A nonprofit publication of the Kentucky Center for Public Service Journalism

Jeff Rubin: Current drug epidemic may be even worst than people think and elderly not immune

Not a day goes by that you can’t pick up a newspaper or listen to the news and not be reminded of the drug epidemic in Kentucky and the surrounding region.

Here, as in many communities across the Commonwealth and our nation, an increasing number of young people, and not so young people, have fallen victim to some sort of substance abuse or addiction. The result of which, accidental or otherwise, has often led to overdose, death, and the ruination of people’s lives.

There are no easy answers to address this epidemic. Those who lived through the late 1960’s and 70’s can attest to that fact. Many experienced both the highs (no pun intended) and lows of the times, losing close friends and loved ones to drugs, alcohol, or both. Today, almost 50 years later, we’re seeing it happen again.

Although this time it may come to us from a different perspective and for a few other reasons. Two things appear certain. For most offenders, treating substance abuse as a crime instead of an illness has not been the answer. Nor can the problem be solved just by saying “no.” What remains to be seen is how much more we’ve learned over the years and what else we may need to know.

The latest statistics rank the U.S. as the number one user and abuser of prescription drugs in the world. We consume approximately 80 percent of the world’s opioids and 99 percent of its hydrocodone according to 2006 National Survey on Drug Use. What may be less well known, according to the Kaiser Foundation, is that Kentucky leads all states in the issuance of prescriptions for these and other drugs per capita in the country.

The reason may surprise you.

According to a 2016 Marshall University Medical Journal Report, there is another drug epidemic in Appalachia barely getting noticed. It is the over prescribing of drugs to the elderly. This has been cited in causing confusion, misdiagnosed dementia, and resulted in inappropriate nursing home placement, falls and associated physical morbidity.

The report further cites Appalachia as “being at a higher risk for such an epidemic given the especially high proportion of elderly in this region.” Kentucky alone, ranks sixth in the nation in the growth of its elderly population.

So what do we know so far? The National Council on Alcoholism and Drug Dependence estimates that approximately 30 percent of adults 65 and over are currently receiving some type of prescription medicine. In addition, according to the Office of Alcoholism and Substance Abuse, 17 percent of people 65 years of age and older abuse their prescription medications.

They also consume more prescribed and over-the-counter medications than any other age group. Add to that the fact that aging makes the body more vulnerable to a drug’s effects and you can see where we’re headed.

Researchers, however, are only just beginning to realize the pervasiveness of abuse among people in this age range. The Substance Abuse and Mental Health Services Administration (SAMHSA) acknowledges as much, saying that despite what’s been reported, the situation remains underestimated, under identified, underdiagnosed, and undertreated.”

The reasons for this are varied. Health care providers tend to overlook substance abuse and misuse among older people, mistaking the symptoms for those of dementia, depression, or other problems common to older adults. In addition, older adults are more likely to hide their substance abuse and less likely to seek professional help.

Many relatives of older individuals with substance use disorders, particularly their adult children, are ashamed of the problem and choose not to address it. The result is thousands of older adults who need treatment and do not receive it.

Substance abuse is difficult to detect in older adults for many reasons. They may no longer work. Some are isolated. Many have legitimate reasons for opioid and other pain relief medications. Because of this and the fact that functional impairment is less obvious in an older adult, physicians tend not to question substance abuse in their older patients.

In speaking about older adults today, we’re not only talking about “granny.” Aging baby boomers are increasingly part of that mix and present additional challenges that may presuppose possible addiction.

According to the Hanley Center, a substance abuse treatment facility for adults, older adults, and baby boomers in Southern Florida, “boomers are at a critical stage in life when stress mounts from age-related health issues, blended families, grief and loss, financial strain and caring for both aging parents and children. It can easily open the door to alcohol addiction, drug abuse or both.”

Boomers also are not prepared to accept aging. “There is prescription medication for whatever ails you. It’s real effective. And much of it is highly addictive.”

Some 4.2 billion prescriptions were written in 2011, according to SAMHSA. That equates to an average of 13 prescriptions per American. The Centers for Disease Control further reports that the most common poisoning treatments in ER are caused by misuse of pain medications.

It’s as common as poisonings due to illicit street drugs. The Center also cites the boomer generation’s “high demand for a quick fix, and the disposable income to afford it; an ambivalence towards substances that date back to the 60’s and 70’s; and a tendency towards being self-centered.”

There is a higher risk of substance abuse in this generation than in others.

There is another situation that often goes under reported when it comes to older adults — the increasing number of elders selling their medications to buy food, pay their electric, or often, pay their rent.

Enlightened magistrates and more treatment centers are a step in the right direction. However, until we are prepared to address the other factors (i.e. lack of workers to treat addicts; adequate employment and training; affordable housing and transportation) contributing to this cycle of addiction, how much of a dent in the problem can we expect to make? In the end, it still comes down to what we have learned and what we’re prepared to do about it.

Jeff Rubin is an advocate and adviser on community and aging issues, having spent over 20 years as a director and facilitator of community service programs at the local, state and national levels. An advocate for “Age-friendly” and “Livable” communities, Mr. Rubin is currently working to advance these initiatives statewide in Kentucky and invites your comments, involvement, and support. He can be reached at Jeffrubin515@gmail.com.

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