Illicit Drug Use Increases Among Older Adults
In a way, you can’t blame them. Facing unending pain from chronic illness, trying to assuage the sorrow of losing a loved one, or just trying to combat the ever-increasing litany of physical problems associated with aging – today’s older adults are turning to illicit drug use in droves.
It can’t be a coincidence. But it is a growing problem and one that the 2000 National Household Survey on Drug Abuse (NHSDA) laid out at the end of 2001. At the time, notes the report, an estimated 568,000 persons aged 55 or older – or 1 percent of all older adults in the U.S. – had used illicit drugs in the past month and over 5 million were “binge” alcohol users, including more than 1 million who were heavy alcohol users. Included in the report highlights was the troubling warning that the number of illicit drug users among older adults would likely increase in the coming years due to the aging of the “baby boom” generation.
Fast forward to 2010, and the prophecy is beginning to come true. Released at the end of December 2009, the latest National Survey on Drug Use and Health (NSDUH), available at http://oas.samhsa.gov/2k9/168/168OlderAdults.htm shows just how much illicit drug use among older adults has increased. An estimated 4.3 million adults aged 50 or older – or 4.7 percent of adults in that age range – had used an illicit drug in the past year, based on data from 2006 to 2008. Now the warning is even more specific: “High rates of lifetime drug use among the baby boom generation (persons born between 1946 and 1964), combined with the large size of that cohort, suggest that the number of older adults using drugs will increase in the next two decades.”
Specifically, the NSDUH summary states:
• Predictions indicate that by the year 2020, the number of persons needing treatment for substance abuse disorder will double among persons aged 50 or older as the baby boom generation moves into older adulthood.
• These changes have already begun, as indicated by recent increases in illicit drug use among persons aged 50 to 59.
• Illicit drug use is associated with many health and social problems, and age-related physiological, psychological, and social changes make older adults more vulnerable to the detrimental effects of illicit drug use.
• Many older adults also use prescription and over-the-counter (OTC) drugs that could adversely interact with illicit drugs – and may themselves hold the potential for abuse.
• The magnitude of these changes and their potential impact make it imperative to understand and plan for the health care needs of this population. These needs include substance abuse prevention and treatment.
What are Illicit Drugs?
The NSDUH defines illicit drugs as marijuana/hashish, cocaine (including crack), inhalants, hallucinogens, heroin, or prescription-type drugs used nonmedically. Nonmedical use is defined as the use of prescription-type pain relievers, sedatives, stimulants, and tranquilizers that are not prescribed for the respondent by a physician or used solely for the feeling or experience they cause.
What Drugs are Older Adults Using?
The most common illicit drugs used by older Americans are marijuana (2.8 percent) and prescription-type drugs used nonmedically (2.1 percent). This equates to 2.5 million past-year users of marijuana and 1.9 million past-year nonmedical users of prescription-type drugs. Only 664,000 (0.7 percent) of older adults reported use of illicit drugs other than marijuana or psychotherapeutics – including 0.5 percent for cocaine, 0.1 percent for heroin, and 0.1 percent for hallucinogens.
Breaking it down further (among U.S. adults aged 50 or older who used an illicit drug in the past year), 44.9 percent used marijuana only, while 33.4 percent used only prescription-type drugs nonmedically.
Commonly abused classes of prescription drugs include opioids (often prescribed to treat pain), central nervous system depressants (often prescribed to treat anxiety and sleep disorders), and stimulants (often prescribed to treat attention-deficit-hyperactivity disorder or ADHD, narcolepsy, and obesity).
Long-term use of opioids or central nervous system depressants can lead to physical dependence and addiction. When taken in high doses, stimulants can lead to compulsive use, irregular heartbeat, dangerously high body temperatures, and paranoia. Psychoactive drugs have side effects such as excessive daytime drowsiness, loss of coordination, which leads to falls and other problems, depression, delirium, insomnia, loss of appetite, urinary problems, constipation, weakness, and withdrawal seizures.
Mixing prescription drugs with alcohol or taking multiple prescriptions that may cause adverse reactions may result in life-threatening reactions.
Consider the fact that older adults take at least one prescription drug daily. Some older adults take as many as 8 prescription medications each day. The more medications they take, the more likely they are to experience drug interactions.
What’s the worst that could happen? Harmful drug interactions include fatigue, excessive sedation, coma, and death. These, thankfully, are usually rare, but they are something to be on the guard against. Typically, the effects are mild (change in sleep, appetite or level of anxiety) and can be alleviated by having the doctor adjust the dosage or change medications.
What accounts for the high usage of marijuana among older adults? The therapeutic pain-relieving properties of marijuana have long been touted by respected physicians and researchers – as well as individuals who report beneficial results from smoking cannabis. Despite the fact that marijuana is still classified as a controlled substance (a Schedule I drug by the 1970 Controlled Substances Act, considered to have “a high potential for abuse,” and for which there is “no currently accepted medical use,” and a “lack of accepted safety”) and is illegal under federal law, 14 states have made medical marijuana legal for patients who have a prescription for it from their doctor.
California was the first to legalize medical marijuana back in 1996. In 1998, three more states passed laws making medical marijuana legal: Alaska, Oregon and Washington. Maine joined in 1999. The next year (2000), Colorado, Hawaii and Nevada followed suit. Vermont and Montana came next in 2004, followed by Rhode Island (2006), New Mexico (2007), Michigan (2008), and New Jersey (2010).
In all 14 states where medical marijuana is legal, proof of residency is required in order to be considered a qualifying patient for medical marijuana use. In 13 of the 14 states, patients and their caregivers can cultivate marijuana. In New Jersey, home cultivation is prohibited, and New Mexico requires a special license to do so.
Two other states, Arizona and Maryland, have laws that are favorable to marijuana, but do not legalize it. Arizona’s statute (1996) allows physicians to prescribe marijuana (although federal law prohibits doctors from prescribing Schedule I controlled drugs). Maryland’s existing law, passed in 2003, allows medical use defense in court.
As of April 2010, 14 states have pending legislation or ballot measures to legalize medical marijuana. These states include: Alabama, Delaware, Illinois, Iowa, Kansas, Maryland, Massachusetts, Mississippi, Missouri, New York, North Carolina, Pennsylvania, South Dakota, Tennessee, Wisconsin and Virginia.
Given the probability that medical marijuana will be legalized in a number of the states with pending legislation or ballot initiatives, the likelihood that marijuana will continue to be used by older adults is very high indeed. This is not a treatise on whether or not medical marijuana serves a useful purpose, or to address its potential for abuse and/or dependence and addiction. It is simply recognition of the huge potential market for such a substance and the availability of the drug to meet the growing demand.
For an informed look at the top 10 pros and cons on the question of making marijuana a medical option, go to ProCon.org (http://medicalmarijuana.procon.org/view.resource.php?resourceID=000141.
Older Adults and Prescription Drugs
Research shows that older adults consume more than one-third of all prescriptions in the United States. In addition, the older Americans are, in general, less compliant with their medication schedules, more isolated than those in younger age groups, and therefore are at greater risk of developing substance abuse problems.
While it is estimated that 10 percent of the total U.S. population abuses alcohol, an estimated 17 percent of Americans over the age of 65 are alcohol abusers. Similarly, with the increase in prescription drug abuse among the older population, the sheer volume of these prescriptions puts this group at greater risk for developing substance abuse.
Misuse of medication, forgetting a medication has been taken, doubling up on dosage, whether intentional or not, can also contribute to an increased risk of substance abuse. Other risk factors include:
• Not following instructions on proper drug usage
• Using expired drugs
• Not knowing about the side effects of drugs
• Borrowing or sharing drugs
• Intentionally misusing drugs to hurt oneself
• Taking the wrong drugs
• Mixing drugs with alcohol
• Going to multiple physicians to get more prescriptions of the same drug (such as Valium, which can lead to abuse and addiction)
Older adults also have other risk factors that may be associated with age-related difficulties:
• Inability to read the instructions and package inserts on medication or language that is confusing
• Inappropriate prescribing (prescribing the wrong medication or in the wrong doses)
• Multiple doctors prescribing multiple medications (cardiologist, general practitioner, urologist, gynecologist, etc.)
• Failure to tell the doctor about other medications, OTC medications, vitamins and herbal supplements
• Cognitive problems that make keeping track of medication schedules difficult
• Depression, self-neglect or alcohol use which cause problems in taking medication correctly
• Missing instructions – as a result of vision or hearing problems, language barriers, memory problems, etc.
Millions of Americans live on fixed incomes, and prescription drugs are very expensive. This may cause older adults who have become used to taking prescription pain relievers, for example, to turn to illicit or uncontrolled sources in order to continue to receive their supply of meds.
A Generation At Risk: Applying Prevention Concepts to the Elderly, a brochure available through the California Department of Alcohol and Drug Programs states that although seniors comprise less than 15 percent of the population, they receive 60 percent of the psychoactive prescriptions (for treatment of such problems as pain and insomnia). Nearly 25 percent of older Americans in community-dwelling residences are using some sort of psychoactive drug.
In general, women are more likely to abuse prescription tranquilizers than men. But the fact is that there are no good statistics on the rates of prescription drug abuse among the elderly.
The California brochure identifies five next steps:
• Identify and target risk factors.
• Educate elders about the dangers of over-use of prescribed psychoactive drugs.
• Focus on community-based approaches, or seniors helping seniors through outreach programs.
• Encourage volunteerism – especially to get elderly individuals who are depressed to volunteer.
• Tailor strategies for baby boomers as they age. The brochure points out, for example, that younger cohorts may be encouraged to think about the effects of very strong substances such as crystal meth on how they age.
Implications for Prevention and Treatment
According to the research and study findings, substance abuse is seldom associated with individuals who are nearing or at retirement age. NSDUH data show that there are currently 4 million affected individuals – which help to predict the growth of the problem over the next decade.
In order to reduce and treat drug use problems in this growing population it will be critical to have an integrated system of care that combines behavioral health and medical services to fully address the spectrum of problems elderly patients bring to the primary care setting.
Routine screening of older patients by health care providers – particularly those that specialize in treating the elderly – should become part of the normal interaction between the health care provider and patients.
Substance abuse and prevention program managers will need to look at how they may better serve this population. Reach-out and engagement strategies should include information as well as therapeutic modalities geared toward older substance abuse clients.
Very few treatment programs are geared toward older adults, particularly the elderly adults that are increasing in numbers in America. Evidence does suggest, however, that older adults benefit as much as younger ones with effective treatment programs. Much more education needs to be developed on the cognitive and physical effects of medications commonly prescribed for seniors. This education is necessary not only for the seniors themselves but also for their caregivers, family members, and health care providers.
The Problem Won’t Just Go Away
Picture a society of doddering citizens losing more than just their quality of life by misusing, abusing, or just trying to make it through the day with an assortment of illicit drugs. It’s certainly not a very comforting scenario.
The idea one day you’re going to be old doesn’t much concern you until you’re there – and some would say, by that time, it’s too late. Well, it isn’t too late to do something about the aging population in America which will eventually include all of us. We need to get involved, to educate ourselves, to search out or create and develop programs that will foster better prevention and treatment programs.
Think of the voting bloc that this ever-growing population comprises. If democracy rules, the voting majority needs to be looking out for its best interests and doing what’s necessary to get needed changes implemented.
We can start by doing what we can in our own family structure.
• Take a good look at the medications an older parent, a brother, spouse or close relative uses every day.
• Have a thoughtful discussion with that person to ensure that they are taking the medications as prescribed, that there aren’t any expired drugs, that there’s a full list of medications the individual takes to each doctor he or she visits, and so on.
• Do what you can to help the individual organize the medications or create a workable schedule, or arrange for someone else to dole out the medications as required.
• Properly dispose of unwanted, expired or unusable medications by flushing them down the toilet or sink.
• Note any difficulties that may be interfering with the older person’s ability to comprehend or function normally and make sure to seek medical attention to deal with any problems.
• Check to see that the individual is eating healthy, well-balanced meals.
• Encourage him or her to get out and do some light physical exercise daily, such as a walk around the neighborhood or park.
• Engage your older family member, loved one or close friend in conversation, play games, go to entertainment and sports events and out to dinner. Being active and involved is one of the best ways to help prevent illicit drug use among older adults.
There’s no time like the present. None of us are getting any younger.