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prescriptions from multiple prescribers
(doctor shopping) by obtaining
medications from family members or
friends, or by hoarding medications
'Studies have shown that intentional
abuse of prescription drugs is increasing
among all age groups. As the number
of persons 65 years of age and older
skyrockets with the aging of the
baby boomers, experts predict that
prescription drug abuse among the
elderly also will rise significantly.'13
This then leads into a related issue --
the diversion of prescribed medications.
There is widespread evidence, at
least from the United States, of older
individuals selling their medications to
prescription-drug abusers.27,28 The United
States appears to have the largest per
capita problem in the world in terms of
diversion of prescribed pharmaceuticals,29
with morphine and controlled-release
oxycodone being popular, and the elderly
are a primary source of prescription drugs
on the street.28
'In my neighbourhood we have a lot of
old people who get these pills prescribed;
they get methadone prescribed; they get
needles and all that, and that's how they
make their money. I have 20 different old
people that I can go to.'28
'The elderly have a lot of 80 milligram
Oxys (oxycodone); everybody got the
big green pills, and everybody had
Xanax. There were old people that were,
especially this lady, that was doing like
5 or 6 doctors ... and getting all kinds of
prescription pills. They were just giving
them to her. She was just selling them.'28
Again, there is limited comparable
data available in Australia,29,30 but an
examination of illicit prescription drug
markets in Melbourne, Hobart and
Darwin found they were predominantly
driven by a large number of small-scale
diversions that included legitimate
prescriptions and medication shopping.31
The issue of pharmaceutical misuse has
been identified across Australia as an
emerging problem of significant concern.
As a result, a National Pharmaceutical
Drug Misuse Strategy is being developed
by a consortium led by the National
Centre for Education and Training on
Addiction (NCETA) at Flinders University.
The Strategy is being developed at the
request of the Ministerial Council on Drug
Strategy and is being overseen by the
Victorian Department of Health.29,32
In the United Kingdom, in response to
the increasing reports of prevalence of
substance problems in older people in
an ageing population, along with an
inadequate research base, the Royal
College of Psychiatrists produced a report
-- our invisible addicts,33 which generated
somewhat of a public outcry at even a
suggestion of substance abuse occurring
in the elderly.
As noted recently by Hunter,18 while
it is critical that strategies to reduce
substance abuse in the young are acted
upon, it is also essential that policymakers
do not ignore the impact of alcohol and
drug problems among older people.
For instance, specialist alcohol and other
drug services exist throughout Australia,
but they do not generally cater for older
people and do not collectively provide a
health service attuned to dealing with the
needs of older clients.19
'Older people are not immune to the
development of substance misuse
and dependence on legal and illicit
substances as well as prescribed and
"over the counter medication". The
nature and extent of the problem and
associated psychological and physical
comorbidity is greatly underestimated.
The pharmacist in partnership with
general practitioners and physicians has a
responsibility in reducing misuse among
the older population'.23
1. Crome I, Bloor R. Older substance misusers still deserve better
treatment interventions - an update (Part 3). Reviews in Clinical
2. Pollice R, Casacchia M, Bianchini V, Mazza M, Conti CM, Roncone R.
Severe tramadol addiction in a 61 year-old woman without a history of
substance abuse. Int J Immunopathol Pharmacol 2008;21(2):475--6.
3. Han B, Gfroerer JC, Colliver JD, Penne MA. Substance use disorder
among older adults in the United States in 2020. Addiction
4. Simoni-Wastila L, Yang HK. Psychoactive drug abuse in older adults. Am
J Geriatr Pharmacother 2006;4(4):380--94.
5. Menninger JA. Assessment and treatment of alcoholism and
substance-related disorders in the elderly. Bull Menninger Clin
6. Culberson JW, Ziska M. Prescription drug misuse/abuse in the elderly.
7. Briggs WP, Magnus VA, Lassiter P, Patterson A, Smith L. Substance
use, misuse, and abuse among older adults: implications for clinical
mental health counselors. Journal of Mental Health Counseling
8. Crome I, Bloor R. Older substance misusers still deserve better services -
an update (Part 1). Reviews in Clinical Gerontology 2005;15(2):125--33.
9. Crome I, Bloor R. Older substance misusers still deserve better diagnosis
- an update (Part 2). Reviews in Clinical Gerontology 2005;15(3-
10. Kuehn BM. WHO documents worldwide need for better drug abuse
treatment - and access to it. JAMA 2012;308(5):442--3.
11. DuPont RL. Prescription drug abuse: an epidemic dilemma. J
Psychoactive Drugs 2010;42(2):127--32.
12. Worley J. Prescription drug monitoring programs, a response to doctor
shopping: purpose, effectiveness, and directions for future research.
Issues Ment Health Nurs 2012;33(5):319--28.
13. Martin CM. Prescription drug abuse in the elderly. Consult Pharm
14. Simoni-Wastila L, Zuckerman IH, Singhal PK, Briesacher B, Hsu
VD. National estimates of exposure to prescription drugs with
addiction potential in community-dwelling elders. Substance Abuse
15. McCabe SE, West BT, Teter CJ, Boyd CJ. Co-ingestion of prescription
opioids and other drugs among high school seniors: Results
from a national study. Drug Alcohol Depend 2012. 10.1016/j.
16. Merikangas KR, McClair VL. Epidemiology of substance use disorders.
Hum Genet 2012;131(6):779-89.
17. Crome IB, Crome P, Rao R. Addiction and ageing - awareness,
assessment and action. Age Ageing 2011;40(6):657--8.
18. Hunter B, Lubman DI, Barratt M. Alcohol and drug misuse in the elderly.
Aust NZ J Psychiatry 2011;45(4):343.
19. Wilkinson C. Ageing Australia: facing the future. Of Substance 2009;
20. Blow FC, Oslin DW, Barry KL. Misuse and abuse of alcohol, illicit drugs,
and psychoactive medication among older people. Generations
21. Immonen S, Valvanne J, Pitkala KH. Prevalence of at-risk drinking among
older adults and associated sociodemographic and health-related
factors. J Nutr Health Aging 2011;15(9):789--94.
22. Immonen S, Valvanne J, Pitkala KH. Alcohol use of older adults: drinking
alcohol for medicinal purposes. Age Ageing 2011;40(5):633--7.
23. McGrath A, Crome P, Crome IB. Substance misuse in the older
population. Postgrad Med J 2005;81(954):228--31.
24. Colliver JD, Compton WM, Gfroerer JC, Condon T. Projecting drug use
among aging baby boomers in 2020. Ann Epidemiol 2006;16(4):257--
25. Jinks MJ, Raschko RR. A profile of alcohol and prescription drug
abuse in a high-risk community-based elderly population. DICP
26. Wetterling T, Schneider B. Prescription drug abuse in elderly psychiatric
patients. Psychiatr Prax 2012;39(6):275--9.
27. Inciardi JA, Surratt HL, Cicero TJ, Kurtz SP, Martin SS, Parrino MW. The
"black box" of prescription drug diversion. Journal of addictive diseases
28. Inciardi JA, Surratt HL, Cicero TJ, Beard RA. Prescription opioid abuse
and diversion in an urban community: the results of an ultrarapid
assessment. Pain medicine 2009;10(3):537--48.
29. Nicholas R, Lee N, Roche A. Responding to pharmaceutical drug misuse
problems in Australia. A matter of balance: a review of the literature
supporting the development of Australia's National Pharmaceutical
Drug Misuse Strategy. National Centre for Education and Training on
Addiction (NCETA), Flinders University, 2011. At: http://nceta.flinders.
30. Hallinan R, Osborn M, Cohen M, Dobbin M, Wodak A. Increasing the
benefits and reducing the harms of prescription opioid analgesics.
Drug Alcohol Rev 2011;30(3):315--23.
31. Fry C, Smith B, Bruno R, O'Keefe B, Miller P. Benzodiazepine and
pharmaceutical opioid misuse and their relationship to crime: An
examination of illicit prescription drug markets in Melbourne, Hobart
and Darwin. Hobart: National Drug Law Enforcement Research Fund,
32. Nicholas R, Lee N, Roche A. Pharmaceutical drug misuse in Australia:
complex problems, balanced responses. National Centre for Education
and Training on Addiction (NCETA), Flinders University, 2011. At: http://
33. Royal College of Psychiatrists. Our Invisible Addicts. London: Royal
College of Psychiatrists, Jun 2011 (Council Report 165). At: www.
'The pharmacist in
and physicians has
a responsibility in
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