Prescription Drug Abuse and Misuse in the Elderly

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Prescription Drug Abuse and Misuse in the Elderly

• Thomas L. Patterson, Ph.D.
• Support for this work NIMH Center Grants P30
  MH49693 and MH45131, and by the Department of
  Veterans Affairs

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Number of Americans 65 (Millions)

U.S. Bureau of Census
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Drug Problems in the Elderly Current State of
Affairs

• Alcohol
• Illicit drugs
• Prescription/OTC

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Prescription Drugs are consuming more health
costs (Reinhardt et al., 2004)
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Increased costs are related to use by elderly
(Baugh et al. 2004)
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Increased Spending primarily due to increased use
(Reinhardt et al., 2004)
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Age and gender effect number of Meds taken
(Linjakurapu et al., 2002)
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Past decade has seen increased use of virtually
all classes of meds (Linjakurapu et al., 2002)
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Estimated Numbers of People with Psychiatric
Disorders in USA
Age Group
(Jeste et al., Arch Gen Psychiatry, 1999)
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DAWN (2003)
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Estimated Number (in thousands) of U.S. Residents
(Age 12 and Older) Reporting Lifetime
Non-Medical Use of Prescription Pain Relievers,
2003
Prior to 2002, the NSDUH was known as the
National Household Survey on Drug Abuse. Due to
changes in the survey, estimates from the 2002
and 2003 NSDUHs should not be compared with
estimates from the 2001 and earlier NHSDAs to
assess changes over time. SOURCE Adapted by
CESAR from Substance Abuse and Mental Health
Services Administration (SAMHSA), Overview of
Findings from the 2003 National Survey on Drug
Use and Health, 2004.
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Large numbers of U.S. Population Misuse
Prescription Drugs
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Prescription Drug Abuse/Misuse

• Most drugs for medical conditions
• Psychoactive drugs (e.g., benzodiazepine) most
  often abused in elderly
• Inpatient addiction program 16 prescription
• Comorbidities
• Prescription alcohol
• Psychiatric diagnoses
• Baby-Boomer impact unknown
• Problems identifying cases

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Prescription drug abuse is probably
underestimated by 20Problems in Defining
DrugDependence in the Elderly (DSM-IV)

• Criteria Increased tolerance to effects of
  substance
• changes in pharmacokinetics
• Criteria Report of adverse consequences
  (e.g., poor work performance, suspension from
  school etc.)
• fails to consider lifespan changes

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Abuse/Dependence in the Elderly

• Factors associated with abuse
• Genetics
• Stress
• Co-morbidities
• Metabolism
• Structural Problems
• Research not consider aged
• Dosage one size fits all
• Age related changes in abuse
• Maturing out Theory
• Mortality
• Morbidity
• Maturational Factors
• Until problems emerge difficult to ID
• Access to prescription drugs is changing

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Prescription Drug Abuse

• Prevalence affected by sampling
• Increased in nursing homes and hospitalized
• Less evidence for ambulatory aged
• Reason for misuse of meds
• Difficulties reading and following prescription
• Cognitive deficits
• Cost
• Complexity of drug treatment

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Prescription Drug Use

• Types of misuse
• Over dose
• Under dose
• Use for other than prescribed
• Drug combinations

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Antipsychotic Adherence
Gilmer, et al 2004
Cumulative Annual Possession Ratio
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Medical Care Expenditures Increasing
(Reinhardt et al., 2004)
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Under-use of Medications May be increasing
(Archives of Internal Medicine, 2004)

• Two-thirds of older patients reduce use of
  medications due to cost

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1197.pdf
Inappropriate use of drugs effected by
ethnic/cultural factors (Raji et al. 2003)
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Meds may be purchased without prescription in
Mexico and other countries.
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The Internet is Becoming a Larger Source of
Prescription Drugs

• The internet has become a virtual wild west
  bazaar for spam emails and websites that sell
  controlled substances with little or no
  oversight.. DEA, 2004

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General Information is available on many
drugs(9/9/04)
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There are many sites that sell prescription
drugs (9/9/04)
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Modified Swiss Cheese ModelAfter James Reason
Healthcare System
Organization
ADVERSE EVENT
Local Care Environment
Equipment Tools
Provider(s)
Patient
EVENT TRAJECTORY
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Modified Swiss Cheese ModelAfter James Reason
Healthcare System
Organization
ADVERSE EVENT
Local Care Environment
Equipment Tools
Provider(s)
Older Patient
EVENT TRAJECTORY
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Summary

• Scope of use
• 30 of prescription consumed by 12 of population
  65 years
• 15 billion/year in elderly (4xs younger
  individuals)
• Abuse and misuse is a problem
• Estimates of scope of problem hindered by a
  number of factors
• Access to prescription drugs is easier than ever
  before

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Specific Goals and Suggested Strategies

• Improve diagnostic criteria
• Focus research on compliance
• Standardize prescription labeling
• Develop treatment programs tailored to elderly
• Consider dual diagnosis (e.g., PTSD drug use)
• Explicate age related changes in drug abuse
• Examine impact of internet/foreign purchase of
  meds
• Examine ethnic and cultural differences