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
The pathway from appropriate use,
through misuse to abuse can result from
 Patient behavior
 Prescriber behavior
 Both
Prescription Drug Misuse
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Patient 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 Misuse
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Prescriber 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
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Physician visits
Laboratory tests
ER visits
Hospitalizations
It might lead to prescription drug ABUSE
Prescription Drug Misuse
Risk Factors
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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 Abuse
Older 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
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Narcotic analgesics
Anxiolytics
Sedative/Hypnotics
Stimulants
Prescription Drug Abuse
is UNSAFE!
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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
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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
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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 eyeopener)?
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 takeback programs
Case Study
Place Holder
Key
Messages
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
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Prescription and Illicit Drug Abuse: Information on
trend among older adults, tips on prevention, treatment
http://nihseniorhealth.gov/drugabuse
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Substance Abuse and Mental Health Services
Administration (SAMHSA)
www.samhsa.gov
888-662-HELP (4357) SAMHSA
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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
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An online resource to help find medication disposal
programs at the local independent community
pharmacy near you
Drug Take Back Network
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Information on permanent and regularly recurring drug
take-back events
www.takebacknetwork.com/local_efforts.html
SMARxT Disposal
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http://www.smarxtdisposal.net/
STAMP Out Prescription
Drug Misuse & Abuse!
QUESTIONS?