Prescription Drug Nonmedical Use and Abuse in Older Women

1
Prescription Drug Nonmedical Use and Abuse in
Older Women

• Drug abuse in the 21st century what lies ahead
  for the baby boomers?
  
• Linda Simoni-Wastila, Ph.D.
• University of Maryland, Baltimore
• School of Pharmacy
• National Institute on Drug Abuse
• Bethesda, Maryland
• September 16-17, 2004

2
Introduction

• Purpose To review the evidence of illicit drug
  use among aging women
  
• Focus prescription drug misuse and abuse
• The Hidden Problem
• Under-recognized
• Under-screened
• Under-treated

3
Todays Discussion

• Context Older women and risk
• Substance use in older adults
• Prescription drugs with potential for misuse and
  abuse
  
• Continuum and extent of prescription drug use ?
  abuse
  
• Risk and protective factors
• Gaps in knowledge
• Conclusions - Implications for research

4
Older Women and Risk

• Mature women may be particularly at risk for Rx
  misuse and abuse
  
• Greater likelihood for exposure
• Biology body size hormones body fat metabolic
  differences
  
• Propensity for care seeking ? propensity for
  treatment
  
• Consequences of Rx misuse and abuse
• Cognitive impairment and increased sedation ?
  falls/injury depression suicide interactions
  w/ alcohol and other drugs
  

5
Substance Abuse in Older Adults

• Nearly 2.8 M people aged 50 and older or 3.5
  have used 1 or more illicit substances in the
  past year
  
• Of these past-year users, 16.0 (446,844) may
  have illicit drug abuse or dependence problems
  
• 262,032 are male (58.6)
• 184,812 are female (41.4)
• Two substances of choice
• Prescription drugs
• Marijuana
• (2002 NSDUH)

6
Substance Use - Type by Gender 50 and Older
(2002 NSDUH)
7
Substance Use in Older Adults

• Alcohol use is also high in 50 population 2.3
  Million, or 14.1, meet criteria for alcohol
  abuse/dependency
  
• 1.84 Million are male (80.0)
• 459,000 are female (20.0)
  (2002 NSDUH)

8
Rx Drugs With Potential for Misuse and Abuse

• Interest is only on those Rx drugs with abuse
  potential, a la CSA
  
• Opioid analgesics (morphine, Dilaudid, OxyContin,
  Darvon, Percocet)
  
• CNS stimulants (Ritalin, amphetamine)
• Minor tranquilizers (Valium, Ativan, Librium)
• Sedative-hypnotics (Seconal, amobarbital,
  Noctec)
  

9
Continuum of Rx Use in Older Adults

• Proper Use
• Misuse (by patient and/or provider)
• Abuse
• Dependence

(APA, DSM-IV, 1994)
10
Prescription Drug Misuse

• Any Rx drug can be misused
• Misuse Non-medical use Any use that is
  outside of medically prescribed regimen, eg
  
• Non-compliance
• Taking different dose
• Sharing
• Obtaining from non-medical source
• Taking for psychoactive effects
• Use with alcohol

11
Prescription Drug Abuse

• Abuse use resulting in
• Decline in work, school, or home performance
• Legal problems
• Use in risky situations
• Continued use despite social/personal
  consequences (APA, DSM-IV, 1994)

12
Prescription Drug Dependency

• Dependency use resulting in
• Tolerance
• Withdrawal sx
• Decline in normal activities
• Unsuccessful attempts to cut down or control use
• Use for longer period or larger amounts than
  intended
  
• Use consumes lot of time to acquire and/or
  recover from effects
  
• Continued use despite knowledge that it caused
  physical and/or psychological problems (APA,
  DSM-IV, 1994)
  

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Extent of the Problem Medical Exposure

• General US population1
• Women 20.0
• Men 12.5
• Among elders aged 65 and older, 21.7, or 7.22M,
  receive at least 1 abusable Rx annually2
  
• Women 24.6
• Men 17.7

1Simoni-Wastila et al, Sub Use and Misuse, 2004
2Simoni-Wastila et al, under review, 2004
15
Medical Exposure to Abusable Rx Drugs by Gender
and Age
Simoni-Wastila et al, under review, 2004
16
Extent of the Problem Misuse

• General population 4.0, or 8.27M, misuse Rx
  drugs annually
  
• Opioids 2.4 (4.84M)
• Tranquilizers 1.5 (2.98M)
• Stimulants 1.1 (2.35M)
• Sedatives 0.9 (1.84M)
• Estimates of elder Rx misuse ranges from 0.6 of
  elders (300k) to 5.0 (2.8 M)

Simoni-Wastila and Strickler, Am J Pub Health 2004
17
Extent of the Problem Abuse and Dependency

• General population 0.6-0.9, or 1.3-2.1M
  individuals may be abusing Rx drugs
  
• Opioids 0.2-0.6 (1.5M)
• Tranquilizers 0.2 (509k)
• Stimulants 0.2 (437k)
• Sedatives 0.1 (155k)
• The elderly ?

Simoni-Wastila and Strickler, Am J Pub Health
2002 NSDUH, SAMHSA
18
Risk Factors for Prescription Drug Misuse and
Abuse - General Population

• Most consistent correlates in the general
  population for Rx misuse and addiction
  
• Female gender
• Young age
• Older age
• White race
• High SES
• Poor physical health
• Mental illness

19
Role of Gender in Rx Drug Misuse and Abuse

• Females 1.43X more likely than males to misuse
  any Rx drug (95 CI 1.19-1.69)
  
• Driven by opioid analgesics (OR 1.41) and minor
  tranquilizers (OR 1.54)
  
• Stat significance disappears when do not control
  for daily ETOH and illicit drug use
  
• Simoni-Wastila et al, Sub
  Use Misuse 2004
  
• Females 1.49X more likely than males to have
  abuse/dependency on Rx drugs (95 CI 1.06-2.08)
  
• Driven by opioid analgesics (OR 2.00) and minor
  tranquilizers (2.00)
  
• Simoni-Wastila and
  Strickler, AJPH 2004
  
• Gender NOT statistically significant predictor of
  stimulant or sedative-hypnotic misuse or
  abuse/dependency

20
Risk Factors for Rx Misuse and Abuse in Older
Women

• Among older women, possible risk factors
  include
  
• Social isolation
• Lower SES and education
• Poor health
• Current or history of behavioral health problems
• Loss of economic and social support
• HC system factors

21
Social Isolation and Health Status
Simoni-Wastila et al, under review, 2004
22
Baby Boomers Come of Age

• Current Problem lack of knowledge of substance
  use in elders
  
• Substance use in elders will be a huge problem in
  
• Accepting of alcohol and drug use
• Used more in youth
• Use more NOW
• Use more psychoactive Rx drugs now
• 3-4x more emotional disorders

23
Adults 50 and Older in Population and Needing
Treatment (in millions)
Gfroerer et al., SAMHSA, 2003
24
Research Gaps

• Data inadequacies
• Lack of data sources
• Small number of elders
• Cross-sectional data
• Lack of medical information
• Definitional issues of misuse and abuse in elders

25
Diagnosis and Treatment Gaps

• No screening/assessment tools specific to Rx
  drugs
  
• Dx and tx strategies not age- or
  gender-sensitive
  
• Efficacy of treatment modalities not tested in
  elders, women
  
• Absence of clinical guidelines
• Problems in organization and financing of health
  care
  

26
Conclusions

• We need to better understand elder Rx misuse and
  abuse
  
• Prevalence
• Diagnosis
• Prevention
• Treatment
• Older women are at special risk for Rx misuse and
  abuse
  
• Gender- and age- specific risk and protective
  factors