When thinking about prescription drug dependence, one might automatically and understandably envision a young adult. Those “18 to 25 years old are the greatest abusers of medicine… ADHD stimulants, opioid pain relievers, and anti-anxiety drugs,” according to the National Institute on Drug Abuse. Research indicates that there has been a rush over the earlier decade in opioid misuse that includes prescription heroin in addition to pain narcotics such as fentanyl feeding an overdose plague in older adults.
Actually, between 2002 and 2014 opioid misuse doubled in those 50 and older (from about 1 to 2%), while falling in younger age classes. And a report by the Agency for Healthcare Research and Quality released in September discovered that among people 65 and older, opioid-related inpatient stays were up 34 percent and opioid-related emergency room stays were up 74 percent from 2010 to 2015. (That relates to a 17 percent decrease in non-opioid-related ER visits and hospital stays.)
In 2015, there were 124,300 hospital admittances of opioid-related patients 65 and up from the U.S.” So it is a significant issue,” states Dr. Arlene Bierman, director of AHRQ’s Center for Evidence and Practice Improvement, who had been involved in the study and is the corresponding author on the report.
To be sure, the report did not breakdown what proportion of hospital admissions or emergency department visits associated with abuse of the drugs versus, for instance, side effects that occurred when opioids were taken by an older patient as prescribed. Bierman and other experts observed that older adults usually have chronic pain, along with different other conditions, and opioids are prescribed to deal with that pain.
Previous research finds in 2016 that around 1 in 3 seniors enrolled in a Medicare prescription drug program, or Part D, obtained prescription opioids and that “a significant number received higher doses than recommended for extended intervals, placing them at increased risk of abuse,” as mentioned in the AHRQ report.
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However, as with adults who struggle with addiction, the risks seniors confront continue to other prescription medicines also, including benzodiazepines, which are often used along with opioids. Recommended for everything from anxiety to insomnia older adults tend to be left on the medication such as Xanax, Valium Klonopin for long-term, even though short-term usage if they are to be used in seniors, is generally prescribed.
Older adults may have trouble metabolizing those medications, or clearing them out of their system, along with side effects like confusion and dizziness. There is also an increased risk for dependence when there is a person on a medication for a more extended period.
One study published in JAMA Internal Medicine found a third of older adults prescribed benzodiazepines initially by nonpsychiatric clinicians (such as primary care providers( who prescribe most these drugs ) went on to take them long term. “While treatment guidelines recommend only short-term prescribing if any, these long-term patients were prescribed nearly 8 months’ worth of benzodiazepine,” the researchers note.
Adds study lead author Dr. Lauren Gerlach, a geriatric psychiatrist and assistant professor of psychiatry at the University of Michigan: “At one year after patients were newly started on these medications, nearly 1 in 4 remained on the medications.”
The research didn’t map the addiction. But the higher number of drugs adults often take leads to risk people will become dependent on drugs such as benzodiazepines or opioids, which makes it more difficult to stop them. And this may lead to addiction, which often goes unobserved and unidentified.
Although misuse of substances like heroin is also a problem, experts say overdose deaths in older adults involve prescription drugs, and that abuse occurs without or gradually first intent to misuse the medication. “They are not using these drugs to get high or for risk-taking, but they’re using them to manage their pain,” states Kenneth Leonard, director of the Clinical and Research Institute on Addictions at the University at Buffalo.
However, often medical and mental health experts say despite raising doses of pain medication, and due to an increased immunity for opioids, by way of instance, many consider more of the drugs and still are not effective in managing their pain. “Sometimes they combine them with benzodiazepines that they are prescribed. And many of the deaths that we see involve a combination of opiates and benzodiazepines,” Leonard says.
Treatment and Prevention of Prescription Drug Addiction
“The standard of care in the field would be to use some kind of medication to help in the addiction treatment — and that is largely buprenorphine or methadone,” Leonard says. “And there’s not any reason to think that those wouldn’t be appropriate for the older population.”
Other experts agree that what works for younger adults generally should for seniors also.
“While drug abuse in older adults often goes unrecognized and therefore untreated, study suggests that currently available addiction treatment plans can be as effective for them as for younger adults,” the National Institute on Drug Abuse claims.
Some adjustments in addressing addiction in adults can help — where, by way of instance, the problem goes undiscussed by people, and doctors and family do not ask about it. Along those lines, experts suggest:
Encourage conversation. Often it is incorrectly assumed that seniors do not struggle with addiction to drugs or alcohol, which disturbs many younger individuals. Because of this, there’s too little discussion around the subject not only in homes, but in the doctor’s clinic specialists says, where often patients don’t disclose potential problems, and clinicians don’t ask about them.
Seek out, age-appropriate service groups. Although there are limited choices for addiction therapy focused on older adults, some service groups are tailored to older individuals. These may offer a more comfortable atmosphere to share concerns and learn from generational peers.
Ensure other problems are adequately treated. Many seniors have co-morbidities — or several issues at the same time — with chronic pain frequently being one. So, bringing a medicine used to treat pain may be difficult.
However, experts recommend taking the moderate dose of opioids for the shortest period possible to work, and also considering non-drug choices to deal with chronic pain; AHRQ did a systematic review of non-opioid strategies to handle chronic pain, including things like exercise, yoga and tai chi. “I think that there is a real benefit for beginning first with non-drug therapy,” Bierman says.
Ask about having drugs “de-prescribed.” As a Geriatric Psychiatrist, Gerlach spends a substantial amount of time with patients moving over drugs they are taking and seeing what they might no longer need and could be removed — or that she could “de-prescribe,” Gerlach says. “It’s really important to periodically kind of reevaluate the medications that patients are on to figure out if there’s a way that patients can safely come off of these medications.”
Whatever the approach to therapy or prevention, experts highlight; older adults and family should not overlook the risks of addiction with prescription drugs (just like other substances like alcohol). Even though some stigma still surrounds dependence that may make it challenging to open up, clinicians say it is vital to talk about any concerns about that or any adverse effects, or side effects, with a primary care provider.
Senior Citizens and Substance Abuse
Alcohol and drug abuse amongst the elderly is a growing health problem in America.
“Addiction among people 65 and up is frequently underestimated and under-diagnosed, which can keep them from getting the treatment they require.”
As per Office of Alcoholism and Substance Abuse Services, drug abuse amongst senior citizens can be categorized into two general kinds: the “hardy survivor,” or people who were abusing substances for several years and have age of 65, and the “late onset” group, which is those who develop addictions later in time? Despite how old you are or when your dependence began, there are treatment options available to help you getting back on a healthy path.
Reasons for Addiction in the Elderly
Many things could lead to someone turning to substance abuse later in life. These could be cases which take a psychological toll such as -related issues or life-changing events. These events may aggravate drug-abusing activities that can result in a full-scale addiction.
Triggers for alcohol or drug dependence elderly are:
- Death of a pet, family member, partner, or close friend
- Loss of earnings or business strains
- Relocation or employment in a nursing home
- Struggle to sleep
- Family dispute
- Physical or emotional health deterioration (memory loss, depression, major surgeries, etc.)
The Dangers of Elderly Substance Abuse
Alcohol or drug abuse among the elderly is dangerous because citizens are more prone to the deteriorating effects of the substances. Individuals over 65 have a diminished ability to metabolize drugs or alcohol with risen brain sensitivity to them. This makes it risky for elders to use alcohol or drugs at all if the individual isn’t addicted.
Benzodiazepines, which are used to treat pain, anxiety or insomnia, are some of the most dangerous prescription drugs for seniors. These are highly addictive and are usually prescribed. The percentage of senior citizens addicted to benzos increase every year.
Challenges In Identifying Addiction In The Elderly
Drug or alcohol abuse may imitate signs of other health disorders, including dementia, diabetes or depression. That makes it easy for physicians who experience an older patient to chalk up diminishing physical or mental health only to “old age.”
“Not long ago, a medical colleague referred a 67-year-old woman to me with mild depression, weakness and complaints of short-term memory loss. Her physician told her there was no clear medical explanation for her symptoms, given that her physical exam, exhaustive lab tests and brain M.R.I. were all normal… The problem, I soon discovered, was that her alcohol consumption had tripled since the death of her husband a year earlier. She did disclose to her internist that she drank but minimized the amount. She had turned to alcohol, self-medicating her grief, but it only worsened her mood and impaired her memory, typical of alcohol’s effects on the brain.” – Richard A. Friedman, M.D., NYTimes.com