Usage of Prescription Drugs by Adults and Older Adults
The 2007 National Survey on Drug Use & Health (NSDUH) indicates slightly more than four percent of adults (4.9 percent in 2006) engaged in PDM, representing an estimated total of 9,180,000 adults across the US in 2006. Although both the youth and young adult groups reported higher percentages of PDM, the total number of adults involved is larger than youth and young adults combined (7,302,000 youth and young adults), due mainly to the large number of people included in the 26-and-older age group. Although the relative percentage of PDM among adults is lowest of the three age groups (8.6 percent of youth and 15.6 percent of young adults), PDM is a significant adult drug problem affecting millions of adults in the US.
Within California, the 2006 NSDUH data found that 3.7 percent or about 812,000 adults were involved in the misuse of prescription drugs during the same annual time period. As with National data on use, the primary prescription drug used by California adults involves painkillers. Misuse of tranquilizers, stimulants and sedatives are proportionally lower. Overall, while the proportion of PDM was lower among adults, the total number of people involved is higher because of the large size of the NSDUH adult group.
Currently, the misuse of prescription drugs accounts for a relatively small number of admissions to public supported treatment facilities in California. Five other categories of drugs, including alcohol, are more frequently the primary reasons for individuals seeking treatment services. For too many, not dealing with their nonmedical use of prescription drugs results in tragic and deadly outcomes. Over the past three years in California, over 1,200 individuals per year (or three each day) die from the toxic effects of drugs (1,184, 1,252 and 1,333).
Issues for Older Adults
PDM is a growing problem for the baby boom cohort whose lifetime rates of illicit drug use are higher than those of older cohorts and are now developing many chronic age-related conditions. Alcohol and prescription drug misuse may affect as many as 17 percent of older adults according to SAMHSA reports. In addition, proper treatment of many medical conditions requires the use of medications that can be misused, abused, and/or lead to dependency. As a result, concerns have been raised about increasing substance abuse among older adults (age 60 and older) and the need for substance abuse treatment.
Elderly individuals are particularly vulnerable to PDM. While individuals 65 years old and older represent approximately 13 percent of the population in the United States, they account for one third of all medications prescribed. Some factors to consider include:
- The elderly are more likely to be prescribed several different medications at once and for a prolonged duration of time.
- Screening for drug abuse in the elderly can be difficult. Most elderly will deny symptoms and usage.
- 83 percent of people age 60 and over take prescription drugs.
- Elderly women take an average of five prescription drugs at a time, for longer periods of time than men.
Prescription drug abuse is present in 12 percent to 15 percent of elderly individuals who seek medical attention. Health problems related to substance abuse cost Medicare $233 million dollars per year in 1989, and probably account for much larger expenditures today. Although 60 percent of substance abuse is recognized in patients under the age of 60, only 37 percent is recognized in patients over the age of 60.31
In general, prescription drug abuse in older adults begins with misuse due to inappropriate prescribing or lack of patient compliance with medication regimens. Continued misuse may progress to abuse and dependence. Older adults may be more vulnerable to prescription drug abuse because of age-related physiological changes that may influence the metabolism and response to prescription drugs, greater likelihood of having undiagnosed psychiatric and medical comorbidities, and difficulties in compliance with complex multiple drug regimens that may increase the likelihood of drug interactions. For example, benzodiazepines are frequently prescribed to older adults, but age-related changes in drug metabolism, interactions with other prescription and OTC medications, and use of alcohol may lead to increased use/ misuse/abuse and adverse consequences such as impaired functional capacity and cognition.
Considerable attention has been paid in recent years to the problem of older adults misusing their prescription medications. Although some of this clearly involves the deliberate misuse of prescription drugs for nonmedical reasons, it is also very likely that older adults experience a great deal of "unintentional" PDM, either by taking the wrong amounts of prescribed medications, or by inadvertently confusing one medication with another, or by mixing medications with vitamin supplements or alcohol, or by substituting a less costly medication for a more expensive one with the chance expectation that it might have the same beneficial medical effect. There is some confusion about the causes of misuse of prescription medication among older adults that goes beyond the scope of this study. However, it is apparent from the NSDUH data that hundreds of thousands of older adults misuse prescription drugs for nonmedical reasons nationwide, and that tens of thousands probably do so in California in any given year.