Prescription Drug Abuse among Older Adults
As the baby boomer generation enters their senior years and the generation in front of them enjoys increased longevity due to improvements in medical care, the number of Americans classified as older adults – that is, those aged 65 and older – has been increasingly steadily. From 2010 to 2014, according to Pew Research Center, the 65+ group grew by more than 12 percent.
In Florida, comparatively, home to a large proportion of the country’s senior adults, the percentage of the population that are 65 and older is even higher. More than 19 percent of Florida residents fall into this age group, and Florida counties take four of the top 10 spots when it comes to calculating the counties in the country with the highest rates of people aged 65 and older – more than any other state. In fact, Sumter County is the only county in the country with more than half the population over the age of 65 (just under 53 percent). Additionally, the median age of the entire population is 65.9, the highest in the country.
When it comes to metropolitan areas with the highest rates of residents over the age of 65, Tampa-St. Petersburg is first in the country with more than 18 percent of the population aged 65+, with Miami and Jacksonville not far behind.
With a large senior population, it is makes sense that Florida has been hit hard by the epidemic of problematic substance use and accidental overdose that has struck older adults in our country. The Tallahassee Democrat reports that the rate of deaths caused by prescription drug overdose specifically among all Florida residents increased by 7.6 percent from 2013 to 2014, with a loss of more than 2,000 lives in 2014, many of which were not just among people aged 65 and over but between the ages of 55 and 64, as well.
In fact, the Centers for Disease Control (CDC) reports that across the country, the group with the highest increase in rates of opioid analgesic poisoning between 1999 and 2011 was the 55-64 population with a sixfold increase.
Why are senior adults struggling with high rates of substance abuse, accident under the influence, and accidental overdose?
Each person’s story is unique, but there are a number of issues that are prevalent among the senior community in Florida and across the country.
Perhaps one of the greatest factors contributing to high rates of accidental prescription drug overdose is the fact that most senior adults do not just take one or two medications but an array of different drugs at different times of day, usually prescribed by different treatment professionals and filled at different pharmacies.
This is problematic for a number of reasons:
- The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that almost 30 percent of adults between age 57 and 85 are prescribed at least five different medications. They also report that admissions to the hospital due to medical emergency caused by prescription drugs and illicit drugs increased by 96 percent among people aged 65-84 between 1997 and 2008. For people over the age of 85, those rates increased by 87 percent in that time.
- Severe issues like psychosis and delusions can strike and trigger an emergency before anyone has time to recognize that there is a problem.
- Seniors who are struggling with memory issues may forget to mention that they are taking certain drugs when meeting with a doctor, and the doctor may inadvertently prescribe a medication that will conflict with another medication.
- Taking so many different kinds of medications means that there are a number of different ways to “mess up” when taking the drugs. Forgetting to take a medication and missing a dose, accidentally taking a dose twice, and mistaking one pill for another are risks with potentially deadly consequences.
- Similarly, pharmacists who routinely look over all medications prescribed to a patient to ensure that no medications will conflict or that doses appear to be at a safe level will not be able to address issues if they do not have access to all prescriptions.
- Prescribing physicians and pharmacists may or may not provide warnings about mixing certain medications with different illicit substances, foods, or supplements that can cause problematic interactions.
Because accidental overdose is more likely when multiple medications are taken – especially if medication use is combined with illicit drug use, including use of alcohol – and because senior adults, as a group, often take more prescriptions compared to the general public, they are at increased risk of overdose and other issues.
As people age, their bodies break down and process substances at a different rate. In some cases, their bodies may more slowly process out certain substances, increasing the buildup of a substance in the body that is new.
For example, an adult who has been able to drink two glasses of wine over the course of an evening with no effect for years may find that, as they age, those same two glasses may cause them to become tipsy because the alcohol is not as rapidly processed out of the body.
A study published in the journal Best Practice and Research: Clinical Gastroenterology found that changes that occur naturally in liver function can significantly impact how a senior adult processes different substances. Similarly, a study published in the journal Drug Metabolism Reviews noted that altered kidney function can also change how the body processes and metabolizes different substance over time. Specifically, researchers found that in about 66 percent of study participants, all older adults, renal excretion was decreased by as much as 50 percent.
The Center for Applied Research Solutions (CARS) notes too that other issues, in addition to multi-drug use, can impact how those medications affect the user.
Issues that are not always mentioned by a doctor can include:
- Use of over-the-counter medications, including cold and flu or allergy medications, can negate or increase the effect of prescription drugs.
- Use of alcohol and other illicit substances, including marijuana, can alter how the medications impact the user.
- Certain foods can change the effect of different medications.
- Some vitamins and supplements can increase or negate the effect of different medications.
These factors and more can contribute to how a person metabolizes all substances in the body as they age and contribute greatly to negative consequences of prescription and illicit substance use.
Another issue that can compound the risk of medical emergency and overdose with use of prescription drugs among senior adults is the existence of co-occurring disorders. Seniors often take multiple prescriptions and see different specialists because they are struggling with co-occurring medical issues. For many, this can mean a combination of medical ailments. Arthritis, hypertension, heart disease, diabetes, and other chronic ailments are all more common with age, depending on genetics and lifestyle. For others, it can mean medical health issues as well as a mental health disorder such as anxiety or depression. For still others, substance abuse or addiction is one of the co-occurring disorders.
Co-occurring disorders always complicate matters when it comes to treatment. Attempting to extricate one disorder and treat it in isolation is rarely effective, especially when the treatment for one issue can trigger an increase in symptoms or a potentially fatal episode with another disorder. For example, attempting to treat a mental health disorder like depression without addressing prescription or illicit drug abuse or intoxication due to heavy use of medications will not work.
Similarly, the Drug Metabolism Reviews study found that medical issues like coronary heart disease and hypertension, both common among senior adults, could further decrease the ability of the liver to metabolize medications and decrease kidney function. This, in turn, could contribute to substance use and abuse, and mental health symptoms associated with living with a chronic medical disorder; thus, when a senior adult undergoes treatment for a substance use disorder, co-occurring medical and mental health issues must be addressed as well.
It is not just those aged 65 and over who are struggling with problems associated with heavy prescription drug use. The problem is increasing significantly among adults between the ages of 55 and 64 as well, according to the National Institute on Drug Abuse (NIDA).
NIDA reports that in addition to the issues cited above (e.g., altered metabolism and mixing medications), older adults also have greater rates of disorders that require the use of addictive medications like benzodiazepines and painkillers, including:
- Sleep disorders
- Chronic pain
- Anxiety and panic
Additionally, higher rates of cognitive decline as compared to the general public, an issue that can increase the chance of mismanaging doses and medications, are significant among this age group.
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), about 19 percent of Americans in this age group struggle with some combination of alcohol use or abuse and misuse of medications. They also report that about 25 percent of older adult are prescribed medications that are addictive with a potential for misuse and that this population group is more likely to continue taking these kinds of medications for a longer period of time as compared to younger adults. Like adults aged 65 and over, the 55-64 group needs support and information to make positive choices about prescription drug and alcohol use.
Signs of Drug Abuse among Older Adults
It is not always easy to identify when an older person is struggling with the effects of drug abuse or misuse. Too often, they can look like symptoms associated with cognitive decline, depression, or other ailments common among older adults.There are, however, red flags that can indicate that a substance abuse issue is part of the problem, including:
- Obsession with medication, doses, and getting more of the medication, and fear of being without the drugs
- Starting to take doses that are different than what is prescribed, taking normal doses more frequently, or otherwise not following the doctor’s prescription
- Drinking alcohol or using other illicit substances in combination with prescriptions
- Trying to fill prescriptions at multiple pharmacies or getting multiple doctors to prescribe psychoactive drugs
- Continuing habits listed above despite negative consequences
If these issues are noted, it is essential to connect with immediate treatment and medical support.
Obstacles to Treatment
Unfortunately, older adults are rarely receptive to the idea that they are living with a substance use disorder or that treatment for that disorder is needed. Like all people living in addiction, there is resistance to change that would impact their ability to continue using the substances.
But there are other issues that can be specific to this population that can make it more difficult to identify the problem of substance abuse and/or help them to connect with treatment:
- English literacy and/or health literacy can impact a person’s understanding of how best to manage medication use.
- The stereotype of a drug user does not include a senior adult; thus, many may not see a substance use disorder because they do not think it is possible.
- Family members may assume that problems they see are a normal part of aging or a natural side effect of a medication.
- Doctors may not think to ask about potential issues that could indicate a problem; thus, even the patient may believe that the symptoms they are experiencing are normal.
- A lack of coordinated care among physicians treating a single patient for different ailments and/or filling prescriptions at different pharmacies can mean that different medications may be prescribed that negatively interact.
The good news is that if family members and physicians are paying attention, and clients are educated about what to expect with treatment, substance use disorders can be prevented or treated early. Because there are high rates of prescription drug use among senior adults, it is important for family members and medical professionals to work together to check in, pay attention, and intervene when it is clear that a problem with drug use has developed.