Prescription Medication Use in the Elderly
Per the Substance Abuse and Mental Health Services Administration (SAMHSA) 3 out of 10 people between the ages of 57 to 85 use 5 prescription medications or more.1 What is alarming about this statistic is over the next decade, individuals over 50 abusing prescription drugs could increase 190% to 2.7 million by 2020.2 There are many reasons why prescription drug use in the older individuals is a difficult topic to address. Often, individuals over the age of 50 have medical conditions that warrant the use of these drugs. However, the use of impairing compounds such as opioids and benzodiazepines have contributed to accidents and injuries. Also, with age the liver is less efficient in metabolizing medications from the body. An older person may have a higher drug available for a longer period of time than a younger individual. Tolerance and addiction are also common in individuals over the age of 50 even at lower doses.
Common impairing drugs prescribed for individuals over the age of 50 are opioids (oxycodone or Oxy Contin, oxycodone/acetaminophen or Percocet, and hydrocodone or Vicodin) used for their ability to block pain and benzodiazepines (alprazolam or Xanax, clonazepam or Klonopin, diazepam or Valium, and lorazepam or Ativan) used for anxiety, panic attacks, insomnia and stress due to traumatic experiences. In addition, in the May 1, 2013 Drug Abuse Warning Network SAMHSA report, it was noted that the FDA historically has recommend dosages of the short-term insomnia treatment drug Zolpidem (Ambien, Ambien CR, Edluar, and Zolpimist) be reduced by half when prescribed to the elderly. Regardless of these recommendations, the elderly are often prescribed larger doses.3 These medications are normally safe when used properly for short periods of time. However, in the elderly, larger and even average dosages at regular intervals for extended periods of time can lead to adverse effects.1
The figure below from Chapter 1 of “Substance Use by Older Adults: Estimates of Future Impact on the Treatment System” is an excellent visual representation of the impact on drug use/abuse in the elderly in the next 32 years.1 Even at the lowest projections the population of individuals age 65 years or older will be approximately 58 million in the United States by the year 2050.1 Through patient and the medical community education; hopefully the impact of the larger population of individuals using impairing compounds can be managed and prevention of accidents and injuries will be accomplished.
1. Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Substance Use by Older Adults: Estimates of Future Impact on the Treatment System. OAS Analytic Series #A-21, DHHS Publication No. (SMA) 03-3763, Rockville, MD, 2002. <http://www.samhsa.gov/data/aging/chap1.htm> Date accessed: May 5, 2013
2. Johns Hopkins Medicine. Drug Abuse and the Elderly. April 13, 2010. <http://www.johnshopkinshealthalerts.com/reports/prescription_drugs/3363-1.html> Date Accessed: May 5, 2013
3. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (May 1, 2013). The DAWN Report: Emergency Department Visits for Adverse Reactions Involving the Insomnia Medication Zolpidem. Rockville, MD.