Hundreds of thousands of the nation's seniors are misusing prescription drugs, including narcotic painkillers, anxiety medications and other pharmaceuticals, for everything from joint pain to depression.
When Betty Van Amburgh began treatment last year for her addiction to prescription painkillers, she was told to bring along all her medication.
She arrived with a shopping bag — boxes of transdermal patches laced with fentanyl, a narcotic up to 100 times stronger than morphine; bottles of hydrocodone, another powerful opioid; packages of Xanax, an addictive sedative.
"They kept saying, 'How did you get so much?' " recalls Van Amburgh, 68, who'd been on an increasingly potent mix of medications since a series of back surgeries 20 years earlier. "The doctors just kept prescribing them. It was always, 'Do you have pain? Let me give you a prescription. ...' But I got addicted. I was a zombie."
Hundreds of thousands of the nation's seniors are misusing prescription drugs, spurred by a medical community that often is quick to offer narcotic painkillers, anxiety medications and other pharmaceuticals for everything from joint pain to depression. And despite a push by public health officials to slash dispensing rates, doctors are prescribing the highly addictive drugs at record levels.
By many measures — rising overdose deaths, a spike in emergency room visits, increasing admissions to addiction treatment programs — the toll on the senior community is enormous, a USA TODAY review of government data finds.
"There's this growing group of seniors, they have pain, they have anxiety … and a lot of (doctors) have one thing in their tool box — a prescription pad," says Mel Pohl, medical director at the Las Vegas Recovery Center, which treats seniors for pain and drug dependence. "The doctor wants to make their life better, so they start on the meds."
Over time, patients build up a tolerance or suffer more pain and they ask for more medication, Pohl says. "And without anyone necessarily realizing, it begins a downward spiral with horrible consequences."
Older brains and bodies are prone to drug complications, from falls and respiratory failure to cognitive problems and dementia. Yet studies project the number of seniors misusing pharmaceuticals will continue to grow, fueled by aging Baby Boomers and the medicate-first approach many doctors take in treating them.
BIG PROBLEM, BIG TOLL
To assess the scope and impact of the prescription drug problem among older Americans, USA TODAY studied data from an array of federal agencies and private firms. Key findings:
• More prescriptions: The medical community is increasingly giving older patients prescriptions for two especially addictive drug classes: opioid pain relievers and benzodiazepines, psychoactive medications such as Xanax and Valium often used for anxiety. According to data collected from IMS Health, which tracks drug dispensing for the government, the 55 million opioid prescriptions written last year for people 65 and over marked a 20% increase over five years — nearly double the growth rate of the senior population. The number of benzodiazepine prescriptions climbed 12% over that period, to 28.4 million.
• More misuse: In 2012, the average number of seniors misusing or dependent on prescription pain relievers in the past year grew to an estimated 336,000, up from 132,000 a decade earlier, according to survey data from the Substance Abuse and Mental Health Services Administration (SAMHSA). Misuse is defined as using the drugs without a prescription or not as prescribed.
• More damage: Among people 55 and older seeking substance abuse treatment from 2007-11, there was a 46% jump in the share of cases involving prescription narcotics, SAMHSA data show. Annual emergency room visits by people 65 and over for misuse of pharmaceuticals climbed more than 50% during that time, to more than 94,000 a year. And the rate of overdose deaths among people 55 and older, regardless of drug type, nearly tripled from 1999-2010, to 9.4 fatalities per 100,000 people, based on data from by the Centers for Disease Control and Prevention.
The misuse of prescription medication by seniors has the hallmarks of an "emerging epidemic," says Wilson Compton, a psychiatrist and deputy director of the National Institute on Drug Abuse, part of the National Institutes of Health. Both prescribers and patients need better education on the uses and risks of painkillers and psychoactive drugs, Compton says. "We have not focused as specifically on this older population as we might. ... It's a serious problem."
LIVES TAKEN OVER
Van Amburgh figures the doctors treating her back pain wanted to help; by the time she figured out that they were doing just the opposite, it was too late.
Through two decades of back pain, she saw general practitioners, orthopedists, pain specialists. Each would assess her drug regimen, maybe switch a narcotic, tweak a dosage.
"No one ever told me to cut back," she says.
Over time, Van Amburgh felt too foggy to drive, so she gave up her license. She grew isolated, distant from friends, even her two grown daughters. By last summer, she was sleeping through her cherished family vacations.
"For my husband, my family, I was non-existent," she says.
It's a common pattern — an older patient is medicated for a chronic problem, dosages escalate over time, leading to dependence. But different people take different paths.
Some are Boomers who grew up with drug use and never shook it. David Walsh, 62, a facilities services foreman in Boston, has struggled with substance abuse since his teens in the late '60s, including treatment for alcohol, cocaine and heroin. As he aged, he turned to opioid painkillers.
"It was mostly Percocet and Vicodin — I'd buy them off the street, steal them from my wife, my son, from friends' (medicine chests)," says Walsh, who completed treatment last fall. "And if I had an operation or something and the doctor didn't know I was an addict, I'd always ask for Vicodin."
Then there are the seniors who never touched drugs until they were prescribed late in life.
Retired dentist Keith Blair was put on narcotics in his mid-80s to treat back pain. His daughter, Marian Hollingsworth, says he initially was prescribed Percocet. Taking it left him too dazed to get out of bed. After moving to a hospital for back scans, doctors added powerful anti-psychotics to a mix of painkillers. He fell into a semiconscious state. Over the following weeks, as he bounced between two hospitals and a nursing home, his heart and kidney functions declined, then failed.
Blair died without returning home.
"All of these drugs were being given to him without our knowledge; nobody talked about the risks," says Hollingsworth, who later got her father's medical records and complained to the state health department that the medications were inappropriate. Some had "terrible side effects for someone with the (health) problems he had. ... This was stuff he never should have been given."
1 IN 4 OLDER ADULTS ON RISKY DRUGS
No other segment of the population is prescribed more drugs than seniors, and none faces higher risks of complications.
"The elderly take more prescriptions than other people partly because they have more (medical) conditions, (and) there are special concerns about prescribing to these people," says Leonard Paulozzi, a CDC epidemiologist specializing in drug-related injury. "Everybody needs more education about the use of these drugs, whether it's prescribers or patients."
About one in every four adults 50 and over use psychoactive medications — mostly opioids for pain and benzodiazepines for anxiety — according to research cited in a 2012 brief prepared by SAMHSA and the Administration on Aging. And because older bodies metabolize drugs less quickly, those medications tend to build up in their bodies.
The problem, according to Paulozzi and other experts, is that both types of drugs can cause disorientation and affect balance, compounding the risk seniors face of falling. And combining the two, which many physicians do, can depress respiratory function at high doses — a potentially fatal problem for older people, who often are weakened by other ills.
CDC data from 2010 show that 75% of pharmaceutical overdose deaths involved opioid painkillers, and nearly a third of those cases also involved benzodiazepines.
Yet the number of seniors using — and misusing — those drugs continues to climb.
"The problem really is being fueled by over-prescribing," says Andrew Kolodny, chief medical officer for Phoenix House, which runs scores of addiction treatment programs nationally, and president of Physicians for Responsible Opioid Prescribing.
Kolodny notes that the graying of the Baby Boomers has created a bubble of people inclined to seek drugs for chronic pain, menopause-related anxiety and other age-related afflictions. And patients who ask their doctors for narcotics are far more likely to get them prescribed — a phenomenon documented this year in a study in Medical Care.
Researchers see two underlying factors: Drug companies are aggressively marketing pain medications for older consumers, and physicians are treating more aging patients without proper training in addiction.
"Many physicians are not well trained on the consequences of using these drugs so widely," says Susan Foster, who heads policy research at CASAColumbia, a non-profit that studies strategies to prevent and treat addiction. "They're not attending to the fact that these are highly addictive substances that can cause a lot of complications for older patients."
WHEN IT'S TIME TO SAY 'NO'
Part of the challenge is determining which patients truly need prescription drugs — and how long they should stay on them.
Long-term treatment with opioids and benzodiazepines is widely accepted in some cases, especially for patients with certain cancers and end-of-life conditions, and there is debate on whether efforts to constrain prescribing might limit legitimate use of the drugs.
But multiple studies show that opioids lose their effectiveness as patients build tolerance and have little value as a long-term tool for managing chronic pain. Benzodiazepines, such as Valium, also are not considered effective for long-term use.
As those realizations have taken hold, fewer new patients are being introduced to those medications, says David Oslin, an addiction specialist and psychiatry professor at the University of Pennsylvania's Perelman School of Medicine. The bigger challenge is weaning elderly patients who were put on the drugs years ago.
"It's really hard to get them off," Oslin says. "And there's a stigma — people don't want to take away a 70-year-old's medications."
Van Amburgh's dependence on painkillers grew inescapable; when she forgot to put on a fresh fentanyl patch, she felt nauseated, feverish.
"I wanted my life back," she says.
She returned to her most recent doctor, who agreed that her course of pain medicine had become a concern, and she ended up in Pohl's Las Vegas treatment program. The withdrawal was gut-wrenching, but she emerged with less back pain than she had during all her years on narcotics — a common outcome among people who build a tolerance to opioids.
"They told me I'd be in less pain and I didn't believe them, but I'm like a new person," she says. "The thing that still pisses me off, though, is that nobody tried to take me off the drugs sooner. From one doctor to another to another, they just wrote more prescriptions.
"Really," she adds. "I think it was just ignorance."