It's Not a Secret You Should Keep

Too many people try to keep it a secret: It is embarrassing to talk about grandma’s or grandpa’s drug addiction, but at least 20% of the population over the age of 65 suffers with drug abuse problems (https://americanaddictioncenters.org/rehab-guide/addiction-statistics/). Researchers suspect underreporting, with the statistic for drug addiction likely being much higher.

Drug addiction in the elderly occurs with prescription drugs as well as self-prescribing over-the-counter (OTC) medications. Some of the common drugs that are abused are: benzodiazepines (benzos), steroids, sleeping pills, and opioids, as well as laxatives, cough syrup, alcohol, and nicotine. (https://www.activebeat.com/your-health/10-addictively-dangerous-yet-legal-drugs/10/). Benzos are commonly prescribed to manage a variety of problems: sleeping disorders, anxiety, loneliness, or depression. Drugs in this category include: Ativan, Xanax, Dalmane, Valium, Klonopin, Restoril – to name a few.
           
There is a serious problem with co-prescribing, especially with benzos and opioids. Older adults tend to have multiple physical and psychological issues, and all too often a pill is offered as a solution. This happens too easily with little monitoring or coordination of care. One doctor may prescribe opioids for pain, and another doctor orders benzos for anxiety or sleep. (https://www.dualdiagnosis.org/drug-addiction/elderly-addicts/). On top of that, the same person might be self-prescribing with OTC medications. There are also many side effects to consider. Some can be dangerous (exacerbating dementia or causing hallucinations); others can even be fatal (inducing seizures, affecting breathing or causing a rise in blood sugar with a diabetic). Yet there are other ways to manage these problems other than taking drugs; some approaches include sleep hygiene, exercise, nutrition, physical therapy, massage and various behavioral cognitive approaches such as meditation, biofeedback, positive thinking, journaling, and therapeutic socialization.
           
Then why are pills used and not these other approaches? Ask yourself: Are you willing to try sleep hygiene methods or do you just want to pop your Restoril?  Are you willing to spend weeks or months in physical therapy to address your pain or do you just pop the opioid? Will you change your diet and activity level to address constipation or do you simply choose a laxative? We are a pill-popping society, and we have become accustomed to expecting immediate results. Although it is considered bad medical practice to not oversee prescriptions more diligently, the system does not allow for the time to manage, educate, and follow-up with patients (https://www.nytimes.com/2018/03/16/health/elderly-drugs-addiction.html).
Providers are constantly confronted with patients who are noncompliant and refuse to make an effort with lifestyle changes.
           
Most of my work as a healthcare consultant involves overmedication with geriatric patients, drug issues and/or drug addiction. It is very time-consuming to address overmedication and reduce the number of drugs when patients are overmedicated. The plan of care must be customized for the individual, especially older adults when there are multiple existing medical conditions. The side effects add to the milieu of problems that the elderly may encounter, such as confusion, balance problems, neurological problems, breathing issues, etc. It is even more challenging with addiction. Weaning off drugs (like opioids and benzos) can take months if not years. A drug such as Klonopin may take as long as five years, and some people might not be able to tolerate the withdrawal, since it can cause psychotic episodes, seizures, confusion, etc (https://americanaddictioncenters.org/withdrawal-timelines-treatments/clonazepam/).
           
Thus it is important to ask about each new prescription: Why are you taking it? How long should you take it? What are the common side effects? Will it interact poorly with your other medications? Is there an alternative to taking a drug? If the side effects are serious or contraindicated for you, is there an alternative drug or something OTC that can be taken? Take the time to educate yourself, ask questions, and follow-up with your physician. It is best not to keep your drug use a secret.