Signs Of Prescription Drug Abuse In The Elderly
As the U.S. grapples with its opioid abuse epidemic, it might come as a surprise that contributing to that crisis are senior adults who are dealing with prescription drug abuse, particularly where opioids are involved.
The nation’s baby boomers—the generation born after World War II between 1946 and 1964—are reportedly the fastest-growing population in the country who are battling opioid dependence and addiction. Their experiences signal to what is to come, observers say. As the U.S. adult population is projected to live longer, it is predicted that more people will battle geriatric substance abuse or addiction as they live out their golden years.
By 2020, the number of American adults who need drug and alcohol rehabilitation treatment is expected to double to about six million. By 2030, older adults will account for roughly 20 percent of the U.S. population, according to a State of Aging and Health in America 2013 report.
WHY SENIOR PRESCRIPTION DRUG ABUSE EASY TO MISS
The beginnings of senior prescription medication abuse and addiction are easy to go unrecognized or misdiagnosed.
First, older adults buy many prescription medications. Data reported by the National Institute on Drug Abuse show that U.S. residents age 65 and older account for more than one-third of total outpatient spending on prescription medications although they make up only 13 percent of the country’s population.
NIDA also cites research saying that “more than 80 percent of older patients (aged 57 to 85 years) use at least one prescription medication on a daily basis, with more than 50 percent taking more than five medications or supplements daily.”
So, to see an older loved one buy and use these drugs likely won’t raise many eyebrows, especially when the person’s prescription medications come from a reputable doctor’s office.
For adults age 50 and older, misusing or abusing prescription drugs may be related to the natural process of aging. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), this population is said to be at a higher risk for medication misuse than the general population because of their slower metabolism and elimination as well as the higher rates of pain, sleep disorders, and anxiety.
Also, as we age, our memory changes. It becomes common to forget a name or where the keys were last placed as we grow older. The American Psychological Association notes that as the brain changes so does a person’s behavior. An older person may forget how much medication they should be taking or they may forget that they have taken their medication already. They also may mix up medications, which is very common.
Taking any drug, whether legal or illegal, can affect the brain and therefore what a person remembers or how they behave.
However, not all memory loss or forgetfulness in older adults is related to their age. If cognitive difficulties increase after a person chronically misuses their medication, it could be a sign of medication abuse.
Other signs of substance abuse that are commonly confused with aging are:
- Losing track of time (not remembering what day it is or what time of day it is)
- Coordination problems (such as walking unsteadily, falling)
- Chronic, unexplained aches, pains
- Concentration difficulties
- Changes in the sleeping schedule (such as sleeping all day, staying up at night), eating habits
- Unexplained cuts, bruises, marks
- Mood changes, irritability, sadness, depression, loneliness
- Lethargy, personality changes, energy levels
If you or an older person you know is exhibiting changes such as these after taking medications, it might be worth looking into how they are taking their medications to ensure they have the right medications and that they are taking those medications properly.
MANAGING PAIN: IS IT START OF GERIATRIC SUBSTANCE ABUSE?
Older people are more susceptible to prescription drug abuse as they try to treat chronic pain ailments.
Nearly half of older U.S. adults have a chronic pain disorder, and the chances of them having chronic pain increase as they age, according to a SAMHSA report. For this reason, doctors are likely to treat older adults’ ailments with medications and more likely to prescribe more than one medication if multiple ailments are present and need treatment.
Seniors with prescription medications for long-term ailments are at risk of using these medications incorrectly. Incorrect use means they may take more than the dose prescribed, whether on purpose or not, or they may inadvertently mix medications with each other. They also may inadvertently mix their prescription meds with alcohol if they still drink. SAMHSA cites data that says the combination of alcohol and medication misuse has been estimated to affect up to 19 percent of older American adults. The interaction of medicines and alcohol can be dangerous. People are advised to avoid alcohol if they are taking a medication and are not aware of the effects it may have on a substance. Keep in mind that alcohol and medications can still cause risky interactions even if they are not taken at the same time. Because older people have a slower metabolism and the body doesn’t break down substances as quickly as they once did, the likelihood that they will mix drugs and alcohol is high.
Senior prescription drug abuse often involves two kinds of medications: opioid pain relievers and benzodiazepines.
Opioid pain relievers are prescribed to treat and manage pain in groups across the age spectrum. Oxycodone (OxyContin), Percocet, hydrocodone, Vicodin, codeine, and many others are among the drugs commonly prescribed for this group. Opioid dependence and addiction are not good for any group, no matter the age. But for seniors, opioid abuse complicates health matters. Many older people who develop a dependence on these potent pain medications first started using them legitimately to manage chronic health problems.
According to data in a report from the Administration on Aging and the Substance Abuse and Mental Health Services Administration, the number of older U.S. adults who misuse opioids is projected to double from 2004 to 2020, from 1.2 percent to 2.4 percent.
By the year 2020, the number of addicted older U.S. adults who need drug and alcohol treatment is expected to double to about six million. By 2030, older adults will account for roughly 20 percent of the U.S. population, according to the State of Aging and Health in America 2013 report.
To combat opioid misuse and abuse, the U.S. Centers for Disease Control and Prevention (CDC) has issued guidelines for prescribing opioids for chronic pain. The CDC said the guidelines aim to improve communication between healthcare providers and patients about the risks and benefits of opioid therapy for chronic pain in addition to other goals.
Benzodiazepines, or “benzos” for short, are prescribed to treat anxiety, alcohol withdrawal, insomnia, muscle relaxation, and seizures. These medications act on the central nervous system and produce sedation, sleepiness, and muscle relaxation. Widely prescribed benzos include Xanax, Ativan, Klonopin, and Valium.
A March 2018 article in The New York Times called benzo use “a quiet drug problem among the elderly.” “Despite warnings from experts, older people are using more anti-anxiety and sleep medications, putting them at risk of serious side effects and even overdoses,” the article’s opening reads. The report goes on to highlight how using the medications can worsen an already common problem for people in the senior adult population: falls and fractures. Benzos, the article notes, cause dizziness.
“Set aside the opioid issue,” Michael Schoenbaum, an epidemiologist at the National Institutes for Health, told the newspaper for its report. “Way too many older Americans are getting benzos. And of those, many — more than half — are getting them for prolonged periods. That’s just bad practice. They have serious consequences.”
Donovan Maust, a Michigan psychiatrist, told The New York Times that benzodiazepines also negatively affect memory and cognitive function.
OVER-THE-COUNTER MEDICATIONS ALSO RISKY
Abusing medicines doesn’t only involve the ones people have a prescription for. Over-the-counter medications can be abused as well. Always check with your personal doctor to confirm if taking pharmacy-bought medications are OK to use and if so, follow the directions on the label or the ones your doctor fives.
GERIATRIC SUBSTANCE ABUSE: WHAT ARE THE SIGNS?
While it may be challenging to pick up on the warning signs of prescription medications abuse among seniors, there are ways to tell that something is going on. Changes in behavior are a place to start. Warning signs include:
- Making an effort to get a prescription for a medication from two or more doctors, a practice known as “doctor shopping”
- Going to two different pharmacies to fill a prescription for the same medication
- Taking more of a medication than they used to or taking more than is instructed on the label
- Using the medication in a manner inconsistent with its purpose
- Taking the medication at different times or more often than instructed on the label or by a physician
- Becoming withdrawn, isolated or angry
- Appearing confused or forgetful
- Talking often about a medication to the point of seeming preoccupied with it
- Being fearful of going somewhere without taking a medication first
- Becoming defensive or “touchy” when asked about a medication
- Giving excuses for why a medication is needed
- Keeping “extra” pills handy when there appears to be no reason to
- Sneaking or hiding the medication.
- Using the medication in secret or privately outside of the knowledge of friends, family
- Having a history of substance abuse or abusing alcohol, drug, or prescription medications
These warning signs may motivate some people to reach out for help likely after they have been prompted to do so by others. But the reality is some older adults simply won’t receive the help they need for substance abuse disorders involving prescription medication. Many are ashamed and won’t seek professional help because of that shame. Others are in denial and know they need help but won’t reach out to find it. People in both groups may not even realize their misuse or abuse has led to an addiction that requires professional treatment to stop.
Observers say changing the perception of who abuses drugs and alcohol will be important as the nation’s health care professionals work to identify and help older people who are dealing with substance abuse and addiction.
Medical professionals have been advised to look for a personal history or family history of substance abuse of medications when screening older patients. Geriatric substance abuse is not an easy topic to discuss among older populations for various reasons, but having that conversation can be just what’s needed to uncover a problem and help people get the help they need.
ABUSING PRESCRIPTION DRUGS AND CAN’T STOP? WE CAN HELP
Older adults are at a higher risk of misusing or abusing their medications for several reasons, and they may not always be aware when such use is dangerous or has led to a physical or psychological dependence. Substance abuse among the elderly can be difficult to quit without professional help from trained addiction specialists, but that’s what Pathway to Hope is here for. We can help you.
Pathway to Hope, a Delphi Behavioral Health Group facility, specializes in helping people who are battling with substance addiction, whether that substance is legal or illegal. We focus on the roots of your addiction and mental health condition and help you or your loved one start healing from substance abuse and give you the tools to leave it behind for good.
If you or someone you know is struggling with senior prescription drug abuse, call Pathway to Hope at (855) 757-2128 today or contact us online, so we can help you find the right treatment program. Don’t delay. If you need addiction treatment, now is the time to make that important step for your health and your life.