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Saturday, December 3, 2011

Getting High With Grandpa and Grandma



 "The use of narcotic pain relievers such as OxyContin and oxycodone 
has increased nearly 1,000 percent on a per capita basis since 1997, 
said Orman Hall, director of the Ohio Department of Alcohol and Drug Addiction Services."

(Dave Larson, "Seniors at Higher Risk of Abusing Prescriptions, Dayton Daily News, November 7 2011)

Would it surprise you to know that death rates from unintentional drug/medication-related poisoning are highest for Ohioans ages 45-54, with rates for males 1.5 times greater than the rates for females? ("Epidemic of Prescription Overdose In Ohio, Ohio Department of Health)

A recent national report estimated that adults over 65 account for more than 175,000 emergency department visits for adverse drug reactions each year, and commonly prescribed medications accounted for 33 percent of these drug reactions.

“Essentially, we are treating chronic pain with pharmaceutical-grade heroin, which we believe is a very dangerous practice,”  Orman Hall, director of the Ohio Department of Alcohol and Drug Addiction Services, says. “Seniors, along with most people in our state, really don’t have an adequate understanding of how dangerous and addictive these types of substances are.”

 

The Silent Epidemic: What Is Happening To Put Seniors At Risk?

1. Lack of Information

Seniors (and most other people in the state) don't have an adequate understanding of how dangerous and addictive these substances are.

2. Polypharmacy  

The use of multiple medications, or “polypharmacy,” can increase a person’s risk for bad interactions and unintended side effects, especially in older patients who metabolize drugs differently than younger people..

About 80 percent of seniors have at least one chronic health condition and 50 percent have at least two, according to SAMHSA. “Simply having two or three chronic conditions can get them a prescription list of six to 10 medications,” Dr. Brian Clymer, medical director of Miami Valley Hospital’s hospitalist program says.

3. Multiple Physicians 

Services aren’t being coordinated across different practices, and this error may create a degree of risk for seniors to be in receipt of opiates and other controlled substances that might put them at risk.

"Many of those people who are using opiates at the highest level are receiving drugs from multiple physicians,” Hall said.

4. Deadly Prescription Combinations

Taking opioids for pain in conjunction with benzodiazepine drugs such as Xanax and Valium for sleep or anxiety disorders can be a dangerous combination. Nearly 60 percent of Montgomery County’s unintentional prescription drug deaths in 2010 involved a combination of opioids and benzodiazepines," says Russel Falck,  the Center for Interventions, Treatment & Addictions Research at Wright State University’s Boonshoft School of Medicine. CITAR’s associate director.

People who have been prescribed narcotics or benzodiazepines to help control their symptoms “usually have a good reason to be on them and it’s not a pathological dependence,” Dr. Brian Clymer, medical director of Miami Valley Hospital’s hospitalist program says.

Also, Dima M. Qato, from the University of Chicago (Journal of the American Medical Association) found that 68 percent of older adults used prescription drugs plus over-the-counter medications or dietary supplements. Among those combining drugs, 4 percent were in danger of having an adverse drug reaction. (Steven Reinberg, "Drug Combinations Putting Seniors At Risk," http://prohealthcare.org, December 23 2008)

Moreover, the rate of adverse drug interactions increased with age, particularly among women. Over 50 percent of these interactions involved the use of over-the-counter medications, the researchers found.
The most common adverse interactions occurred with blood thinners such as warfarin and antiplatelet drugs such as aspirin, Qato's group found.

"Physicians and pharmacists need to ask older patients about all the medications they use -- prescription and nonprescription -- and patients need to be prepared to share this information," Qato said. "This is especially important in patients who see multiple providers and patients that fill at multiple pharmacies."

5. Shame To Admit a Problem

Ruth Sanchez-Way, director of the federal Center for Substance Abuse Prevention. She says many older people either don't realize or are ashamed to admit they've got a drug problem. Yet her agency estimates that 17% of Americans age 60 and older abuse prescription drugs or alcohol. Sanchez-Way says that, in many cases, prescription drug abuse goes hand in hand with a drinking problem. (Kathleen Fackelmann, "More Seniors Are Addicted to Prescription Drugs, USA TODAY, July 23 2001)

"Valium, Librium, Xanax, Halcion and ProSom are some brand names for these drugs that are prescribed for anxiety and insomnia, two common problems among older Americans," says Sidney Wolfe, director of Public Citizen's Health Research Group in Washington, D.C. "In most cases, they are addicted to them," he says.

6. Increasing Doses for Insomnia, Chronic Pain, Fractures, and Other Legitimate Health Problems

Many seniors get an order from their doctor for legitimate health problems such as insomnia and fill it legally at the local drugstore.

In some cases, seniors get addicted to painkillers like Demerol or Vicodin, morphine derivatives often prescribed after painful hip fractures, says Cathy Napier, the director of a drug and alcohol treatment center at the Presbyterian Hospital of Dallas.

But more frequently, an older person gets a prescription for a benzodiazepine, then gets into trouble without ever realizing the risk, she says. 

In many cases, people feel better while taking a benzodiazepine. They take more and more of it, then ask the doctor to refill their prescription. To make matters worse, doctors often prescribe an inappropriately high dose of these drugs to seniors, Kenneth Schmader, a geriatric medicine specialist at Duke University Medical Center in Durham, N.C. says. Older people metabolize drugs less efficiently and thus need a lower dose, he says. Age-related changes influence the way in which their bodies respond to prescription drugs.

NIDA advises against taking these drugs for more than four months. Schmader and others say these drugs can be used safely — if used as directed for short periods of time

7. Denial From Family Members

Often, family members look the other way when an older relative suffers from a drug problem, Napier says. They may not realize that an older person's drug use has escalated, Schmader adds. They'll say: "There's no way that Grandma is abusing these drugs." But if the dose has gone up and Grandma is nodding off in the corner, Schmader suggests that family members take a closer look.  

Families often don't realize the harm that such drugs can do. For example, older people taking a high dose of benzodiazepines run the risk of developing memory or thinking problems, Schmader says. A higher than necessary dose of these drugs can trigger confusion, a problem that can result in a car accident or difficulty getting home from a familiar place. (Kathleen Fackelmann, "More Seniors Are Addicted to Prescription Drugs, USA TODAY, July 23 2001)

8. Increased Injury In the "Fog" of Medications

Another risk with a benzodiazepine-induced fog is that an older person will stumble. "They can fall and fracture a hip," Schmader says. A hip fracture can kick off a cascade of serious health problems, he says.

And in some cases, a benzodiazepine problem can trigger an addiction to another drug or to alcohol. That's what happened to 73-year-old Gerry Lucas of Durant, Okla. Lucas says she became addicted to Valium during the 1960s and kicked the habit only to suffer from alcohol abuse later in life.

9. Other Addiction Factors Include 

(a) Loneliness,
(b) Depression.

“There is literature to support the notion that people who are depressed or who have suffered some degree of trauma may be more predisposed to opiate addiction than people who don’t have those conditions,” Hall said.



And, Seniors Can Choose To Become Criminals

Seniors in Ohio are being recruited by drug dealers to obtain prescription medication for “diversion” or illegal resale. “A higher percentage of seniors are living on fixed incomes and prescription painkillers are a pretty hot commodity,” Orman Hall says. Drugs such as Percocet or Vicoden sell from $7 to $15 on the street, while in-demand opiates such as OxyContin can bring as much as $40 per pill.

A new state report describes this activity in Ohio. “Reportedly, dealers stand outside of drugstores and approach seniors about selling their prescriptions, or dealers will convince a senior to go to the doctor and fake pain to get a prescription,” according to a description of activity in the Toledo area. (Andrew Welsh-Huggins, "Report: Drug Dealers Tap Seniors For Pills," Associated Press - The News Herald, October 5 2011)

“If the senior agrees, the dealer will drive the senior to the doctor and to the pharmacy to fill the prescription and will then pay them,” the report says. “That’s the only way they can make ends meet,” the report continues, referring to activity in the Youngstown area.

In Dayton, “people who had suffered injury and the elderly who were given a legitimate prescription were identified as dealers,” the report says.

These trends could continue as the economy worsens, Hall said.
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