Prescription Drug Misuse/Abuse in Seniors. April Rovero Founder/Executive Director

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1 Prescription Drug Misuse/Abuse in Seniors April Rovero Founder/Executive Director

2 Deaths per 100,000 Population Overdose Demographics Drug Poisoning Death Rates by Age: United States (2010) and Over Age Range This is NOT a problem confined to young adults National Center for Health Statistics. NCHS data on drug poisoning deaths. Updated December Figure adapted from: National Vital Statistics System Accessed 12/03/13. 2

3 Reality of Substance Misuse/Abuse High Performing Students & Athletes Those with Mental or Physical Health Issues Youth, Parents, Friends, Co-Workers, Elderly Anyone!

4 Average Annual Rx Use by Age Age Range Number of Prescript ions Filled per Year Source: Center on an Aging Society, Georgetown University, 2000

5 Typical Rx Use for Seniors Million Use 1 Medication Per Week 14 Million Use 5 Medications Per Week 4.2 Million Use 10+ Medications Per Week Source: JAMA 2002:287:337-44

6 Senior Vulnerability Factors Living Alone Multiple Prescribers/Poor Monitoring Unnecessary/Unsuitable Med Prescriptions Taking Multiple OTC & Prescribed Meds Financial Situation (e.g., Taking Expired Meds, Other People s Meds, etc.)

7 Physiological Factors Increased Medication Sensitivity Slower Metabolism Slower Elimination

8 Medical Factors Half of all Americans 65+ have a disability, 1/3 of those have severe disability Disease and physical ailments increase in those 85+ Falls affect 1/3 of Americans 60+ Hospitalization due to adverse drug effects is 6 times greater

9 Ways Seniors Misuse Meds Forgetful, Confused, Don t Understand Instructions Take More than Prescribed Longer Duration than Prescribed Skip Doses Take Expired Meds Use for Purposes Other than Prescribed Use With Other Meds or Alcohol

10 General Misuse/Abuse Risk Factors for Seniors Multiple Physical Health Issues Dementia/Memory Problems Isolation Multiple Prescribers and Drugs Depression/Loneliness

11 Meds Most Misused Painkillers Sedatives Reality: Estimated 10% of Elderly Misuse PD s

12 Meds Most Likely to be Misused Anti-Anxiety Drugs Like Xanax Sleeping Pills like Ambien Opioid Painkillers like Vicodin Note: Central Nervous System Depressants (CNS)

13 Painkillers OxyContin Vicodin Opana Percocet Effects Drowsiness Constipation Slowed or Stopped Breathing

14 General Opioid Overdose Risk Factors Prescribed long term for chronic cancer or non cancer pain High doses (greater that 100 mg Morphine Equivalent Units (MEU s) Used with Benzodiazepines, Antidepressants and/or Alcohol

15 Other Contributing Factors Loss of Vision Loss of Hearing Health Provider Time Constraints Use of Non-Prescription Medications, Including Herbal and Alternative Asian Medications

16 Other Contributing Factors Vision Loss Hearing Loss Health Provider Time Constraints Use of Non- Prescription Medications

17 Medical/Social Risk Factors for Opioid Overdose Medical History Sleep apnea 1 Cardiovascular disease 1 COPD 1 Psychiatric disorder(s) 1 Prior substance abuse 1 Veterans 2 Social History Recent release from incarceration or a substance abuse treatment facility/ program 4 Rererences: 1. Bohnert A, et al. JAMA. 2011;305: Seal K, et al. JAMA. 2012;307:

18 Sedatives Valium Xanax Codeine Ambien Effects Slowed Brain Function Lack of Coordination Disorientation Lethal Seizures Shallow Breathing

19 Potential Health Consequences Cognitive Decline Depression Falls Confusion Hip Fractures Benzos and Opioids Excessive Sedation Vision Impairment Attention Impairment Respiratory Depression Constipation & Other Digestive Problems

20 Signs of Possible Misuse/Abuse Solitary or Secretive Use Mixing Alcohol With Medications Frequent Use of Sedatives Chronic & Unsupported Health Complaints Hostility or Depression Memory Loss and Confusion

21 Signs of Possible Abuse Changes in Mood or Attitude Loss of Appetite Drug Paraphernalia Pinpoint or Enlarged Pupils Slurred Speech Lack of Personal Grooming Unexplained Weight Loss or Gain Unusual Temper Outbursts Missing Work/Family Activities

22 Physical Signs Stimulants Opiates

23 What Can YOU Do?

24 Observe and Ask Constantly Thinking About Medication? Fears That They Can t Function Without Meds? Take Action! Loss of Appetite & Low Energy? Unusual Mood Changes?

25 Properly Manage Medications Proper Disposal Safeguard

26 Drug Street Value Drug Dosage Street Value Dilaudid 4 mg Tablet $15 - $20 Fentanyl 1 Patch $10.00 Hydrocodone 1 Tablet $ $5.00 Morphine 10 Tablets $30.00 Oxycodone 80 mg Tablet $ $40.00 OxyContin 80 mg Tablet $ $80.00 Promethazine & Codeine Pint $200 - $300 in L.A. Diazepam 5 mg. Tablet $ $2.00 Vicodin ES Tablet $5.00 Xanax 2 mg. Tablet $ $5.00

27 Always Ask Prescribers?? What Are the Side Effects of This Medication????? Can This Medication Be Addictive? What Other Treatment Options Are There? Always Read & Follow Drug Labels

28 Use Alternative Treatment Options Pain Issues OTC Medications Physical/Water Therapy Braces/Corsets Acupuncture Chiropractic Care Anxiety/Sleep Issues Exercise Meditation Yoga Mindfulness Training Massage

29 Make Sure Caretakers Know Signs of Overdose Convulsions Unconscious Difficulty Breathing Drowsiness Hallucinations Nausea & Vomiting Sweating or Hot Skin Violent, Aggressive, Paranoid, Delusional Behavior Call 911!

30 Keep Naloxone Rescue Kits On Hand

31 Family/Caregiver Tips Document Medication Use and History Have Pharmacy Put Meds in Blister Packs Keep Current List of Meds Readily Available Be on Alert for Missing or Too Many Meds Visit Often and Be Observant Dispose of Outdated and Unused Medications

32 Resources National Institute on Drug Abuse Centers for Disease Control & Prevention National Council on Aging

33 National Coalition Against Prescription Drug Abuse (NCAPDA) Spread the Word One Pill Can Kill

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