Drug Abuse in The Elderly
Substance abuse and addiction research in India is in a nascent stage. Awareness needs to spread on these issues and their implications on the health of the elderly. Clinical research in the area has focused primarily on alcohol and substance related co-morbidity, but there is very little research on the pharmacological and psychosocial interventions. Regional variations and the severity of the health issues arising from this are now being explored.
Unscrupulous pharmacies in India sell drugs without any qualms leading to large scale drug abuse. Spending on prescription medication and dependency on drugs in elders is steadily rising. Use of over the counter (OTC) medications and dietary supplements by elderly is encouraged, without realizing the implications of their long term use. Age related changes in metabolism, a high rate of co morbid illnesses and drug interactions lead to cognitive decline, loneliness, depression, and helplessness.
Drug abuse happens when the elderly take too many medications in their anxiety to alleviate pain. Substance Abuse and Mental Health Services Administration (SAMHSA) of USA has published in a report that nearly 10 people between the age of 57 and 85 consume at least five medications every single day. Harmful side effects especially medication induced delirium and dementia is a growing concern for the elderly above 64 years of age.
Elders become withdrawn and angry due to drug abuse, reliance on medication increases and they feel they cannot function without it
Going through the natural transitions of life, like loss of loved ones, injuries due to loss of balance, sleep related issues, physical pain and psychological and social factors all add up to the elders’ vulnerability to drug abuse and addiction.
The elderly population is the largest consumer group of prescription medication, hence also at a greater risk for drug abuse and addiction. While intake of prescription drugs increases with age, body functions become lethargic, slowing down the liver’s ability to filter medicines out of the body. This means that an older adult is much more prone to addiction than a younger person at the same level of medication.
Prescription drug abuse is high as related to pain, anxiety and sleep medication. Addiction happens when a person’s reliance on medication increases to such a level that they start believing that they will not be able to function without it. Ignoring the physician’s instruction, they start experimenting with the dosage and timing, or mix the medication with alcohol resulting in serious drug interactions and over.
The most common medications used to control pain in the elderly are opioids. Prolonged use of these has a huge potential for misuse and abuse. Opioids are drugs for relief from pain like oxycodone and combinations of oxycodone with either acetaminophen, or hydrocodone. Benzodiazepines are prescribed for the treatment of anxiety, panic attacks or insomnia. Valium and xanax are the most common ones. Long term use of these is addictive and a high dosage is lethal.
The relationship between aging and substance abuse is well known. Long term treatment of chronic pain with opioid medication results in increased drug tolerance, leading to a need for increase in dosage and thus addiction. Monitoring for signs of drug abuse is crucial, but when coupled with dementia, delirium or symptoms of alcohol intake, symptoms overlap and identification becomes difficult. The lack of testing on the elderly to assess memory loss or confusion caused by medication from that caused by early Alzheimer’s, is another area of concern.
Elders become withdrawn and angry due to drug abuse, reliance on medication increases and they feel they cannot function without it. They do not adhere to the physicians instructions on medication timing and dosage. Reporting this to the physician and seeking help is critical.
Harmful side effects especially medication induced delirium and dementia is a growing concern for the elderly above 64 years of age
Treatment for this form of addiction depends on the drug being used, the severity of addiction and the risk of withdrawal symptoms. For elders, alcohol or drug dependency is considered shameful and a moral failing. It is a taboo subject due to social reasons. Most symptoms are confused with age-related changes and acceptance becomes a norm when it should not be so. Apart from counselling and medicine, love, understanding, patience and handholding support is crucial to this age group both in the urban and rural population.