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Drug abuse has been regarded as one of the most urgent public health issues in the USA as well as worldwide. The major focus has been mainly on adolescents and young adults, while the growing population of older adults has proved to be more vulnerable (Kirschner, Ginsburg, & Sulmasy, 2014). It is estimated that over 10% of older patients report misusing some type of prescribed opioids, which is almost twice as high as compared to young adults prescription drug misuse (5,9% and it is declining) (Kirschner et al., 2014). The adverse effects of drug abuse among the elderly have been acknowledged, with the primary attention paid to the increased risk of falls, delirium, and respiratory failure. The government and other stakeholders (non-profit organizations and healthcare facilities) have come up with various policies and programs to address the issue. Some of these efforts have been rather efficient, while many have no effect or can even be harmful to the stakeholders. This paper includes a brief description of the problem and a potentially effective policy to address the public health concern in question.
Background Information and Problem Statement
The use of illicit drugs among older adults is mainly associated with the misuse of prescribed drugs. People older than 65 are often at a higher risk of the development of addiction to prescribed opioids due to numerous reasons (Airagnes, Pelissolo, Lavallée, Flament, & Limosin, 2016). These people often have chronic health conditions, face significant life changes (such as retirement), have to cope with the loss of close ones. Although the prevalence of the health issue seems rather controllable (11%), it urgently requires effective solutions. The aging population of the USA is rapidly growing, and the number of drug abusers is likely to increase considerably. According to Kirschner et al. (2014), drug abuse costs reach up to approximately $534 billion annually. These costs include law enforcement, health care, crime, and other costs. Clearly, this budget burden is substantial and can become excessive in the present-day economic environment. Therefore, it is essential to develop cost-effective strategies that could address this public health problem.
Existing and Possible Solutions
The government and other stakeholders try to solve the issue in different ways, but their efforts seem rather inconsistent and inefficient. For example, researchers and practitioners have acknowledged the benefits of non-medication-based treatment (Span, 2018). Nevertheless, there are no clear guidelines as to the cases when medication-based or other strategies can and should be used (Jann, Kennedy, & Lopez, 2014). Under the Drug Enforcement Administration (DEA), physicians, pharmacies, and other stakeholders have to record the use of opioids, but they are not required to report (Kirschner et al., 2014). New York is the only state where such mandatory reporting is established (Jann et al., 2014). Although its use has been criticized extensively, the rate of misusers has decreased.
Such institutions as the DEA, the Food and Drug Administration, and the Veteran Affairs introduce guidelines for physicians and other healthcare professionals. Furthermore, Medicaid and Medicare cover some of the most common opioids prescribed, but other types of treatment are not funded (Davidson, 2018). It is also evident that older patients isolation and alienation are associated with prescription drug misuse. However, the insufficient number of programs aimed at addressing this trend has been developed and introduced.
A Possible Solution and Its Impact on the Health Care Delivery System
The solutions mentioned above have been associated with positive and negative outcomes. Therefore, it is possible to combine the most cost-effective measures to achieve the best results. At the same time, it is also clear that a database for drug prescription is essential. It is critical for healthcare professionals to be aware of the past and present prescriptions when treating an older patient. The first step can be the development of a statewide project based on the principles of electronic health records (EHR). The primary stakeholders are policymakers who will develop the guidelines and reinforcement strategies. Healthcare practitioners will be informed about the new policy and trained accordingly. Healthcare administrators will be responsible for their staff informing and training.
The digital database should include the data of prescribed drugs (opioids) and health records. Besides, it should contain red flags and warnings, as well as recommendations concerning alternative ways to treat pain and psychological issues (including yoga, walks, counseling, support groups, and art therapy). Importantly, it is necessary to make sure that these regulations are properly reinforced. Thus, healthcare professionals who fail to report and follow the guidelines provided in the system can be punished (fines or even loss of licensure are possible). The development of this database, as well as staff training, will require the allocation of certain funds. The project can be financed by the federal and state governments, as well as non-profit organizations. The implementation of this project and proper enforcement of the new policy may need several million dollars, although thorough research is needed to estimate actual costs. The major benefit of this project is associated with the introduction of significant shifts within the healthcare system. Prevention and efficient use of resources will be the governing principles of the Health Care Delivery System.
Conclusion
On balance, the increase in prescription drug misuse among older adults is an urgent public health issue to be addressed. The elderly are often isolated and alienated, which leads to their misuse of opioids. Healthcare professionals tend to focus on medication-based interventions with this population. The new policy involves the development of a digital database that will enable healthcare professionals to make evidence-based decisions. Effective reinforcement is the key to effective use of the database and associated resources.
References
Airagnes, G., Pelissolo, A., Lavallée, M., Flament, M., & Limosin, F. (2016). Benzodiazepine misuse in the elderly: Risk factors, consequences, and management. Current Psychiatry Reports, 18(10). Web.
Davidson, J. (2018). Unseen face of the opioid epidemic: Drug abuse among the elderly grows. The Washington Post. Web.
Jann, M., Kennedy, W. K., & Lopez, G. (2014). Benzodiazepines. Journal of Pharmacy Practice, 27(1), 5-16. Web.
Kirschner, N., Ginsburg, J., & Sulmasy, L. S. (2014). Prescription drug abuse: Executive summary of a policy position paper from the American College of Physicians. Annals of Internal Medicine, 160(3), 198-200. Web.
Span, P. (2018). A quiet drug problem among the elderly. The New York Times. Web.
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