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Prescription Drug Nonmedical Use and Abuse in Older Women

Prescription Drug Nonmedical Use and Abuse in Older Women. Drug abuse in the 21 st century: what lies ahead for the baby boomers? Linda Simoni-Wastila, Ph.D. University of Maryland, Baltimore School of Pharmacy National Institute on Drug Abuse Bethesda, Maryland September 16-17, 2004.

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Prescription Drug Nonmedical Use and Abuse in Older Women

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  1. Prescription Drug Nonmedical Use and Abuse in Older Women Drug abuse in the 21st century: what lies ahead for the baby boomers? Linda Simoni-Wastila, Ph.D. University of Maryland, Baltimore School of Pharmacy National Institute on Drug Abuse Bethesda, Maryland September 16-17, 2004

  2. Introduction • Purpose: To review the evidence of illicit drug use among aging women • Focus: prescription drug misuse and abuse • The Hidden Problem: • Under-recognized • Under-screened • Under-treated

  3. Today’s Discussion • Context: Older women and risk • Substance use in older adults • Prescription drugs with potential for misuse and abuse • Continuum and extent of prescription drug use  abuse • Risk and protective factors • Gaps in knowledge • Conclusions - Implications for research

  4. Older Women and Risk • Mature women may be particularly at risk for Rx misuse and abuse • Greater likelihood for exposure • Biology: body size; hormones; body fat; metabolic differences • Propensity for care seeking  propensity for treatment • Consequences of Rx misuse and abuse • Cognitive impairment and increased sedation  falls/injury; depression; suicide; interactions w/ alcohol and other drugs

  5. Substance Abuse in Older Adults • Nearly 2.8 M people aged 50 and older – or 3.5% – have used 1 or more illicit substances in the past year • Of these past-year users, 16.0% (446,844) may have illicit drug abuse or dependence problems • 262,032 are male (58.6%) • 184,812 are female (41.4%) • Two substances of choice: • Prescription drugs • Marijuana (2002 NSDUH)

  6. Substance Use - Type by Gender – 50 and Older (2002 NSDUH)

  7. Substance Use in Older Adults • Alcohol use is also high in 50+ population – 2.3 Million, or 14.1%, meet criteria for alcohol abuse/dependency • 1.84 Million are male (80.0%) • 459,000 are female (20.0%)(2002 NSDUH)

  8. Rx Drugs With Potential for Misuse and Abuse • Interest is only on those Rx drugs with abuse potential, a la CSA • Opioid analgesics (morphine, Dilaudid, OxyContin, Darvon, Percocet) • CNS stimulants (Ritalin, amphetamine) • Minor tranquilizers (Valium, Ativan, Librium) • Sedative-hypnotics (Seconal, amobarbital, Noctec)

  9. Continuum of Rx Use in Older Adults • Proper Use • Misuse(by patient and/or provider) • Abuse • Dependence (APA, DSM-IV, 1994)

  10. Prescription Drug Misuse • Any Rx drug can be “misused” • Misuse = “Non-medical use” = Any use that is outside of medically prescribed regimen, eg: • Non-compliance • Taking different dose • Sharing • Obtaining from non-medical source • Taking for psychoactive effects • Use with alcohol

  11. Prescription Drug Abuse • Abuse = use resulting in • Decline in work, school, or home performance • Legal problems • Use in risky situations • Continued use despite social/personal consequences (APA, DSM-IV, 1994)

  12. Prescription Drug Dependency • Dependency = use resulting in • Tolerance • Withdrawal sx • Decline in normal activities • Unsuccessful attempts to cut down or control use • Use for longer period or larger amounts than intended • Use consumes lot of time to acquire and/or recover from effects • Continued use despite knowledge that it caused physical and/or psychological problems (APA, DSM-IV, 1994)

  13. Extent of the Problem: Medical Exposure • General US population1 • Women = 20.0% • Men = 12.5% • Among elders aged 65 and older, 21.7%, or 7.22M, receive at least 1 abusable Rx annually2 • Women = 24.6% • Men = 17.7% 1Simoni-Wastila et al, Sub Use and Misuse, 2004 2Simoni-Wastila et al, under review, 2004

  14. Medical Exposure to Abusable Rx Drugs by Gender and Age Simoni-Wastila et al, under review, 2004

  15. Extent of the Problem: Misuse • General population: 4.0%, or 8.27M, misuse Rx drugs annually • Opioids – 2.4% (4.84M) • Tranquilizers – 1.5% (2.98M) • Stimulants – 1.1% (2.35M) • Sedatives – 0.9% (1.84M) • Estimates of elder Rx misuse ranges from 0.6% of elders (300k) to >5.0% (2.8 M) Simoni-Wastila and Strickler, Am J Pub Health 2004

  16. Extent of the Problem: Abuse and Dependency • General population: 0.6-0.9%, or 1.3-2.1M individuals may be abusing Rx drugs • Opioids: 0.2-0.6% (1.5M) • Tranquilizers: 0.2% (509k) • Stimulants: 0.2% (437k) • Sedatives: 0.1% (155k) • The elderly: ? Simoni-Wastila and Strickler, Am J Pub Health; 2002 NSDUH, SAMHSA

  17. Risk Factors for Prescription Drug Misuse and Abuse - General Population • Most consistent correlates in the general population for Rx misuse and addiction • Female gender • Young age • Older age • White race • High SES • Poor physical health • Mental illness

  18. Role of Gender in Rx Drug Misuse and Abuse • Females 1.43X more likely than males to misuse any Rx drug (95% CI 1.19-1.69) • Driven by opioid analgesics (OR 1.41) and minor tranquilizers (OR 1.54) • Stat significance disappears when do not control for daily ETOH and illicit drug use Simoni-Wastila et al, Sub Use Misuse 2004 • Females 1.49X more likely than males to have abuse/dependency on Rx drugs (95% CI 1.06-2.08) • Driven by opioid analgesics (OR 2.00) and minor tranquilizers (2.00) Simoni-Wastila and Strickler, AJPH 2004 • Gender NOT statistically significant predictor of stimulant or sedative-hypnotic misuse or abuse/dependency

  19. Risk Factors for Rx Misuse and Abuse in Older Women • Among older women, possible risk factors include: • Social isolation • Lower SES and education • Poor health • Current or history of behavioral health problems • Loss of economic and social support • HC system factors

  20. Social Isolation and Health Status Simoni-Wastila et al, under review, 2004

  21. Baby Boomers “Come of Age” • Current Problem: lack of knowledge of substance use in elders • Substance use in elders will be a huge problem in < 20 years b/c boomers: • Accepting of alcohol and drug use • Used more in youth • Use more NOW • Use more psychoactive Rx drugs now • 3-4x more emotional disorders

  22. Adults 50 and Older in Population and Needing Treatment (in millions) Gfroerer et al., SAMHSA, 2003

  23. Research Gaps • Data inadequacies • Lack of data sources • Small number of elders • Cross-sectional data • Lack of medical information • Definitional issues of misuse and abuse in elders

  24. Diagnosis and Treatment Gaps • No screening/assessment tools specific to Rx drugs • Dx and tx strategies not age- or gender-sensitive • Efficacy of treatment modalities not tested in elders, women • Absence of clinical guidelines • Problems in organization and financing of health care

  25. Conclusions • We need to better understand elder Rx misuse and abuse • Prevalence • Diagnosis • Prevention • Treatment • Older women are at special risk for Rx misuse and abuse • Gender- and age- specific risk and protective factors

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