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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 Department.

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Presentation on theme: "Substance Abuse in the Elderly – An Overview Timothy P. Condon, Ph.D. Deputy Director, National Institute on Drug Abuse National Institutes of Health Department."— Presentation transcript:

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 Those born between (and including) 1946 and 1964 (40- 58 yrs old) Currently represent 29% of the U.S. population

7 Source: A Profile of Older Americans: 2003, Administration on Aging, HHS Changing Demographics: More Elderly

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 Only 2% was spent to treat the substance abuse problem itself. *Does not include outpatient hospital visits, physician office visits and home health care. 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 Source: IMS Health and Competitive Media Reporting, Inc Just a Click Away - Drug Advertising is Ubiquitous

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 Number of Prescriptions (in 1000s) 0 10000 20000 30000 40000 50000 60000 70000 80000 1994199519961997 1998 199920002001 Source: SAMHSA, DAWN, 2002 Hydrocodone Oxycodone prescriptions 0 6000 12000 18000 24000 ED Mentions emergency

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 Functions reward (motivation) pleasure,euphoria motor function (fine tuning) compulsion perseveration Serotonin Pathways Functions mood memory processing sleep cognition nucleus accumbens hippocampus striatum frontal cortex substantia nigra/VTA raphe

28 Age-related reductions in D2 receptor binding in striatum Source: Volkow, N.D. et al., Brookhaven National Laboratory. 2.0 2.5 3.0 3.5 4.0 4.5 5.0 5.5 6.0 1020304050607080 DV(BG) / DV (CB) Age r = 0.69, p < 0.0001 (n = 25) [11C]Raclopride 24 years 44 years 86 years

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 Young Old EtOH Intake (g/kg/day) EtOH Preference Cannabinoid Agonist Stimulated G-Protein Binding Amygdala Old (26-48 weeks) Young (6-10 weeks) Limbic Forebrain

33 How does aging affect susceptibility to the toxic effects of drugs of abuse?

34 Modified from Miller et al., Annals of the New York Academy of Sciences 914 (1) 194, 2000 Age-related increases in methamphetamine-induced toxicity

35 How does early exposure to drugs of abuse affect the aging process? What are the potential consequences?

36 Prolonged Drug Use Changes the Brain In Fundamental and Long-Lasting Ways Science Has Generated A Lot of Evidence Showing That…

37 Dopamine D2 Receptors are Lower in Addiction DA D2 Receptor Availability control addicted Cocaine Heroin Alcohol DA Reward Circuits DA Reward Circuits DA Drug Abuser Non-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 Adolescence Self-Administer 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 Sources: Collins et al, 2004, Levin et al, 2003, NIDA Notes v19.2 *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.

41 Medical Consequences:  Heart attacks  Strokes  Cancer  Psychiatric Disorders Consumption becomes compulsive, despite negative social and health consequences If in youth, drug addiction can cause serious medical complications… 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

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