Older Adults Take More Medicine • Consume 1/3 of all prescription meds • One in four older adults has used psychoactive meds with abuse potential • Prescription drug misuse and abuse is a growing problem • May be as high as 11% of older adult population
Definitions Prescription Drug Misuse • The use of a medication other than as directed • May be accidental or willful Prescription Drug Abuse • Intentionally taking medications that are not medically necessary
Misuse can Lead to Abuse Patient behavior Prescriber behavior Both The pathway from appropriate use, through misuse to abuse can result from
Prescription Drug MisusePatient Behavior • Taking more of a drug than prescribed • Missing doses • Taking the wrong drug • Using a drug for other than the prescribed reason • Sharing or borrowing drugs • Using drugs that have expired • Combining drugs with alcohol or other substances
Prescription Drug MisusePrescriber Behavior • Medications w/o indication • Multiple drugs from same class • Dose too high; duration too long • High risk drugs or inappropriate for elderly • Inadequate instructions for taking meds • Failure to question about use of alcohol or other drugs with abuse potential
Prescription Drug Misuse is UNSAFE! • Treatment failure • Increased health resource utilization • Physician visits • Laboratory tests • ER visits • Hospitalizations It might lead to prescription drug ABUSE
Prescription Drug MisuseRisk Factors • Number of medications • Multiple prescribers • Inappropriate prescribing • Limited English language proficiency • Low health literacy • Memory problems • Hearing/Vision impairments • Treating symptoms and not the cause
Prescription Drug AbuseOlder Adults • Present in nearly 15% who seek medical attention • Second only to alcohol abuse • ED visits doubled between 2004 & 2008 • 20% age 70 and older • 1/3 required hospitalization • Projected to double over two decades, to 2.7 million by 2020 • 4.4 million will need substance abuse treatment
Commonly Abused Medications • Narcotic analgesics • Anxiolytics • Sedative/Hypnotics • Stimulants
Prescription Drug Abuse is UNSAFE! • Increased health problems • Higher risk of accidents • Higher risk of falls and injuries • Serious side effects • Physical dependence and addiction
Prescription Drug AbuseRisk Factors • Female gender • Social isolation or loss of social supports • History of mental health problems • History of substance abuse • Exposure or access to prescribed medications with abuse potential
Recognizing Prescription Drug AbuseCan Be Difficult • Older adult does not fit the typical drug abuser profile • No validated screening instruments to identify/diagnose drug abuse in geriatric population • Many diseases caused by substance abuse are common disorders in later life • Many symptoms of prescription drug abuse mirror common signs associated with aging
Warning Signs Prescription Drug Abuse • Sudden change in behavior • Withdrawal from family, friends, activities • Sleeping during day • Changes in personal grooming, hygiene • Worry about . . . Are the drugs “really working” Having enough medication on hand • Giving excuses as to why they need pills • Sneaking or hiding pills • “Doctor shopping” for several prescriptions
Identifying Prescription Drug Abuse Modified CAGE questionnaire 1. Have you felt you ought to cut down on your drinking or drug use? 2. Have people annoyed you by criticizing your drinking or drug use? 3. Have you felt bad or guilty about your drinking or drug use? 4. Have you ever had a drink or used drugs first thing in the morning to steady your nerves, get rid of a hangover or get the day started (as an eye-opener)?
Prevention Tactics Improving medication adherence. Making sure that older adults understand how to take medications and what to avoid when taking a prescription medication. Encouraging older adults to share concerns and ask questions about their medication. Encouraging older adults to inform health care providers of all medications they take regularly. Encouraging older adults to keep a current medication list.
Prevention Tactics Provide medication aids Address communication barriers Community informational and intervention support programs Educate prescribers Adequate treatment of underlying conditions Standardized screening Transitional care and medication review
Help fight Prescription Drug Misuse & Abuse CLEAN OUT THE MEDICINE CABINET!!
Proper Disposal of Unused/Expired Meds DO NOT FLUSH unused medications DO NOT POUR them down a sink or drain Take advantage of community drug take-back programs
Case Study Place Holder
STAMP Out Prescription Drug Misuse & Abuse!Tool Kit Developed by Supported by an educational grant from Purdue Pharma L.P.
Tool Kit Available ASCP.com/stampout
For More Information • Prescription and Illicit Drug Abuse: Information on trend among older adults, tips on prevention, treatment http://nihseniorhealth.gov/drugabuse • Substance Abuse and Mental Health Services Administration (SAMHSA) www.samhsa.gov 888-662-HELP (4357) SAMHSA • Find a Senior Care Pharmacist: Specializing in the medication needs of older adults https://www.ascp.com/find-senior-care-pharmacist
Medication Disposal DisposeMyMeds.org An online resource to help find medication disposal programs at the local independent community pharmacy near you Drug Take Back Network Information on permanent and regularly recurring drug take-back events www.takebacknetwork.com/local_efforts.html SMARxT Disposal http://www.smarxtdisposal.net/
STAMP Out Prescription Drug Misuse & Abuse! QUESTIONS?