Abuse and Misuse of Medications in the Elderly A. Prescription and OTC Drug Use
B. Minimizing OTC Misuse/Abuse
C. Future Increase?
I.A Modern-Day Disease - INTRODUCTION Prescription drug abuse is a modern-day disease. In an estimate, over six million American have abused prescription medication. However, there is no completely accurate way to measure prescription drug abuse. The number is not that important, but the fact that many people suffer from addiction to prescription drugs is. Torn apart families, destroyed lives, and deaths are some of the negative effects. Some people think that by focusing on prescription drug abuse, we may scare physicians away from reasonably prescribing helpful medications for patients who really need them (Prescription Drug Abuse, 2002).
II. Pain Medications and Addiction
What is the most common reason people go to the doctor? It is pain. Doctors all over the country wonder how they can prescribe accurate medications so the patient is relieved of pain without becoming addicted to that medication. Many doctors under-prescribe powerful painkillers. They overestimate the potential for patients becoming addicted to painkillers such as morphine and codeine. When doctors limit pain medication, thousands of patients suffer needlessly. Doctors' fear that patients will become addicted to pain medication is known as "opiophobia".
"Opiates, including morphine and codeine, and synthetic opioids, such as Demerol and fentanyl, work by mimicking the endogenous opioid peptides, pain- relieving chemicals produced in the body. These peptides bind chemically to opiate receptors, activating pain-relieving systems in the brain and spinal cord. But opioids can cause undesirable side-effects such as nausea, sedation, confusion, and constipation. With prolonged use of opiates and opioids, individuals become tolerant to the drugs, required larger doses, and can become physically dependent on the drugs" (Bellenir, 2000, P. 120).
III. Prescription Drug Abuse (Reference to Lader)
Addiction to prescribed drugs or to those used in treatment is term iatrogenic. The most common drugs susceptible to addiction are those prescribed for psychological problems. Some act on the mind, having low potential for abuse and dependence. Examples are anti-psychotics, anti-depressants, and lithium salts. Other, like barbiturates and amphetamines, have high potential.
"Tolerance and physical dependence can rapidly occur during therapy - and abrupt withdrawal can result in a severe and life-threatening withdrawal state. Large quantities can be injected into a vein or muscle, often producing abscess formation. Other users take large amounts by mouth, on a binge or spree bais. Some users become permanently intoxicated and totally engrossed in maintaining their supply. Withdrawal can be hazardous, with the risk of seizures or psychotic features, when discontinuing chronic usage of 500 milligrams a day or more" (Lader, 1995, P. 844).
B. Benzodiazepines The benzodiazepines replaced the barbiturates because they appeared to be at least as effective, with few side effects, and a less chance of causing addiction. Benzodiazepines have been abused all around the world during different periods of time. They have been used as the main drug of abuse as well as part of a polydrug-abuse pattern. Alcohol abusers also abuse benzodiazepines. When combined, the drug interaction that occurs is particularly powerful. Most benzodiazepine abuse is with legally obtained drugs. About half of benzodiazepine abusers were introduced to the drug through medical context.
Amphetamines raise mood, increase the sense of energy and alertness, and decrease appetite. A few users react oppositely, becoming drowsy, anxious, and irritable. Some people feel the need to stay awake for long periods of time. Medical interns and long-distance truck drivers sometimes use amphetamines for this cause. The effects wear off after a couple of hours, leaving the abuser exhausted, drowsy, and depressed.
Methamphetamine can be synthesized easily. Intravenous use of methamphetamine is usual and tolerance occurs quickly. Larger and more frequent doses become required to achieve the desired effect. A very negative outcome could be that a paranoid type of psychosis would develop. This would cause a loss of reality and delusions of persecution.
D. Appetite Suppressants
Most appetite suppressants are stimulants. Patters of use and abuse vary greatly. A therapeutic dose may result in chronic daily ingestion, while use of larger quantities may cause an individual to binge or spree. The more amphetamine, like the appetite suppressant, the greater the chance is of abuse. Stopping the use of appetite suppressants can be difficult for abusers because of withdrawal symptoms like tiredness, discomfort, or depression. These problems have caused many doctors to stop prescribing them.
IV. Common Abused Prescription Drugs
Prescription drugs help patients manage pain, restore balance, control sleep disorders, and fight obesity. However, when abused they can be incredibly dangerous. Three commonly abused prescription drugs are opioids, depressants, and stimulants.
Opioids, including morphine and codeine, as well as other related drugs such as Vicodin and Demerol are generally given to relieve pain. When taken correctly, opioids can be used to manage pain without unpleasant side effects. Chronic use can result in tolerance. Long-term use can also be dependence and addiction. Withdrawal can occur when someone stops using the drugs. Symptoms may include restlessness, muscle and bone pain, insomnia, diarrhea, and vomiting. Those addicted to opioids are more likely to overdose, which could be fatal.
Barbiturates are some of the mostly commonly prescribed CNS depressants. Some like Mebaral and Nembutal are prescribed to treat anxiety, tension, and sleep disorders. Benzodiazepines like Valium and Xanax are prescribed to treat anxiety, acute stress reactions, and panic attacks. Other benzodiazepines like Halcion and ProSom are used for short-term treatment of sleep disorders. All of these depressants produce a beneficial drowsy or calming effect. Use over a long period of time will result in tolerance. Larger doses will then be needed to attain the original effects. Continued use can also lead to physical dependence and withdrawal. Both barbiturates and benzodiazepines have the chance of being abused and should be used only as directed. As with opioids, overdose can be fatal.
Stimulants enhance brain activity, increase alertness and energy, raise blood pressure, and elevate heart rate and respiration. Stimulants like Ritalin and Dexedrine are prescribed to treat narcolepsy, attention-deficit/hyperactivity disorder, and depression. They may also be used for short-term weight management. Some become addicted to the sense of comfort and improved energy that stimulants produce. However, using high doses frequently over a short time can lead to feelings of hostility or paranoia. Very high body temperatures and an irregular heartbeat can also result from an uptake of stimulants. (Petracca, 2002).
Every year millions of prescription pills enter the illicit drug market. In 1993 prescription drugs were sold for about $25 billion in the illegal drug market. Enormous amounts of people in the U.S. use prescription drugs for the wrong reasons. Nationally, the federal government spends about $13.5 billion on the drug war, but only $70 million goes to investigate prescription drug offenses.
By having an accurate dosage, a high purity level, and a lower price, prescription pills have established a place next to regular street drugs. Medical offices and pharmacies help supply a large amount of these drugs. "Doctor shoppers," lie to doctors by claiming to have injuries or ailments to get prescriptions. A woman by the name of Vicki J. Renalso tricked 42 doctors and 26 pharmacies into giving her codeine tablets during an eight-month period.
There is no glory in catching doctors and pharmaceutical companies involved in this illegal drug trafficking. Media coverage is small due to the fact there are no guns and no bundles of case for the world to see. Sometimes action is taken, but the results are usually small. Very few doctors, dentists, and pharmacists are prosecuted annually for prescription fraud.
Doctors, even when convicted, have very small sentences compared to those caught selling cocaine or marijuana. A certain Dr. eric C. Tucker issued more than 7,000 questionable prescriptions for the stimulant Preludin and other 7,600 for Dilaudid. More Dilaudid, also known as "drugstore heroin," was distributed from Tucker's office per year than from the LAC-USC Medical Center, the West Coast's largest public hospital. Tucker pleaded guilty and lost his medical license, but only served eight days in jail. On the other hand, Daniel G. Siemianowski was prosecuted in Los Angeles at about the same time as Tucker. He was arrested with four ounces of crack and was sentenced to a year in prison.
Don Simpson, a Hollywood producer, died from a mix of cocaine and 20 prescription drugs. Since then, prescription abuse has received more attention in Los Angeles. "Abuse of prescription drugs is a serious problem in our society, but nobody pay attention until somebody big and powerful like Don Simpson drops dead," said Steve Simmons, the California Medical Board's senior investigator on the case.
In a research of an estimated 10 prescription frauds, one doctor received a short sentence; the other nice pleased guilty and were put on probation. Part of the problem is that medical practitioners are usually charged under laws carrying low prison penalties. The laws are written allowing health car professionals to escape serious drug trafficking charges, no matter how fraudulent. About 75% of physicians convicted of prescription drug crimes got to keep their license. Medical and pharmacy board investigators are seeking more court orders to suspend licenses after someone is arrested (Bellenir, 2000, P. 19, 20, 21).
VI. Abuse and Misuse of Medications in the Elderly
A. Prescription and OTC Drug Use
The elderly use prescription drugs about three times as often as the general population, and they use over-the-counter (OTC) medications even more extensively.
Medication misuse occurs when patients consume medications in a way that deviates from the recommended prescribed dose. Misuse may include overuse as well as underuse. A patient can abuse a drug intentionally or misuse a drug unintentionally.
B. Minimizing OTC Misuse/Abuse
There are many reasons why the elderly misuse prescription or OTC medications. Medication misuse can occur when someone starts losing sight, hearing, and strength. As someone gets older, they may become forgetful and take their medication more than once. Some might not be able to read the directions. Other, when told the amount they should take, just don't hear very well and then have to guess. Finally, an older person who is weak or has arthritis may overuse the medication to feel better.
The elderly should avoid polypharmacy. When there is lack of communication, it is possible that the patience will get medications from more than one source. It has been recommended that the elderly get their medication from only one pharmacy.
C. Future Increase?
The greater exposure to medications by the elderly, along with age-related changed and problems, puts them at a greater risk of medication misuse. As we begin to love longer, there may be an increased use and abuse/misuse of prescription and OTC medications (Patterson, 1999).
SUMMARY Prescription drug abuse is a modern-day disease that affects millions of Americans. Sometimes people become addicted to painkillers and then start abusing them. Some even lie to their doctors to get more medication. A few of the drugs being abused are barbiturates, benzodiazepines, amphetamines, and appetite suppressants. If people are not careful, overdose of these drugs could kill them.
Even though there is little coverage of prescription drug abuse, it is continually happening. It can and does affect many in various ways. Sometimes doctors, dentists, or pharmacists are involved in illegal drug trafficking. However, if caught they receive small sentences. The elderly are also involved in medication misuse. When they take the medicine, they don't always take the right amount at the right time due to loss of sight, hearing, and strength. As we begin to live longer, we need to be careful so we don't abuse or misuse prescription medication.