November 25, 2010

Drug-Related Emergency Department Visits Involving Pharmaceutical Misuse and Abuse by Older Adults

As the baby boom generation ages, a large cohort of older adults with a history of moderate to high rates of drug use may levy a costly burden on the American health care and substance abuse treatment systems. In fact, researchers have predicted that both the number of adults aged 50 or older with a substance use disorder and the rate of pharmaceutical misuse or abuse in this age group will double by 2020.^1,2 Data from the National Survey on Drug Use and Health (NSDUH) confirm that the rates of nonmedical pharmaceutical use among adults aged 50 to 59 increased from 2.2 percent in 2002 to 3.9 percent in 2009.³

The Drug Abuse Warning Network (DAWN) is a public health surveillance system that monitors drug-related emergency department (ED) visits in the United States.⁴ To be a DAWN case, an ED visit must have involved a drug, either as the direct cause of the visit or as a contributing factor. This issue of The DAWN Report provides trend statistics from 2004 through 2008 with a focus on 2008 findings concerning ED visits involving pharmaceutical misuse or abuse by adults aged 50 or older (hereafter referred to as "older adults").

In 2004, there were an estimated 115,803 ED visits involving pharmaceutical misuse and abuse by older adults (Figure 1). In 2008, there were 256,097 such visits, representing an increase of 121.1 percent.

Figure 1. Emergency Department (ED) Visits for Pharmaceutical Misuse or Abuse among Adults Aged 50 or Older: 2004 to 2008

Of ED visits involving pharmaceutical misuse or abuse by older adults, more than one third (35.6 percent) were made by those aged 50 to 54 (Figure 2). Visits by adults aged 55 to 59 accounted for 23.2 percent of such visits, and 19.7 percent were made by adults aged 70 or older.

Figure 2. Emergency Department (ED) Visits Involving Pharmaceutical Misuse or Abuse among Adults Aged 50 or Older, by Age Group: 2008

Slightly more of these ED visits were made by females (53.6 percent) than by males. The majority of such visits were made by older non-Hispanic white adults (78.1 percent), 15.2 percent were made by older non-Hispanic black adults, and 5.2 percent were made by older Hispanic adults.

Pain relievers were the type of pharmaceutical most commonly involved (43.5 percent) in ED visits by older adults; the majority of these visits involved narcotic pain relievers (33.9 percent) (Table 1). After pain relievers, drugs used to treat anxiety or insomnia (31.8 percent) and antidepressants (8.6 percent) were the most commonly reported for such visits.

Pain relievers were involved in 45.4 percent of visits by those aged 50 to 64 and 38.8 percent of visits by those aged 65 or older. Drugs used to treat anxiety or insomnia were involved more commonly in visits made by patients aged 50 to 64 than those made by patients aged 65 or older (35.6 vs. 22.5 percent). Antidepressants were involved in 10.1 percent of drug-related ED visits made by those aged 50 to 64 and 5.0 percent of visits by those aged 65 or older.

One in five (20.4 percent) ED visits related to pharmaceutical misuse or abuse by older adults also involved alcohol (Table 1). Visits involving alcohol in combination with pharmaceuticals were more likely to be made by adults aged 50 to 64 than by adults aged 65 or older (24.9 vs. 9.5 percent). Specifically, in comparison with patients aged 65 or older, patients aged 50 to 64 had a higher proportion of ED visits involving alcohol in combination with drugs used to treat anxiety and insomnia (47.3 vs. 32.1 percent) and alcohol in combination with antidepressants (13.2 vs. 5.0 percent).

Among older adults who visited the ED for pharmaceutical misuse or abuse, more than half (52.3 percent) were treated and released, and more than one third (37.5 percent) were admitted to the hospital. Of those admitted to the hospital, 60,378 were admitted to an inpatient unit (62.9 percent), 23,120 (24.1 percent) were admitted to an intensive care unit (ICU), and 11,695 (12.2 percent) were admitted to chemical dependency/detoxification or psychiatric unit.

Recent increases in the rate of pharmaceutical misuse and abuse among the baby boom generation, coupled with the anticipated growth in the number of older adults, will increase the demand for health care generally and for substance abuse treatment specifically. Health care costs for pharmaceutical misuse or abuse presenting to the ED can be great, especially if these cases result in hospital stays that require intensive care. The findings in this report show that more than one third of ED visits made by older adults misusing or abusing pharmaceuticals resulted in a hospital admission; of these, nearly a quarter of visits resulted in an admission to the ICU.

Because many substance abuse treatment and prevention programs were designed for adolescents and young adults, new approaches to addressing substance abuse in older adults may be necessary. Specifically, prevention messages that target older adults could warn against the dangerous combination of alcohol and pharmaceuticals. With one fifth of ED visits by older adults involving pharmaceutical misuse or abuse occurring among adults aged 70 or older, caregivers (e.g., adult children of aging parents) may be able to help prevent abuse by being alert to the symptoms and dangers. Education for caregivers about the abuse potential of certain medications and the early warning signs of abuse may be needed.

Moreover, the administration of pharmaceuticals requires oversight by medical professionals to guard against life-threatening interactions and dependency. Thus, it is important that physicians know about all pharmaceuticals (prescription and over-the-counter) a patient is taking before prescribing additional medications. Educating pharmacy and medical personnel as well as behavioral health specialists such as social workers and psychologists about substance abuse trends in older adults may help them to be more vigilant about the serious public health problem of pharmaceutical misuse and abuse by older adults.