is abusing a prescription medicine, contact his or her doctor to discuss your concerns. The doctor can help determine if there is a problem and help to establish a treatment plan. Treatment may include counseling, detoxification, and careful monitoring of prescription medicines.

It is also important to help older family members or friends manage their medicines by:5

• Knowing all the medicines they take and why they take them
• Making sure they take the correct amount
• Encouraging them to use pain medicines (opioids) and tranquilizers (benzodiazepines) only as prescribed
• Encouraging them to switch to OTC medicines as soon as possible
• Looking for alternative treatments such as physical therapy or exercise
• Reminding them to avoid alcohol when taking medicines
• Encouraging them to bring all their medicines to their annual checkup to make sure the doctor is aware of what they are taking
• Properly discarding any leftover medicines, especially opioids and benzodiazepines, once they are no longer needed
• Taking control of medicine administration, if necessary

References

1.  University of Michigan. Older adults’ experiences with opioid prescriptions. National Poll on Healthy Aging. U-M Institute for Healthcare Policy & Innovation. July/August 2018. www.ismp.org/ext/115
2.  DARA (Drug & Alcohol Rehab Asia) Thailand. Elderly and substance abuse. AlcoholRehab.com. www.ismp.org/ext/116
3.  American Academy of Family Physicians. Prescription drug abuse in the elderly. Familydoctor.org. 2017. www.ismp.org/ext/117
4.  Burke V. Prescription drug abuse among older adults. Medicare.com. 2017. www.ismp.org/ext/118
5.  Sollitto M. The growing problem of prescription drug addiction in seniors. AgingCare.com. 2018. www.ismp.org/ext/119

Created on November 12, 2018

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