By Judy Kirkwood
The problem of older adults abusing prescription medications and illicit drugs hasn’t gotten enough attention, says Dr. Gaya Dowling, acting chief of science policy branch at NIDA (National Institute on Drug Abuse). “When we think of drug abuse, we think of young people,” says Dowling. But there has been an undeniable rise in the number of patients over 50 who require intervention and treatment. Many more remain in the shadows, undiagnosed.
One study that measured the rate of hospital admissions for conditions related to prescription medications and illicit drug use of people 65 to 84 between 1997 and 2008 cited aneye-popping increase of 96 percent. Dowling notes that ERs have seen an increase in people 55 and over with conditions that involve the use of drugs, and there has been an increase in the number of people 55+ being admitted to treatment facilities for addiction.
“The concern with drug abuse by older adults is that, even if they are not using at the same level as young people, the consequences could be greater because of changes in the way the aging body is able to process drugs: smaller amounts cause greater consequences when you factor in age-related diseases and conditions and adverse interactions among medications.”
Over 20 percent of people between ages 57 and 85 use at least five prescriptions, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). Some of those prescriptions may be for painkillers, or opiates, which are addictive. Add alcohol to the mixture and senior behavior may mimic dementia or cause physical symptoms such as falling and other home accidents.
A study conducted by the Hanley Center, a treatment facility in Florida, found that 63 percent of older adults blamed depression and anxiety for their prescription drug and alcohol substance abuse; 30 percent said economic and financial stress was to blame; and 20 percent cited retirement as a contributing factor. Dr. Barbara Krantz, Medical Director of the Hanley Center, called this transitional time of life and aging “the perfect storm for [drug and alcohol] dependency.”
An article in the Boston Globe in late August by Meg Murphy reported that in Massachusetts “a significant number of adults over 54 seek substance abuse services, with a surprising number seeking treatment for heroin addiction.” Murphy notes the shocking news that although alcohol abuse accounts for about 75 percent of substance treatment admissions in that area among older adults, “heroin is now the second-most popular substance of choice.”
It is rare that older adults will voluntarily seek help for addiction to prescription medication or illicit drugs. Besides the shame and desire for privacy, denial is part of the disease of addiction, which is why it is important for family members to be able to recognize signs of medicine or drug abuse.
A friend who sought help for her mother when she realized her behavior was being affected by her prescription drugs said, “Doctors are in a bind because they are told it’s unethical to let elderly patients be in pain and they strive to make them comfortable, perhaps not realizing that their older patient drinks heavily, for instance.” In addition, older patients, like younger drug-seeking patients, may “doctor-shop” and get prescriptions from more than one doctor. This is one of the arguments for the creation of a national drug registry so that any doctor can check to see what other medications have been prescribed for a patient.
When my friend realized her mother was not making sense on phone calls and having many more health crises and mood swings than previously, she arranged to have her admitted to a drug and alcohol treatment program for older adults: “She was on a tranquilizer, painkiller, antidepressant, sleeping, pill, and drinking alcohol.” Unfortunately, her mother left, feeling she could handle her problems on her own, but at least her doctor is now aware of her mother’s problem of prescription drug abuse mixed with alcohol.
“The best thing is to have your friend or family member talk to their physician,” says Dowling. “Not all physicians routinely ask their older patients about prescription drug abuse or illicit drug use. But we are really engaging physicians more in substance abuse.” NIDA has a drug screening tool for doctors to use with patients for instance.
Dowling also recommends the National Institutes of Health senior healthsite as a tool for recognizing signs of addiction in a family member and getting help for the problem: http://nihseniorhealth.gov/drugabuse/improperuse/01.htmlto.
The good news is that older adults respond as well as younger ones to substance abuse therapies, which is why diagnosis and treatment are so important.