Psychoactive drug abuse in older adults

https://doi.org/10.1016/j.amjopharm.2006.10.002Get rights and content

Abstract

Background:

Misuse and abuse of legal and illegal drugs constitute a growing problem among older adults.

Objective:

This article reviews the prevalence, risks and protective factors, and screening and diagnosis of drug abuse in older adults. Treatment concerns and the consequences of drug problems are examined briefly.

Methods:

MEDLINE and PsychInfo were searched using the terms substance-related disorders, drug-use disorders, abuse, dependency, opioid-related disorders, stimulant-related disorders, cocaine-related disorders, marijuana-related disorders, and withdrawal syndrome. The review included articles published in English between January 1, 1990, and May 31, 2006.

Results:

Despite a wealth of information on the epidemiology and treatment of alcohol abuse in older adults, few comparable data are available on drug abuse in this population. The evidence suggests that although illegal drug use is relatively rare among older adults compared with younger adults and adolescents, there is a growing problem of the misuse and abuse of prescription drugs with abuse potential. It is estimated that up to 11% of older women misuse prescription drugs and that nonmedical use of prescription drugs among all adults aged ≥50 years will increase to 2.7 million by the year 2020. Factors associated with drug abuse in older adults include female sex, social isolation, history of a substance-use or mental health disorder, and medical exposure to prescription drugs with abuse potential. No validated screening or assessment instruments are available for identifying or diagnosing drug abuse in the older population. Special approaches may be necessary when treating substance-use disorders in older adults with multiple comorbidities and/or functional impairment, and the least intensive approaches should be considered first.

Conclusions:

Psychoactive medications with abuse potential are used by at least 1 in 4 older adults, and such use is likely to grow as the population ages. The treatment of disorders of prescription drug use in older adults may involve family and caretakers, and should take into account the unique physical, emotional, and cognitive factors of aging. Further research is needed on the epidemiologic, health services, and treatment aspects of drug abuse in older adults, as well as the development of appropriate screening and diagnostic tools.

References (100)

  • SzwaboP.A.

    Substance abuse in older women

    Clin Geriatr Med.

    (1993)
  • IguchiM.Y. et al.

    Benzodiazepine and sedative use/abuse by methadone maintenance clients

    Drug Alcobol Depend.

    (1993)
  • FinlaysonR.E. et al.

    Prescription drug dependence in the elderly population: Demographic and clinical features of 100 inpatients

  • ZacnyJ. et al.

    College on Problems of Drug Dependence taskforce on prescription opioid non-medical use and abuse: Position statement

    Drug Alcohol Depend.

    (2003)
  • ReidM.C. et al.

    Geriatric substance use disorders

    Med Clin North Am.

    (1997)
  • American Psychiatric Association
  • BeersM.H.

    Explicit criteria for determining potentially inappropriate medication use by the elderly. An update

    Arch Intern Med.

    (1997)
  • BeersM.H. et al.

    Explicit criteria for determining inappropriate medication use in nursing home residents

    Arch Intern Med.

    (1991)
  • BriesacherB. et al.

    Evaluation of nationally-mandated drug use reviews to improve patient safety in nursing homes: A natural experiment

    J Am Geriatr Soc.

    (2005)
  • BlowF.C.

    Substance abuse among older adults treatment protocol (TIP)

    (June 2001)
  • ZhanC. et al.

    Potentially inappropriate medication use in the community-dwelling elderly: Findings from the 1996 Medical Expenditure Panel Survey

    JAMA

    (2001)
  • FinlaysonR.

    Misuse of prescription drugs

    Int J Addict.

    (1995)
  • SalzmanC.

    The APA Task Force report on benzodiazepine dependence, toxicity, and abuse

    Am J Psychiatry.

    (1991)
  • SalzmanC.

    Issues and controversies regarding benzodiazepine use

    NIDA Res Monogr.

    (1993)
  • Finfgeld-ConnettD.L.

    Treatment of substance misuse in older women: Using a brief intervention model

    J Gerontol Nurs.

    (2004)
  • WoodsJ.H. et al.

    Current benzodiazepine issues

    Psychopharmacology (Berl)

    (1995)
  • MenningerJ.A.

    Assessment and treatment of alcoholism and substance-related disorders in the elderly

    Bull Menninger Clin.

    (2002)
  • HanlonJ.T. et al.

    Benzodiazepine use and cognitive function among communitydwelling elderly

    Clin Pharmacol Ther.

    (1998)
  • SheahanS.L. et al.

    Psychoactive medication, alcohol use, and falls among older adults

    J Behav Med.

    (1995)
  • LeipzigR.M. et al.

    Drugs and falls in older people: A systematic review and meta-analysis: I. Psychotropic drugs

    J Am Geriatr Soc.

    (1999)
  • FoutsM. et al.

    Choice of hypnotics in the elderly

    P-T News.

    (1994)
  • CowanC.D.

    Coverage, sample design, and weighting in three federal surveys

    J Drug Issues

    (2001)
  • JoransonD.E. et al.

    Trends in medical use and abuse of opioid analgesics

    JAMA

    (2000)
  • JinksM.J. et al.

    A profile of alcohol and prescription drug abuse in a high-risk community-based elderly population

    DICP

    (1990)
  • SolomonK. et al.

    Alcoholism and prescription drug abuse in the elderly: St. Louis University grand rounds

    J Am Geriatr Soc.

    (1993)
  • PrigersonH.G. et al.

    Older adult patients with both psychiatric and substance abuse disorders: Prevalence and health service use

    Psychiatr Q

    (2001)
  • RiversE. et al.

    Cocaine use in elder patients presenting to an inner-city emergency department

    Acad Emerg Med.

    (2004)
  • McBrideD.C. et al.

    Crack use and correlates of use in a national population of street heroin users

    J Psychoactive Drugs

    (1992)
  • SchonfeldL. et al.

    Cognitive-behavioral treatment of older veterans with substance abuse problems

    J Geriatr Psychiatry Neurol.

    (2000)
  • EdgellR.C. et al.

    Nonalcohol-related use disorders in geropsychiatric patients

    J Geriatr Psychiatry Neurol.

    (2000)
  • FulopG. et al.

    Identification of alcoholism and depression in a geriatric medicine outpatient clinic

    J Am Geriatr Soc.

    (1993)
  • AdamsW.L. et al.

    Epidemiology of problem drinking among elderly people

    Int J Addict.

    (1995)
  • AnthonyJ.C. et al.

    Syndromes of drug abuse and dependence

  • HserY.I. et al.

    A 24-year follow-up of California narcotics addicts

    Arch Gen Psychiatry

    (1993)
  • Substance Abuse and Mental Health Services Administration, Office of Applied Studies

    Treatment Episode Data Set (TEDS): 1994-1999. National Admissions to Substance Abuse Treatment Services. DASIS Series S-14

  • CookA.E.

    Strategies for containing drug costs: Implications for a Medicare benefit

    Health Care Financ Rev.

    (1999)
  • ThomasC.P. et al.

    Growth in prescription drug spending among insured elders

    Health Aff (Mill-wood)

    (2001)
  • WillcoxS.M. et al.

    Inappropriate drug prescribing for the communitydwelling elderly

    JAMA

    (1994)
  • ZuckermanI.

    Inappropriate Medication Use and Transition to Nursing Home Among CommunityDwelling Elders

    (2005)
  • ZuckermanI. et al.

    Inappropriate medication use and transition to nursing home

    • Cited by (227)

    • Substance Use Disorders in the Elderly

      2022, Psychiatric Clinics of North America

    • Quality of life in older adults with opioid use disorder: A scoping review

      2022, Geriatric Nursing

    • Aging with drug use: Theorizing intersectionally with material gerontology and critical drug studies

      2022, Journal of Aging Studies
      Citation Excerpt :

      In response to this discourse, critical drug studies problematize the aging cohort theory by raising questions of inequalities in treatment provision, care needs, and individual life circumstances as important factors that complicate the mere concept of aging (see Dennis, 2021). Studies on habitual illicit drug use have focused on marginalized drug scenes, including gradual aging as a regular member of drug scenes (Anderson & Levy, 2003; Courtwright, Joseph, & Des Jarlais, 2013), commencement of drug use in the later stages of life (Matheson, Hamilton, Wallace, & Liddell, 2019; Taylor & Grossberg, 2012), the use of licit and illicit drugs as part of self-care and pharmacological pain management (Fernandez & Cassagne-Pinel, 2001; Koechl, Unger, & Fischer, 2012; Sznitman, Vulfsons, Meiri, & Weinstein, 2020), and entering marginalized drug scenes after escalating prescription opioid use (Simoni-Wastila & Yang, 2006; Wu & Blazer, 2011). In addition, lack of participation of these cohorts in decision making, policy, and political discourse positions such forms of unconventional lives especially vulnerable to multiple marginalization and underrepresentation.

    • Illicit Drug Use in Older Adults: An Invisible Epidemic?

      2022, Clinics in Geriatric Medicine

    • Abuse/Misuse of Prescription Medications in Older Adults

      2022, Clinics in Geriatric Medicine

    • Accidental substance-related acute toxicity deaths in older adults in 2016 and 2017: a national chart review study

      2024, Health Promotion and Chronic Disease Prevention in Canada
    View all citing articles on Scopus
    View full text
    Copyright © 2006 Published by Elsevier Inc.