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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?
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