Do you know what the fastest-growing U.S. population is? Here’s a hint: This population is expected to double in the next 20 years. If your answer was adults older than 65 years old, you were correct. What age group do you think uses more psychoactive medications than any other group? That’s right, our seniors, and that’s possibly your Grandma or Grandpa, or even your Mom or Dad who take prescription medication on a daily basis.
According to a recent report by the National Institute on Drug Abuse, as many as 1,800,000 Americans over the age of 65 may be dependent on Medicare-provided prescription drugs. The National Institute on Drug Abuse (NIDA) has released a report that suggests that older adults tend to use prescription medication three times more frequently than the general population and have the poorest compliance rates related to taking medications as directed.
Senior Substance Misuse & Nationwide Health Care Dilemma
Our senior citizens currently are at risk of addiction from regularly using benzodiazepines or a group of central nervous system depressants, such as tranquilizers Xanax, Klonopan, Valium, Ativan and Librum; along with sleeping medications such as Ambien, Halcion, Dalmane and Restoril; muscle relaxants such as Soma, Flexeril and Robaxsin; and alcohol. In addition, opiates and analgesics for pain relief, such as Vicodin, Codiene, Oxycontin, Ultram, Morphine and Duragesics place our seniors at risk.
Causes of Misuse. Our older people may have been misusing or abusing alcohol or drugs for years, or now they may have problems with chronic pain, anxiety and insomnia, or emotionally suffer from the loss of a spouse or other traumatic events, creating feelings of grief or loneliness, possibly complicated by financial or medical problems.
Discontinuation Difficulty. In general, seniors want to feel calmer and sleep better, however, find it difficult to discontinue the use of their drugs and are unaware or ashamed to admit when they are become dependent. What’s worse is that family members tend to ignore their drug problems because they don’t imagine their aging parent or grandparent being hooked on drugs. Maybe it’s depression or they are just getting sick. Could drugs have caused that accident, or was it a simple fall?
Accidents later in life often lead to complications that can become deadly, or seriously hurt someone else if under the influence while driving. In fact, Ambien can cause both retrograde amnesia and antregrade amnesia: seniors will often eat in their sleep, sleepwalk, drive their cars in their sleep and not remember doing it.
Easy Access. It is easy for a senior to get a prescription. All they have to do is mention pain to get the drug they want. Did you know that older adults are prescribed higher doses of some medications for longer periods of time than younger adults, even though there is a decrease in ability to metabolize medication later in life? Unfortunately, it’s easy for seniors to get hooked on drugs from the high numbers of prescriptions they use. Family members may not understand that mood swings, depression, irritability, fatigue, insomnia and the inability to stay focused or involved in a conversation are not just signs of old age, but of misuse or addiction.
Generational Influences. This Baby Boomer generation grew up in a time when hard-core drugs were more widely accepted and were known to use a number of drugs at one time. They believe if a doctor prescribed the drugs, they must be safe, and do not realize that these drugs cause dependency and interact with one another, resulting in confusion. They may also believe they are immune to addiction and experience the misconception that mixing medications or doubling up on their medications are a fast fix to their health problems. It’s also a fast way to an accidental overdose when combining sedatives and opiates with alcohol. Consequently, this fast-fix mentality is leading to a nationwide health-care dilemma.
Have you reached the phase of life where you need to parent your parents? If you have, you are about to face watching your loved ones suffer symptoms of aging, complicated by “solutions” of mixing medications or what we call travelling.
The Slippery Slope of Side Effects to Senility
The slippery slope to senility begins when you notice some common signs and symptoms of aging. Signs and their consequent physical side effects to watch for in your loved ones follow:
- Metabolism Decrease. As seniors mature, their metabolism decreases. Decreases in metabolism cause declines in renal and hepatic functions, which result in more accumulation of the chemicals in their body and for longer periods of time. What this really means is that the drugs attain a higher peak and last longer.
- Dehydration. Seniors often become dehydrated, either from decreasing their fluid intake due to congestive heart failure or renal failure, or even from the use of diuretics. This results in higher peak levels and a longer duration of drug concentration in the blood stream, even though they have not increased their dose of medication.
- Insomnia. Older adults require less sleep and often cat nap during the day, causing a pattern of insomnia and subsequent anxiety. Regarding insomnia, pharmaceutical companies are now directly advertising to consumers. There are frequent ads on television, radio and in magazines for pharmacological sleep aids, such as Ambien or Lunesta. These ads are often accompanied by a coupon for free trial pills, and this is when the free slide to senility starts.
What if a medical provider refuses to give patients prescriptions for free medications? Oftentimes our seniors will see other health care providers, and the dilemma continues. One prescription for Ambien for seven days is just enough time to get a senior dependent on the medication, and if they stop taking it, they will experience rebound insomnia and anxiety.
This situation is similar to seniors being placed on benzodiazepines in the 1980s for anxiety, depression and insomnia, and then the discontinuation of these drugs, which resulted in insomnia and consequently justified their continued use. Stopping these medications cold-turkey could result in seizures and delirium.
- Chronic Pain. As seniors mature, arthritic pains may develop, placing them on opiate analgesics for degenerative back disease and their worn-out hip and knees. In fact, 25 to 45 percent of older adults suffer from chronic pain conditions. However, discontinuation of opiate analgesics is often manifested by a well-documented withdrawal syndrome that includes myalgias and arthralatgies, the same symptoms for which the patients have started to take medication in the first place. The opiates also affect their gastrointestinal track, causing constipation and diaherra when the drug wears off. Now these patients are diagnosed with irritable bowel syndrome when they actually have narcotic bowel syndrome. Relative to constipation, large dosages of opiates can cause such severe constipation that can perforate their bowels.
- Neurological Diseases. Seniors may develop neurological diseases such as Parkinson’s disease, dementia, neuropathy and restless leg syndrome and stroke, which necessitate the need for treatment with psychoactive medication, leading to possible misuse and negative interactions with other medications.
- Multiple Specialists. Seniors are often referred to multiple specialists and placed on additional medications that may completely inhibit the metabolism of their existing medications. This is called polypharmacy which often causes the primary care physician to become unaware of all the medications his or her patient may be receiving.
- Polypharmacy. Polypharmacy can result in mixing medications as a solution to our senior’s mixed problems. Several medications will cause several physical effects. For example, opiates cause constipation; antihistamines cause urinary retention; opiate withdrawal causes diarrhea; and benzodiapenes withdrawal causes anxiety and insomnia; and early alcohol withdrawal does the same thing, causing anxiety, insomnia and tremors. Late alcohol withdrawal can cause tremors, seizures and delirium hallucinations.
Side Effect Sequences
- Senior Secrets. Seniors are often reluctant to give their physicians accurate substance abuse histories, or doctors fail to ask the questions. How much do you drink? How often do you drink? If the patient is experiencing mild alcohol withdrawal, he often goes to the doctor and complains of the symptoms of alcohol withdrawal, such as anxiety and insomnia, and is then prescribed a benzodiapene for the anxiety and insomnia, which will only — over time — make things worse if he continues to drink and use pills.
- Misdiagnosis. Sometimes the side effects of a medication may generate a new diagnosis and further treatment with still more medication. For instance, if you look up in the physician desk reference side effects for Klonopin, Valium and Lorazepan, you will find the most common one is depression. The doctors may misdiagnosis the patient, not realizing the depression is caused by the pill, and will treat the depression as a primary disease and start him with an antidepressant, such as Prozac. If the patient is currently taking codeine for his arthritic pain and he is given Prozac, it will inhibit the breakdown of metabolism of the codeine to its active metabolite, which is morphine, and the patient will no longer get pain relief from the medication.
- Many elderly patients are treated with opiate narcotics that cause constipation when you first take them, and diarrhea when they go off of them. This patient is often diagnosed as having irritable bowel syndrome, when he or she actually has narcotic bowel syndrome.
- Using the over-the-counter antihistamines that are often found in cold and allergy medication can cause urinary retention; subsequently, a patient may be diagnosed as having BHP. These patients may be treated with Proscar or Avadar, which decreases the already heavily declining testosterone levels. Long-term opiate analgesics also have been associated with declining testosterone levels through the inhibition of hypothalamic pituitary axis.
- Episodic ailments, such as cold and allergies will often require over-the-counter medication that can further complicate drug metabolism and impair mental gonadal status.
- Chronic back pain is often treated with opiate analgesics that can lower a patient’s serum testosterone, never allowing the patient to regain his strength or muscle tone to recover from his initial injury.
- Patients are given opiates analgesics for back pain. When the medication wears off, the early withdrawal symptoms are often myalgias and arthralgas; the patient receives a diagnosis of fibromyalgia. Subsequently, he or she is treated with more opiate analgesics at higher and higher doses until he or she becomes physically dependent and cannot discontinue the medication without going through opiate withdrawal syndrome. This feels like a bad flu with muscle aches, joint aches, runny nose and sneezing, abdominal cramps and diaherra, severe anxiety and insomnia. All of this justifies continued use and supports the misdiagnosis.
Drug interactions and mixing medications, as discussed, often mimic medical and psychotic illnesses in the senior citizen. For instance, opiates analgesics and benzos have been associated for a long time with cognitive impairment. Use of opiates and benzos at bedtime can cause sleep disturbances and exasperated sleep apnea, causing a further decline in patient’s cognitive ability.
Usually this process is gradual. So grandma and grandpa are planted on the couch and just thought of to be experiencing simple senility or senile dementia.
Stop Time: Detoxify or Die
Senior drug addiction is something most seniors thought they would not have to overcome. Withdrawal symptoms are devastating, so a safe and slow withdrawal should be the protocol with a board-certified physician trained in addiction medicine who has specific experience with senior addiction issues and medical needs.
Recognizing senior drug addiction is complicated. If you or someone you love is dealing with addiction, know detoxification is better than senility or death. It can be amazing to witness the cognitive improvement a patient will experience once you can assist him through the three to five hard days it takes to detoxify your grandmother or grandfather to get off this medication.
Remember, these patients are better treated by a Board Certified Addiction Medicine Specialist (ABAM) who can treat these patients in an ambulatory setting and in the comfort of their own homes (as opposed to a psychiatric hospital where they do not truly belong). At this time, ABAM is a new specialty board and there are few qualified specialists around. In addition, many HMOs and third-party payers do not recognize the specialty and refer patients to mental health specialists, where they are often diagnosed with bipolar patient and placed on more medications.
Many senior treatment centers are seeing marked improvement in their patients with holistic practices such as yoga, stretching, meditation and relaxation techniques. Using nutritional supplements and exercise also produce exceptional results in recovery from senior drug addiction. After-care works wonders. If you are interested in relaxation and meditation CDs visit: www.mymentalwellcare.com or if you are interested in DNA-based, all-natural nutritional supplements made just for your senior, visit: www.mydnawellcare.com.
For the purpose of continuing education unites, the course objectives for this article are:
- You will be able to identify the three main causes of prescription drug misuse by seniors.
- You will be able to identify the common signs and symptoms of aging and how complications of mixing medications can possibly cause side effects and misdiagnosis.
- You will be able to understand how prescription drugs mimic physical and psychoactive illness by taking too much or too little.
- You will be able to distinguish which medications cause depression and distinguish which medications cause anxiety, insomnia, and withdrawal.