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
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
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
- 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
- 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
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
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
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
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