Prescription Tranquilizer/Sedative Sources for Misuse in Older Adults

Abstract

Background: Older adult prescription tranquilizer/sedative misuse is understudied, despite evidence of increased misuse prevalence and significant associated consequences (e.g., suicidal ideation). Identification of misuse sources could limit such misuse by offering policymakers and clinicians targets to limit diverted tranquilizer/sedative medication. Objective: To establish the prevalence of tranquilizer/sedative misuse sources in older adults and investigate associated poor outcomes. Methods: Data were from the 2009-14 National Survey on Drug Use and Health, including participants endorsing one or more past-month tranquilizer/sedative misuse sources (n= 3,162) with older adult (50-64 and 65 and older; n= 160) tranquilizer/sedative source prevalence estimated and compared to younger cohorts. Results: Adults 65 and older had the greatest physician source use (38.2%) across ages. Physician source use in those 50 and older, relative to those obtaining medication from friends/ family for free, was linked to a higher prevalence of both past-year prescription opioid misuse (58.6% versus 34.9%) and serious psychological distress (50.1% versus 11.6%). Conclusions/Importance: Physician source use is particularly prevalent in adults 65 and older, and adults 50 and older using physician sources appear at elevated risk of consequences. Careful monitoring of psychiatric symptoms in older adults receiving tranquilizers/sedatives appears warranted. Older adults use a unique pattern of tranquilizer/sedative misuse sources, as compared to younger groups, further signaling that older adult misuse processes differ from those in younger groups.

Prescription Drug Misuse: Taking a Lifespan Perspective

“…124 Physician sources for tranquilizer/sedative medication misuse increase from young adulthood (9.9%) to a peak in those 65 years and older (38.2%), while purchases decrease from young adults (25.9%) to those 65 and older (2.3%). 125 Across age groups, use of multiple sources and purchases is associated with higher relative rates of problematic substance use and SUD, 36,40,41,55,82,125 though even misuse of one’s own medication (ie, physician sources) is associated with elevated risk above those without PDM. 70 Notably, use of physician sources may not be linked with lower relative risk in older adults.…”

“…70 Notably, use of physician sources may not be linked with lower relative risk in older adults. 125…”

“…16,36,40,41,55,125 Throughout the lifespan, obtaining medication from friends or family for free is the most common source, with only small differences between age groups. 16,55,124,125 Notably, the association of specific medication sources and poor outcomes, such as substance use and psychopathology, may change over the lifespan; while use of physician sources (or one’s own medication) is generally associated with lower relative risk in adolescents and young adults, 36,40,41,82 this is not true for older adults. 55,125 Stimulant PDM sources are virtually unstudied outside of adolescent and young adult samples, and the extant evidence suggests differences, such as higher odds of SUD in those using physician sources.…”

“…16,55,124,125 Notably, the association of specific medication sources and poor outcomes, such as substance use and psychopathology, may change over the lifespan; while use of physician sources (or one’s own medication) is generally associated with lower relative risk in adolescents and young adults, 36,40,41,82 this is not true for older adults. 55,125 Stimulant PDM sources are virtually unstudied outside of adolescent and young adult samples, and the extant evidence suggests differences, such as higher odds of SUD in those using physician sources. 36 Future research that separates out friend and family sources is important, given that friend sources are associated with greater odds of problematic substance use.…”

Suizidalität bei Abhängigkeit von illegalen Substanzen und psychotrop wirksamen Medikamenten

“…Glasner-Edwards et al [52] identifizierten bei Patienten mit Methamphetaminabhängigkeit eine stärker ausgeprägte Depressivität (gemessen mit dem Beck Depressionsinventar; > 20 Punkte; OR = 1,8), weibliches Geschlecht (OR = 2,1), intravenösen Methamphetaminkonsum (OR = 2,3), frühere psychiatrische Krankenhausaufenthalte (OR = 1,8) und schwere Depression im Laufe des Lebens (OR = 3,1) als Risikofaktoren für Suizidversuche. Marshall et al [53] fanden unter 1 873 i. v. Drogenkonsumenten lediglich Methamphetamininjektion als Risikofaktor für Suizidversuche, wobei häufigerer Methamphetaminkonsum mit einem etwas höheren Risiko assoziiert war (HR = 2,7) als seltenere Methamphetamininjektionen (HR = 2,1).In einer US-Studie mit über 50-Jährigen zeigte sich ein hochsignifikanter Zusammenhang zwischen suizidalen Gedanken (in den letzten 12 Monaten) und Benzodiazepinkonsum (AOR = 2,4) und Missbrauch von Benzodiazepinen (AOR = 4,6;[54]). Bei Patienten im Alter von über 65 Jahren mit Benzodiazepinmissbrauch oder -abhängigkeit war ein Suizidversuch deutlich häufiger der Grund für die Einweisung in eine psychiatrische Klinik als bei Patienten ohne Benzodiazepinmissbrauch oder -abhängigkeit[55].…”