May 28, 2014

Seniors Abusing Prescription Drugs: A "National Epidemic"

According to an article in the May 20 edition of USA Today, hundreds of thousands of American seniors are misusing prescription drugs. The two biggest culprits? Opioid pain relievers and benzodiazepines, which include psychoactive anxiety meds like Xanax and Valium.

For its investigation, the paper evaluated data from various federal agencies and private firms. Among its findings:
  • Last year, doctors wrote 55 million opioid (pain relief) prescriptions for patients 65 and older. That number represents a 20% increase over five years, which is nearly double the growth rate of seniors during that time.
  • Doctors wrote 28.4 million benzodiazepine (anxiety) prescriptions for seniors 65 and older, up 12% in five years.
  • According to the Substance Abuse and Mental Health Services Administration (SAMHSA), about 336,000 seniors were either misusing or dependent on opioids. That number is up from 132,000 ten years before. SAMHSA defines “misuse” as using drugs without a prescription, or not as prescribed.
  • From 2007-11, for people 55 and older who sought help for substance abuse, there was a 46% increase in the share of cases involving prescription narcotics.
  • During that same period, emergency room visits by seniors 65 and older caused by pharmaceutical misuse jumped 50%, to over 94,000.
  • The CDC reported that death from drug overdosing tripled from 1999 to 2010 among people 55 and older.
  • In 2010, according to the CDC, 75% of deaths from prescription drug overdose involved pain killers. Of those, one third also involved benzodiazepines. The combination presents grave dangers.

According to a 2012 brief prepared by SAMHSA and the Administration on Aging, one in four Americans 50 and older use psychoactive medications, mainly for pain and anxiety. The fact that seniors are developing record numbers of prescription drug problems is the result of an unfortunate perfect storm.
  • To begin with, the Baby Boomers – our population’s biggest generational segment – are aging, and therefore developing more medical problems than ever.
  • Aging bodies metabolize drugs more slowly, so these psychoactive meds build up quickly in seniors’ bodies.
  • The bodies and brains of seniors are particularly subject to drug complications, like falls, respiratory failure, cognitive problems, and dementia.
  • Seniors have more medical problem, take more pills, and increase their risk of adverse drug interactions.
  • Doctors want to help their senior patients, but they often have nothing in their black bags to help their senior patients, except their prescription pads.
  • Most doctors haven’t received properly addiction training.
  • Drug companies – forever on the quest for increased sales – aggressively market psychoactive meds to seniors, especially for pain. Television commercial breaks are filled with pill promotions.
  • Opioids become less effective with use, and patients request higher doses. Like the benzodiazepines, opioids are simply not effective for long-term use.
  • Doctors have a hard time denying their senior patients some pharmaceutical relief, especially when those patients request it. Getting them off those psychoactive meds is the hardest part for doctors.

Ordinary seniors progress from user to abuser quickly, and without much warning. Before they know it, they have a big problem. 

David Walsh, 62, a facilities services foreman in Boston, struggled with his abuse of pain killers: 
It was mostly Percocet and Vicodin — I'd buy them off the street, steal them from my wife, my son, from friends' (medicine chests). And if I had an operation or something and the doctor didn't know I was an addict, I'd always ask for Vicodin.

Betty Van Amburgh, 68, started taking pain medication after a series of back operations 20 years ago. Like hundreds of thousands of others, she got hooked on opioids. She said, "The doctors just kept prescribing them. It was always, 'Do you have pain? Let me give you a prescription. ...' But I got addicted. I was a zombie."

Eventually, Van Amburgh entered a drug treatment center, succeeded in kicking the habit, and found herself with less pain than she had when she was popping pain pills.
They told me I'd be in less pain and I didn't believe them, but I'm like a new person. The thing that still pisses me off, though, is that nobody tried to take me off the drugs sooner. From one doctor to another to another, they just wrote more prescriptions. Really, I think it was just ignorance.

Wilson Compton, a psychiatrist and deputy director at NIH’s National Institute on Drug Abuse calls the misuse of prescription meds by seniors an “emerging epidemic.”

He believes doctors and patients needs better education about the dangerous risks associated with opioids and benzodiazepines. He said, "We have not focused as specifically on this older population as we might. ... It's a serious problem."

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