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Substance Abuse in the Elderly

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Substance Abuse in the Elderly An Overview Timothy P. Condon, Ph.D. Deputy Director, National Institute on Drug Abuse National Institutes of Health – PowerPoint PPT presentation

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Title: Substance Abuse in the Elderly


1
Substance Abuse in the Elderly An Overview
  • Timothy P. Condon, Ph.D.
  • Deputy Director,
  • National Institute on Drug Abuse
  • National Institutes of Health
  • Department of Health and Human Services

Drug Abuse in the 21st Century - What Problems
Lie Ahead for the Baby Boomers? Bethesda,
Maryland Thursday, September 16, 2004
2
What do we know?
3
Past Year Illicit Drug Use, by Age 2002
Source 2002 National Survey on Drug Use Health
(SAMHSA)
4
What do we anticipate seeing from the aging baby
boomer generation?
5
What is a Baby Boomer?
6
What is a Baby Boomer?
  • Those born between (and including) 1946 and 1964
    (40-58 yrs old)
  • Currently represent 29 of the U.S. population

7
Changing Demographics More Elderly
Source A Profile of Older Americans 2003,
Administration on Aging, HHS
8
Estimated Cost of the Consequences of Substance
Abuse Among Mature Women in 1998 - 22.3 Billion
  • Inpatient Hospital Charges (10.1 Billion)
  • Medicare - 8.5 Billion
  • Medicaid - 338 Million
  • Private insurers/individuals - 1.3 Billion
  • Nursing Home Expenses (12.2 Billion)
  • Medicare - 1.4 Billion
  • Medicaid - 5.8 Billion
  • Private insurers/individuals - 5 Billion

Does not include outpatient hospital visits,
physician office visits and home health care.
Only 2 was spent to treat the substance abuse
problem itself.
Source CASA, Under the Rug Substance Abuse and
The Mature Woman, June 1998.
9
What are the cultural/societal factors that may
impact differences in drug use and abuse in this
generation as compared to the previous generation?
10
Birth cohorts that experience high rates of
illicit drug use in youth or young adulthood have
subsequently shown higher rates of use as they
age, relative to other cohorts.
Source The NHSDA Report, Substance Use Among
Older Adults Nov 2001
11
What are some of the behavioral and sociological
factors?
12
Americans are Living Longer
Projected
Sources US Census Bureau and Centers for Disease
Control and Prevention
13
Sex, Drugs Rock N Roll
14
Disposable Income
15
Fewer Family Responsibilities
16
Americans Are Living Better?
17
Mid-Life Crises Distress Over Getting Older
  • 50 is the new 30
  • Physical impairments
  • Losses
  • Kids leaving house
  • Decreased physical prowess
  • Retirement

18
Quick Fix Society
  • More Treatment Options Available
  • Increased Availability of Medications
  • Less Stigma Associated
  • Advertising

19
Just a Click Away - Drug Advertising is Ubiquitous
Source IMS Health and Competitive Media
Reporting, Inc
20
30 of Americans talked to their doctor about
medicine they saw advertised.Of these, 44
received the prescription drug they asked about
  • Source Kaiser Family Foundation Understanding
    the Effects of Direct-to-Consumer Prescription
    Drug Advertising, November 2001

21
As Prescriptions Increase Emergency Room Visits
For Non-Medical Abuse Have Also Increased
Hydrocodone
80000
70000
Number of Prescriptions (in 1000s)
60000
50000
Oxycodone
40000
30000
20000
10000
0
1994
1995
1996
1997
1998
1999
2000
2001
Source SAMHSA, DAWN, 2002
22
Availability on the Internet Delivered in the
Privacy of your Home
Some reasons why you should consider using this
pharmacy No prescription required!
23
Are There Biological Factors to Consider?
24
How Does the Brain Change with Age?
25
Brain Changes Across the Lifespan
Sowell et al, Nature Neuroscience v 6,3 p 309,
2003
26
How Does Aging Affect the Pathways Associated
with Substance Abuse?
27
Dopamine Pathways
Serotonin Pathways
striatum
frontal cortex
hippocampus
  • Functions
  • mood
  • memory
  • processing
  • sleep
  • cognition

substantia nigra/VTA
  • Functions
  • reward (motivation)
  • pleasure,euphoria
  • motor function
  • (fine tuning)
  • compulsion
  • perseveration

nucleus accumbens
raphe
28
Age-related reductions in D2 receptor binding in
striatum
24 years
44 years
86 years
Source Volkow, N.D. et al., Brookhaven National
Laboratory.
29
Age-related decline in dopamine transporter
binding
24 years
44 years
86 years
Source Volkow, N.D. et al., Brookhaven National
Laboratory.
30
Age-related Decreases in Serotonin Transporter
Binding

Source Yamamoto M.. et al., Life Sciences, 71,
pp. 751-757, July, 2002.
31
Will age-related changes in brain function affect
susceptibility to reward or sensitivity to
illicit substances?
32
Age-related declines in cannabinoid receptor
function in mice are linked to age-related
declines in alcohol preference
Source Wang, Lei et al. (2003) Proc. Natl. Acad.
Sci. USA 100, 1393-1398
33
How does aging affect susceptibility to the toxic
effects of drugs of abuse?
34
Age-related increases in methamphetamine-induced
toxicity
Modified from Miller et al., Annals of the New
York Academy of Sciences 914 (1) 194, 2000
35
How does early exposure to drugs of abuse affect
the aging process? What are the potential
consequences?
36
Science Has Generated A Lot of Evidence Showing
That
Prolonged Drug Use Changes the Brain In
Fundamental and Long-Lasting Ways
37
Dopamine D2 Receptors are Lower in Addiction
DA
DA
DA
DA
DA
DA
DA
DA
DA
DA
DA
DA
Reward Circuits
Non-Drug Abuser
DA D2 Receptor Availability
DA
DA
DA
DA
DA
DA
Reward Circuits
control
addicted
Drug Abuser
38
Increased white matter lesions in cocaine
dependent subjects with age
Source Bartzokis, G. et al., American Journal of
Neuroradiology, 20, pp. 1628-1635, October, 1999.
39
Rats Exposed to Nicotine in AdolescenceSelf-Admin
ister More Nicotine Than Rats First Exposed as
Adults
Sources Collins et al, 2004, Levin et al, 2003,
NIDA Notes v19.2
40
Rats First Exposed to Nicotine in Adolescence
Show Greater Sensitization to Cocaine Than Rats
First Exposed as Adults
Activity level after cocaine administration was
measured by counting the number of times in 10
minutes each rat crossed light beams projected in
a grid across its cage.
Sources Collins et al, 2004, Levin et al, 2003,
NIDA Notes v19.2
41
If in youth, drug addiction can cause serious
medical complications
Consumption becomes compulsive, despite
negative social and health consequences
What might be the effect in the elderly?
42
Elderly persons use prescription medications
approximately three times as frequently as the
general population
Source Patterson, et al. Psychiatric Times,
April 1999.
43
What are the consequences of drug interactions
(e.g. between prescription drugs and illicit
drugs)?
44
How does aging affect drug disposition/metabolism?
  • Pharmacokinetics change with aging
  • Reduction in renal drug elimination resulting in
    increased drug serum levels and the potential for
    adverse drug reactions.
  • Volume of drug distribution decreases resulting
    in higher plasma concentrations.
  • Pharmacodynamic effects with aging
  • Neurotransmitter receptor properties may change
    with age.
  • Reduction in homeostatic mechanisms resulting in
    more time required to regain steady-state
    following drug therapy

45
What is the relationship between drug abuse and
co-morbid conditions in the elderly?
  • Psychiatric disorders
  • Neurological disorders
  • Cardiovascular disease
  • Cancer
  • Kidney Disease
  • Liver disease
  • Musculoskeletal disorders
  • HIV

46
Some relevant issues in developing prevention,
detection/diagnosis, and treatment programs for
the elderly
  • Age-related brain changes
  • Changes in drug sensitivity
  • Use of different drugs
  • Side effects more severe/more of an issue
  • Different access to the drugs
  • Different settings (i.e. nursing homes)
  • Age-specific screening instruments needed
  • Stigma
  • Need better education re. prescription drugs
  • Data systems to track prescription use

47
PHARMACOLOGICAL THERAPIES with a Strong Base of
Scientific Evidence NOT TESTED ON ELDERLY
  • METHADONE
  • NALTREXONE 
  • BUPROPION
  • NICOTINE REPLACEMENT THERAPY
  • BUPRENORPHINE

48
Future Research
  • Research on animal models
  • Expanding longitudinal epidemiological studies to
    examine drug abuse in the elderly
  • Behavioral and sociological studies in aging
    populations and substance abuse.
  • Developing age-specific prevention programs,
    screening tools, and treatments
  • Brain imaging over life course

49
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50
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