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More older adults developing prescription drug dependency

Whether accurate or not, most people have a mental picture of what a drug abuser might look like —that image is rarely their grandma or grandpa.

According to research by the National Institute on Drug Abuse (NIDA), the percentage of Americans age 50 to 59 who reported abusing illicit or prescription drugs doubled from 2002 to 2009 from 2.7 percent to 6.2 percent.

Dr. David Lott, medical director of the Addiction Treatment Program at Linden Oaks at Edward in Naperville, says they see older adults with prescription drug addictions often.

"I want to emphasize that this is a growing problem," Lott says of prescription drug abuse among all ages. "It's alarming and staggering how much it's going up."

The problem, according to projections by NIDA, is expected to grow as the number of people 50 and older increases.

"It is our experience and experience around the country and epidemiologic studies show there will be a significant increase in the next one to two decades," Lott says.

How did this happen?

Dr. Martin Gorbien, director of Geriatrics and Palliative Medicine at Rush University Medical Center, points out that a prescription for a narcotic or opioid pain medication does not make someone a drug abuser.

"Is it OK to take narcotic drug medications? Yes it is. It's not just acceptable, for some it is necessary," he explains. There are any number of conditions that cause severe and chronic pain that may require the help of narcotics or for some it is a short-term need following surgery.

But for more and more older adults the relief and even euphoria offered by the medication can be alluring.

While narcotic pain medications can have positive effects for someone in pain, they are depressants and can cause depression, Gorbien says.

Older adults are more likely to be on more than one prescription medication as well.

When a person has a history of long standing use of narcotic pain medication a physician should always dig deeper, Gorbien suggests.

"Often there's more to the story," he says.

Lott says dynamics associated with aging, such as retirement or an empty nest, can contribute to the problem. Additional time to focus on pain or depression coupled with a lack of supervision, create a dangerous situation.

Is there a problem?

Drug abuse and the behaviors associated with it, Gorbien says, have commonalities across all age groups.

"The difference is we are less suspicious of older people," he says.

There are signs to look for, Gorbien says, such as a change in the person's character or that they are always looking for their medication. Other indicators can be fatigue, memory loss or the medication tolerance.

"Often the problem is very insidious," Gorbien says. "(These narcotics) have a dulling effect. They're not necessarily drunk or high. They may think other people around them can't see anything."

If someone doesn't seem like themselves it's worth the time to find out what might be going on.

From a physician's perspective it takes time and a trusting relationship with the patient to determine there is a problem, explains Gorbien. In the beginning of a doctor/patient relationship you never question someone's pain, he says.

"If someone says they are in pain, they are," Gorbien says.

Doctors look at the situation — are they post surgery and their pain may be short term? Or do they have a condition such as diabetic neuropathy and the pain is ongoing?

Doctors, Gorbien says, should look for patterns and responses to suggesting it's time to take a break from a medication.

He says doctors perform tests to look for causes of physical pain or for signs that the person is self-medicating because of an underlying problem such as depression.

"It's acceptable to say 'my back hurts,'  but not so acceptable to say 'I'm sad.'  This is not a generation comfortable with that," Gorbien says.

Unfortunately, he adds, doctors don't always take the time or have the tools to fetter out an addiction or depression. Before prescribing, many doctors check with the patient's pharmacy to see if other doctors are prescribing for the same patient, but addicted patients can be clever using multiple pharmacies and multiple doctors and there is not a system in place to detect duplicate prescriptions.

Getting help

It isn't easy to approach anyone with the possibility of a drug dependency — especially if the person has a doctor's prescription to use medication.

It does need to be handled with care and not ignored, Gorbien says. Dismissing the problem because the person does experience pain or is older is not helpful.

"You might say 'what's the big deal if she's taking three or four pain pills a day?' It's like saying 'she's 80 years old are we going to take away her two cocktails a night?'" Gorbien says. "Well, if she's falling or forgetting or failing… ."

If someone suspects an older adult may have a prescription drug dependency it should be treated no differently than if they had a problem with alcohol or heroin and loved ones should be asking questions.

Loved ones can turn to treatment centers, doctors and even public agencies for tips on how to approach the subject or stage an intervention. Many older adults are not comfortable sharing about difficult topics or don't want to air their dirty laundry so loved ones can stress that there are ways to handle the issue discretely.

Once a need for help is established a doctor can be a starting place or a center or hospital program dedicated to addiction recovery.

Lott says they see a steady flow of older adults coming in to Linden Oaks. While most are in their 60s and 70s there are some who are into their 80s as well.

It is a mix of those who have had substance abuse problems in their past as well as those experiencing it for the first time, he says.

The patients who are new to addiction are often prescription drug abusers.

"They are at an age where they have more health issues, more pain, surgery, they have more exposure (to narcotics)," Lott says.

So what does treatment look like? It varies for each person and each situation, he explains. While some facilities do have programs specifically geared toward older adults, Linden Oaks typically treats patients in similar age groups when possible.

As with many medical-related issues for older adults finances can be a challenge. Medicaid does not cover recovery programs and many insurance programs don't cover them either.

"We work very hard to be a liaison with insurance companies and to find out what is covered as much as we can," Lott  says.

Additional options include programs like Narcotics Anonymous (NA), which are widely available, and there are sometimes resources through employers.

At Linden Oaks they offer a 24/7 help line (630-305-5500) and specialists are available to answer questions and get more details

"They can say 'This is what we think we can do' but eventually we want to see them and decide what they need," Lott says.

For some, group counseling might be fine. F­or older adults with physical issues or hearing loss a one-on-one program may be more effective. Lott says often they will need to determine a path for detoxification whether that's monitored through an outpatient program or through admission in a hospital.
