A Systematic Review of Opioid and Benzodiazepine Misuse in Older Adults

Abstract

Objectives We aimed to assess the prevalence of opioid and benzodiazepine prescription drug misuse in older adults, the risk factors associated with misuse, and age-appropriate interventions. Methods Following PRISMA guidelines, we conducted a literature search for reports on misuse of prescription benzodiazepines and opioids in older adults. We searched PubMed, PsycINFO, and EMBASE for peer reviewed journal articles in English through April 2014 with updates through November 2015. We reviewed relevant publications that included participants ≥ 65 years of age. We also manually searched reference lists of key identified articles and geriatric journals through April 2016. Information on the study design, sample, intervention, comparators, outcome, time frame, and risk of bias were abstracted for each article. Results Of 4932 reviewed reports, 15 were included in this systematic review. Thirteen studies assessed the prevalence of prescription drug misuse and included studies related to opioid shopping behavior, assessment of morbidity and mortality associated with opioid and/or benzodiazepine use, frequency and characteristics of opioid prescribing, frequency of substance use disorders and non-prescription use of pain relievers, and the health conditions and experiences of long-term benzodiazepine users. One study identified risk factors for misuse and one study described the effects of provider education and an electronic support tool as an intervention. Discussion There is a dearth of high quality research on prescription drug misuse in older adults. Existing studies are heterogeneous, making it difficult to draw broad conclusions. We discuss the need for further research specific to prescription drug misuse among older adults.

Prescription tranquilizer/sedative misuse prevalence and correlates across age cohorts in the US

“…Conversely, and as we (Schepis, 2014) and others (Maree et al, 2016) have speculated, older adult tranquilizer/sedative misuse processes may qualitatively differ from those in younger individuals. While the relationship directions were similar to those of younger groups, the magnitude was often lower.…”

“…Despite this, older adults had the lowest PDM rates, supporting the idea of qualitative differences from younger groups. Maree et al (2016) noted increased physical health conditions and insomnia in older adults as potential drivers of tranquilizer/sedative misuse. Insomnia is not assessed in the NSDUH, and other physical health conditions are poorly assessed.…”

“…Much of the focus has been on opioid PDM, given its outsized role in PDM prevalence and consequences, including overdose. As a result, prescription tranquilizer (i.e., primarily capturing benzodiazepine medication, such as alprazolam, used often for anxiety treatment) and sedative PDM (i.e., medications primarily indicated for insomnia, such as zolpidem) remains understudied (e.g., Maree, Marcum, Saghafi, Weiner, & Karp, 2016). In the US, tranquilizer/sedative use disorder treatment increased by 67% from 2003 to 2012 (SAMHSA, 2014), and adult fatal benzodiazepine overdose increased by over 400% from 1996 to 2013 (Bachhuber, Hennessy, Cunningham, & Starrels, 2016), with a nearly 300% increase due to benzodiazepine and opioid co-ingestion (Jones & McAninch, 2015).…”

“…No tranquilizer PDM research could be found comparing PDM and correlates across the lifespan in a US sample, with only one US study on zolpidem PDM (Schepis, 2014). Research evaluating tranquilizer/sedative PDM across the lifespan could have significant clinical utility, as characterization of older adults engaged in tranquilizer/sedative PDM could help prevent significant associated consequences (e.g., falls and fractures, neurocognitive impairments, and increased overdose risk; Airagnes, Pelissolo, Lavallee, Flament, & Limosin, 2016; Maree et al, 2016) by identifying those most likely to misuse. Identification of tranquilizer/sedative PDM correlates across age cohorts could establish whether correlates differ and require different foci by age, or are similar across ages, allowing for consistent prevention targets.…”

The impact of substance use disorders on clinical outcomes in older‐adult psychiatric inpatients

“…There is a dearth of information about SUD in the elderly, with most studies focusing on the abuse of prescription medications, in particular opioids and benzodiazepines. 16 The present study focused on substance use at the time of hospital admission. Over one quarter of subjects 50 and older presented with an SUD, with cocaine being the most common.…”