Prescription Drug Misuse & Abuse in Older Adults

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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 behaviorPrescriber behaviorBoth

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

–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

How Many is Too Many?

Prescription Drug AbuseOlder Adults

Drug misuse and abuse is present in 11% of older adults

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 Abuse Risk 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

Abuse Can 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

Key Messages

• USE YOUR MEDICINE SAFELY

• PREVENT MEDICATION MISUSE & ABUSE!

• CLEAN OUT YOUR MEDICINE CABINET ONCE A YEAR

• DISPOSE OF EXPIRED AND OLD MEDICINE PROPERLY

• NEED MORE INFORMATION ON MEDICATION SAFETY?

STAMP OUT Prescription Drug Misuse & Abuse

Tool KitProgram is brought to you by The American Society of

Consultant Pharmacists (ASCP). STAMP OUT was developed by the ASCP Foundation and 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 adulthttps://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.mnsmartdisposal.net/

STAMP Out Prescription Drug Misuse & Abuse!

QUESTIONS?