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Prescription Drugs Special Report

Drug Abuse and the Elderly

Prescription drug abuse is not just something that happens in the young. People over age 65 also are at risk for drug abuse -- and perhaps even more so. That's because Americans age 65 and older make up 13% of the population but consume about one third of all prescription drugs. Older individuals also take more potentially addictive medications than any other age group.

Prescription drug abuse is difficult to detect in the elderly. Drug abuse is often masked by the myth that addiction is a disease of the young and that if older people do develop a problem, it is with alcohol. What's more, symptoms of drug abuse such as forgetfulness and irritability may be dismissed as the person "just getting old."

Even more worrisome, prescription drug abuse can lead to more dire consequences in the elderly. With age, the liver becomes less efficient at filtering out medications from the body. Because of this slowed drug metabolism, an older person may get addicted -- or suffer serious side effects -- at lower doses than a younger person would. These side effects include falls that can lead to debilitating fractures and an early death.

How Common Is Prescription Drug Abuse in the Elderly? Statistics suggest that drug abuse among older Americans is substantial and growing. A study in Annals of Epidemiology projected that the number of people age 50 and older abusing prescription drugs could increase 190% over the next two decades from 911,000 in 2001 to almost 2.7 million by 2020. According to the U.S. Substance Abuse and Mental Health Services Administration of 184,000 Americans who started treatment for any type of drug abuse in 2005, 10% were age 50 or older.

Which Drugs Are the Riskiest? As with any addictive substance, access increases the risk of abuse. Older people are more likely to get prescriptions for two leading types of drugs with potential for addiction: opioid pain relievers and benzodiazepines.

  • Drug Abuse With Opioids. Among abused prescription drugs, opioids are the most notorious. These drugs, which include oxycodone (Oxy Contin), oxycodone/acetaminophen (Percocet), and hydrocodone (Vicodin), attach to opioid receptors in the brain that block the perception of pain. They also can produce euphoria by indirectly boosting dopamine levels in the parts of the brain that influence our sensing of pleasure -- hence their addictive potential.

    The most common side effects of opioids are nausea, vomiting, dizziness, sleepiness, constipation, and itching. During an overdose, opioids can slow down breathing, which can be fatal. However, a person who takes pain medication for a legitimate ailment or injury has a slim chance of developing an addiction. The risk increases when opioids are given to someone who has a personal or family history of addiction or has a psychological disorder.

  • Drug Abuse With Benzodiazepines. Other potentially addictive medications are benzodiazepines such as alprazolam (Xanax), clonazepam (Klonopin), diazepam (Valium), and lorazepam (Ativan). Doctors commonly use these drugs to treat anxiety, panic attacks, insomnia, and acute stress reactions to traumatic experiences, such as the death of a spouse. Benzodiazepines work by slowing brain activity.

    When used properly -- in limited quantities for a short time -- addiction is usually not a problem. But taking larger doses or even typical dosages on a daily basis for an extended amount of time can easily lead to tolerance, and an individual will soon need larger and larger doses to get the desired effect. In addition, suddenly going off a benzodiazepine can trigger extreme anxiety and discomfort, prompting a desire to keep taking it. The possibility of tolerance is also present with sleeping medications such as zolpidem (Ambien) and eszopiclone (Lunesta) that work at the same place in the brain as benzodiazepines.

    The health consequences of benzodiazepine abuse for older people include memory impairment, impaired reasoning, confusion, nodding off, car accidents, and falls, which could be fatal.

Posted in Prescription Drugs on April 13, 2010

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