18 What Are Medication Misuse, Abuse and Dependence?

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Funded by SAMHSA in collaboration with AoA

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WelcomePrescription Medication Misuse and Abuse Webinar

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Co-ScCo-Scientific Directors Stephen Bartels, MD, MS Frederic Blow, PhDWelcome and Introductions

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Timeframe September 2011 – March 2013 10 Webinars 14 Fact Sheets/Issue Briefs TCE Grantee Meeting January 9 - 10, 2012 Policy Academy Regional (PAR) Meetings Five meetings across the U.S. beginning in March 2012 Older Americans Behavioral Health TAC Overview

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For TCE Grantees Prescription Medication Misuse/Abuse – Today Suicide Prevention – February 15, 2012 Alcohol Misuse/Abuse Partnerships: Key to Success Sustainability & Financing For Aging Services Network Depression, Anxiety, Suicide Prevention Prescription Med & Alcohol Misuse Reaching & Engaging Older Adults Sustainability & Financing Family Caregiver as Clients & Partners in Care All webinars will be archived and available on SAMHSA, AoA, and NCOA’s websites Webinar Series Overview

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To understand why psychoactive medication misuse/abuse is a growing and significant problem among older adults To identify instruments that can be used for prescreening and screening older adults for medication misuse and abuse To apply the evidence-based program—Screening and Brief Intervention and Referral to Treatment (SBIRT)—to psychoactive medication misuse/abuse Webinar Learning Objectives

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To briefly describe the FL BRITE program as an example of successful implementation of SBIRT for medication misuse/abuse among older adults To develop strategies to embed SBIRT screening into existing service delivery systems To discuss the role of the physician and pharmacist Webinar Learning Objectives

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Co-ScStephen Bartels, MD, MS Kathleen Cameron, RPh, MPHOverview of the Problem

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The Demographic Imperative13 percent of U.S. population age 65+; expected to increase up to 20 percent by 2030 78 million ‘Baby Boomers’ (born from 1946-1964) in “Census 2000” Second wave ‘Baby Boomers’ (now aged 35-44) contains 45 million Individuals aged 85 and older are the fastest growing segment of the population.www.census.gov

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Substance Abuse and Older Adults#1 Most common addiction: Nicotine (~18-22%) #2 Alcohol (~2-18%) #3 Psychoactive Prescription Drugs (~2-4%) #4 Other Illegal Drugs (marijuana, cocaine, narcotics) (<1%)

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Polling QuestionApproximately what percentage of older adults use psychoactive medications with abuse potential? 10% 25% 50% 75%

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At least one in four older adults use psychoactive medications with abuse potential (Simoni-Wastila, Yang, 2006)  11% of women > 60 years old misuse prescription medication (Simoni-Wastila, Yang, 2006) 18-41% of older adults are affected by medication misuse (Office of Applied Studies, SAMHSA, 2004) Prevalence of Use and Misuse of Psychoactive Medications

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By 2020, non-medical use of psychoactive prescription drugs among adults aged >=50 years will increase from 1.2% (911,000) to 2.4% (2.7 million) (Colliver et al, 2006) In 2004, there were an estimated 115,803 emergency department (ED) visits involving medication misuse and abuse by adults aged 50 or older In 2008, there were 256,097 such visits, representing an increase of 121.1 percent (SAMHSA, DAWN Report, 2010) Growing Problem

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Polling QuestionWhat type of psychoactive medication is associated with the most emergency department visits related to prescription medication misuse among older adults? Antidepressants Sedatives/tranquilizers Pain relievers Stimulants

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One fifth of ED visits involving prescription medication misuse/abuse among older adults were made by persons aged 70 or older Medications involved in ED visits made by older adults: Pain relievers (43.5%) Medications for anxiety or insomnia (31.8%) Antidepressants (8.6%)  What happened after ED visit? 52.3% were treated and released 37.5% were admitted to the hospital Emergency Department (ED) Use Related to Misuse/Abuse(SAMHSA, DAWN Report, 2010)

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Adverse Drug Events (ADEs)

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What Are Medication Misuse, Abuse and Dependence? (Source: DSM IV)

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What Are Medication Misuse, Abuse and Dependence? (Source: DSM IV)

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Polling Question What are some key risk factors for medication misuse and abuse among older adults?

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Who is at greatest risk for medication misuse/abuse?Factors associated with prescription drug misuse/abuse in older adults Female gender Social isolation History of a substance abuse History of or mental health disorder – older adults with prescription drug dependence are more likely than younger adults to have a dual diagnosis Medical exposure to prescription meds with abuse potential (Source: Simoni-Wastila, Yang, 2006)

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Prescription Drug Abuse in Older AdultsReduced ability to absorb & metabolize meds with age Increased chance of toxicity or adverse effects Med-related delirium or dementia wrongly labeled as Alzheimer’s disease

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“Symptoms” of Medication-Related Problems Due to Misuse/AbuseConfusion Depression Delirium Insomnia Parkinson’s-like symptoms Incontinence Weakness or lethargy Loss of appetite Falls Changes in speech

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Signs of Drug Misuse/AbuseLoss of motivation Memory loss Family or marital discord New difficulty with activities of daily living (ADL) Difficulty sleeping Drug seeking behavior Doctor shopping

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Identifying High Risk Older AdultsUse of certain medications (e.g., warfarin, digoxin, diurectics, psychoactive meds, analgesics) 4 or more medications Certain chronic conditions (e.g., diabetes) Evidence of medication misuse Chronic alcohol use

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Medications to Target in Substance Abuse InterventionsCentral Nervous System (CNS) Depressants – Antianxiety medications, tranquilizers, sedatives and hynotics Benzodiazepines Barbiturates Opioids and Morphine Derivatives— Narcotic analgesics/pain relievers Codeine, hydrocodone, oxycodone, morphine, fentanyl, meperidine

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Last Updated: 8th March 2018