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Prescription Drug Abuse and Misuse in the Elderly

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. Number of Americans >65 (Millions). U.S. Bureau of Census.

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Prescription Drug Abuse and Misuse in the Elderly

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  1. 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

  2. Number of Americans >65 (Millions) U.S. Bureau of Census

  3. Drug Problems in the Elderly Current State of Affairs • Alcohol • Illicit drugs • Prescription/OTC

  4. Prescription Drugs are consuming more health costs (Reinhardt et al., 2004)

  5. Increased costs are related to use by elderly (Baugh et al. 2004)

  6. Increased Spending primarily due to increased use (Reinhardt et al., 2004)

  7. Age and gender effect number of Meds taken (Linjakurapu et al., 2002)

  8. Past decade has seen increased use of virtually all classes of meds(Linjakurapu et al., 2002)

  9. Estimated Numbers of People with Psychiatric Disorders in USA Age Group (Jeste et al., Arch Gen Psychiatry, 1999)

  10. DAWN (2003)

  11. 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.

  12. Large numbers of U.S. Population Misuse Prescription Drugs

  13. 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

  14. Prescription drug abuse is probably underestimated by 20%Problems 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

  15. 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

  16. 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

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

  18. Antipsychotic Adherence Gilmer, et al 2004 *Cumulative Annual Possession Ratio

  19. Medical Care Expenditures Increasing (Reinhardt et al., 2004)

  20. Under-use of Medications May be increasing (Archives of Internal Medicine, 2004) • Two-thirds of older patients reduce use of medications due to cost

  21. 1197.pdf Inappropriate use of drugs effected by ethnic/cultural factors (Raji et al. 2003)

  22. Meds may be purchased without prescription in Mexico and other countries.

  23. 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

  24. General Information is available on many drugs(9/9/04)

  25. There are many sites that sell prescription drugs (9/9/04)

  26. Modified Swiss Cheese ModelAfter James Reason Healthcare System Organization ADVERSE EVENT Local Care Environment Equipment & Tools Provider(s) Patient EVENT TRAJECTORY

  27. Modified Swiss Cheese ModelAfter James Reason Healthcare System Organization ADVERSE EVENT Local Care Environment Equipment & Tools Provider(s) Older Patient EVENT TRAJECTORY

  28. Summary • Scope of use • 30% of prescription consumed by 12% of population >65 years • $15 billion/year in elderly (4x’s 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

  29. 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 med’s • Examine ethnic and cultural differences

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