Tarnishing the Golden Years With Addiction
Her skin itched as if an invisible case of hives were creeping across her flesh. She would shiver, then sweat. She felt suffocated by despair.
She was 65, a doctor’s wife, a proud grandma with a purseful of photographs. But there she was, curled in a ball like any other junkie at the Orange drug treatment center, sobbing as her body withdrew from a diet of painkillers and tranquilizers.
She couldn’t believe it had come to this.
People her age, the woman said, “don’t associate themselves with the lowlifes [who] sneak into doorways to shoot up. No, they sneak into the bathroom for a pill.”
Dogged by loneliness, pain or depression, worn out by bodies that no longer keep up and a society that seems not to care, some senior citizens are finding solace in pills. Tucked away in retirement communities, often far from family, their numbers are elusive. But as the nation rapidly grays, senior citizens--who consume a third of all prescribed drugs--are becoming society’s hidden addicts.
“As they get older, there’s a spiraling decrease in their ability to cope,” said Dr. Max Schneider, an addiction specialist at St. Joseph Hospital in Orange. “They’re grabbing at stuff and screwing up their final days.”
And some, like the doctor’s wife, are ending up in hospital detox beds. There, alongside street junkies half their age, they grapple with addictions to potent prescription-pill cocktails.
After lung surgery in late 1993, the doctor’s wife, a still-pert vision of a 1950s sorority sister, got hooked on the tranquilizer Dalmane--taking up to 10 a day--and the painkiller Vicodin.
Months later, she would say she could not give them up because she still had pain. What she was really medicating, she now believes, was loneliness and fear.
“You’d be like, ‘Oh, I’ll think about that tomorrow, like Scarlett O’Hara,’ ” said the Orange County woman, who told her story on the condition that her name not be used. “I was substituting pills for love.”
She never dreamed she wouldn’t be able to stop.
For many senior citizens, like the doctor’s wife, the addiction starts with a post-surgery pain prescription, or tranquilizers intended to calm grief and anxiety after the loss of a loved one.
Then they can’t--or don’t want to--stop.
“They’re not like a 25-year-old mixing it up to get high,” said Dr. Joseph Pursch, a Laguna Beach psychiatrist and addiction specialist who helped get former First Lady Betty Ford off pills. “They’re trying to make a lonely, miserable life less miserable.”
Behind the walls of sun-drenched retirement communities, the names of the latest life-numbing wonder pills--and the doctors who dole them out--are quietly swapped like favored formulas for hot toddies. This pill equals a pain-free afternoon. Another, a sure night of sleep.
If it’s prescribed by the doctor, how can it be wrong?
Some senior citizens, unwilling to bother far-off--and busy--children or grandchildren, stumble into trouble self-medicating, and wind up hooked. The tablets they take for sleeplessness or pain diminish the dread of losing control, of being poor or ill, of seeing friends pass away.
Pill-taking becomes part of a comforting, doctor-sanctioned ritual, part of a daily routine with dwindling options.
Some doctors and geriatric specialists insist that elderly addicts are rare, and that the medical profession, as a whole, prescribes responsibly. Many senior citizens are legitimately taking a variety of prescription drugs that are helping to improve the quality of their lives, they said.
Addiction specialists and some gero-psychiatrists, however, say doctors frequently don’t have the time or the knowledge to diagnose underlying emotional problems, such as depression. Pressed for time, they too often use pills as Band-Aids for complaints of the elderly.
Eight-Year Addiction
Doctors prescribed Halcion for Larry LeBlanc of Paramount to help him sleep after a heart attack in 1985. Eight years later, LeBlanc was still taking the pills.
“The doctor said I should have a nap. Older people should have a nap,” said LeBlanc, now 86. “Sleep was an escape. . . . I used Halcion like some use alcohol.”
Soon, he needed more to get the same effect. “The doctor kept telling my wife, ‘He’s using too much.’ I begged him for more. I’m old. I was entitled to my sleep,” said LeBlanc, wiping away the tears he said come frequently since he started taking the drug.
When his wife, Mary, hid his Halcion, LeBlanc, who uses a walker, would slowly search the home “stealing the pills out of the bottle,” he said.
Mary LeBlanc, 83, finally flushed the pills down the toilet in August 1993 and took her husband to New Beginnings at Lakewood Regional Medical Center, one of the few addiction programs in the country specifically for the elderly.
“I could see [the Halcion] was certainly changing his character,” she said. “It was scary. I just knew he was going to hurt himself.”
No one knows how many senior citizens might be abusing prescription drugs.
“Nobody goes around collecting statistics,” said Nancy Osgood, a professor of sociology and gerontology at the University of Virginia and a national expert on aging. “It’s part of our ageism: What’s the problem? They’re going to die anyway.”
Usually retired, often widowed and without friends, elderly addicts are easily invisible. No co-workers to notice erratic behavior or absences. No brushes with the law over the drugs they procure legally. No telltale smell on their breath.
“Closet junkies, that’s what we call them here,” said Bill Hermanski, 68, a former Valium addict who runs Pills Anonymous groups in San Diego County. “They’re at home. They’re alone. They’re afraid. They’re just hiding. Their drug pusher is their doctor.”
Shame, and the fear of losing independence, cause many elderly abusers to deny or hide their problem--dirty laundry no one should see. Most never make it into treatment programs that cater to today’s let-it-all-hang-out therapy generation.
Family members in far-flung cities, confident their aging parent is safely tucked into a retirement community or living contentedly in the family home, often mistake the fumblings, slurred speech and memory loss of drug abuse for old age or senility.
Or they may aggravate the problem because they prefer a sedated grandparent, rather than a cranky, complaining one.
Some families believe the drugs can cause or exacerbate depression in those least able to cope, perhaps bringing death much sooner.
One 68-year-old Garden Grove man shot himself two years ago in his backyard after three years of prescription drug abuse. His family and his drug counselors said they believe the depression that led to his suicide was caused by the tranquilizers and painkillers to which he became addicted after hip surgery.
When his wife of 48 years went into his room after his death, she said, she found his “whole headboard loaded with bottles of pills. . . . He had hundreds and hundreds of [prescription receipts] from the pharmacy, just stacked there.”
“When he took the medication it would make him feel good, if it was just one hour or one minute,” said the woman, who asked that her name not be used. “He knew it wasn’t the thing to do, but he just couldn’t control it.”
The woman tried to help her husband--who had bloated to 240 pounds, calling his doctors to say that he was staggering from the numbers of pills.
“They said he was very persuasive, that he wouldn’t leave the office without getting something,” the woman said. “They’re doctors. If they’re so smart, if they looked at him, why did they keep giving him drugs?”
The doctors for some of the addicts in this story, including the Garden Grove man, declined to discuss their patients, but said it would be difficult for them to know if some secretive elderly patients are receiving the same medications from more than one doctor or are faking pains.
“Honestly, how would I know?” said Dr. David Litke, a Garden Grove internist, one-third of whose practice is senior citizens. “How can you ever quantitate or know how much pain someone’s in?”
Litke said that if he has suspicions about a patient, he requires them to sign a contract that they will only get a certain number of pills, period.
Impact of Aging Boomers
Aging and addiction experts say the problems probably will increase as the baby boomer generation grays and the use of an ever-widening array of prescription drugs also increases.
“The baby boomers are into instant gratification,” said Owen Pollard, 71, a drug counselor at the Positive Action Center at Chapman Medical Center in Orange. “They’re used to the fact that there’s a pill you can take to cure anything.”
Thirty-seven percent of Americans over 65 use five or more prescription drugs at the same time, according to medical researchers and federal reports. Although people over 65 make up less than 13% of the population, they use roughly a third of the prescription medications consumed.
The nation’s over-65 population, now at 33 million, will grow to an estimated 53 million in 25 years, according to the Census Bureau. California’s elderly population will double to 6.6 million.
The number of the nation’s “oldest old”--those above 85--is expected to grow faster still, more than doubling to 7 million by 2020. In California, the over-85 population, now at 323,000, is expected to reach 809,000.
“We’ve got an epidemic in this country. And the epidemic is that nobody wants to take care of the elderly,” said Frederick Mayer, head of Pharmacists Planning Services, a nonprofit educational group, and past president of the California Public Health Assn. “If they’re taking all that medicine, shouldn’t someone be watching?”
Peel back the palm tree-and-pool, sunny-and-secure picture of Southern California retirement living and it isn’t hard to find the world of the elderly addict.
Talk to Liz Prince, pharmacy manager at Thrifty drugstore in Seal Beach, down the road from the sprawling Leisure World retirement community. Prince sees them come--in ever-increasing numbers--clutching prescriptions like flimsy lifesavers.
“They’re lonely. They’re bored,” Prince said. “In the evenings that’s how they get through it. They’ll take the sleeping pill and the anti-anxiety pill and mix it with alcohol.”
Sometimes, if the problem is obvious, she said, she or another pharmacist will pull the customer aside. Some will sheepishly admit their addiction and say they don’t know how to quit, Prince said. Others will simply shrug and say they no longer care.
A few are more blunt, she said. “They say, ‘It’s none of your damn business.’ ”
For pharmacists like Prince, it is not uncommon to see senior citizens, such as Larry LeBlanc, who have been taking potent tranquilizers or sleeping medications for a decade or longer.
“You’re supposed to give drugs like Valium for short-term relief of anxiety--four to six weeks at the outside--not four to six years,” said Gerry Graf, a regional managing pharmacist for Price Club/Costco. “The doctors keep giving it to them. We get prescriptions for 300 Valium at a time. Some of these older people, you can tell before they open their mouths that they’ve taken too much of whatever they’re on.”
Graf said he sees elderly women who started taking anti-anxiety drugs during menopause and never stopped.
“It’s cheaper to medicate them than to deal with their problem,” said Graf, who also is president of the San Diego Council on Aging.
Participating in Pills Anonymous
Mary, a 64-year-old San Diego woman, said her doctor gave her the tranquilizer Xanex when she was in her late 50s and anxious about her mother’s serious illness.
“He said it was a wonderful new drug and it was not addictive,” said the woman, who asked that her last name not be used. “But the more I took it, the more anxious I got. . . . The doctor said I needed to take more of it.”
When she tried to cut back, Mary said, she felt like she was going crazy. “I was so embarrassed because whenever I sat down I would fall asleep,” she said.
Six years after she started taking Xanex, she went to Pills Anonymous and found a doctor to wean her off the drug. It took six months of “pure hell” to kick the habit, and a year before she could sleep and eat normally again, Mary said.
“Years of my life I really lost,” Mary said. “For a long time I don’t think my daughters saw me as someone they could turn to, and they needed me. Now, I think if I’d gotten some psychological support, just learned better coping skills, it would have helped me a lot.”
Caught on the pill treadmill, some senior citizens secretly shop their pain to more than one doctor, rotate pharmacy chains and pay in cash to avoid detection. Unbeknown to her family, one wealthy Los Angeles-area woman in her mid-80s created a separate identity to increase her ability to get prescriptions for everything from the painkillers Talwin and Darvocet to Valium. Only after suspicious counselors gave her a drug test did the woman, now in treatment, own up.
“Underneath it all, she was depressed,” said Debbie Fox, coordinator of the outpatient psychiatric program for the elderly at Century City Hospital. Senior citizens “don’t figure they have a role in society. They don’t figure they have a role in their families. This is their way to cope.”
Before she confessed her drug problem to her son and moved closer to family in Southern California, pills had slowly taken over Mary Shimer’s life.
Her son John Shimer, 53, and his siblings thought their independent-minded mother was happily ensconced in a Florida retirement community. She was receiving treatment for an undefined intestinal problem, but that was it.
Then one night Mary Shimer, now 81 and living in San Marcos, Calif., called her son at his home near Seattle and said she didn’t want to live with the pain anymore.
When John Shimer arrived in Florida, he discovered his mother “had become a recluse in her home.” She was seeing at least three doctors and receiving prescriptions from each. She went to different pharmacies to avoid questions. Worse, he learned from her neighbors that his mother had been trying to find someone to sell her pills.
In the middle of the night a tearful Mary Shimer blurted the truth to her son. “She went to her closet and she brought out a great, big shopping bag full of drugs,” he said. “It was her big secret.”
His mother’s secret became the Shimer kids’ guilt-ridden reality.
“She was definitely lonely there, and her loneliness was one of the reasons she turned to drugs,” said John Shimer, who put his mother in a treatment center, then helped move her near his sister in San Diego County. “We had all gone on our way and gone on with our family life. We weren’t really in tune to the changes she underwent as she grew older--her fear of death, her need to be closer to the family.”
Mary Shimer, who now leads two morning exercise classes for senior citizens and regular beach walks, said she is one of the lucky ones.
She sees others making the same rounds of doctors and pharmacies. “Some of them are just lonesome. Some of them their children just forgot them.”
“There’s something wrong with the system for old people,” John Shimer said. “This is one of the great secrets of the geriatric community. Certainly it’s one of the taboo subjects of the doctors.”
Geriatric specialists and some doctors say the push toward HMOs is forcing doctors to see more and more patients to make the same money.
While such managed-care plans can preclude doctor-shopping by members, they also allow physicians less time to talk to patients and get to the real cause of aches and pains--especially if the patient is cranky and demanding.
“It is extremely time-consuming and emotionally upsetting to find out what’s really wrong,” said addiction specialist Schneider. “It takes two minutes to write a prescription. It might take two years to convince people to stop taking the drugs.”
Bill Hermanski of Pills Anonymous is more blunt. “Just like street drugs, the doctors are your pusher. It’s too time-consuming to help patients withdraw, and they don’t make any money doing it.”
The difficulty for senior citizens is that in the past, drugs tended to be tested on younger people. The elderly, whose kidneys and liver are less effective at processing drugs, can be staggered by amounts suitable for someone in their 30s.
“If they tried to stop by themselves, they could die,” said Tustin addiction specialist Dr. Michael Stone, describing the seizures and psychosis that can result from abruptly stopping use of many tranquilizers and painkillers to which one is addicted.
A 75-year-old Orange woman with a two-year Tylenol-with-codeine habit recalled emerging “black and blue” from thrashing about during a three-day detox at Chapman Medical Center.
“I had to kick it like a heroin addict,” the woman said.
Many officials running retirement communities and doctors that work there say they don’t see a problem with drug abuse.
Dr. Howard Caplan at the Leisure World Medical Center in Seal Beach said the only elderly addicts he sees are those who are suffering from a terminal illness or chronic pain.
A year ago, Jane Eggleston, a former nun, and Jean Stewart, a drug counselor, started Journey to the Well, a Santa Ana addiction education center.
As former counselors at St. Joseph Hospital, they said they had seen a troubling increase in pill addicts over 60. But when they offered to give free talks on alcohol and prescription drug abuse, 32 Orange County senior facilities turned them down.
“Can you believe that? Thirty-two people in charge of retirement homes saying we have no problems,” Eggleston said. “No one wants to admit that older adults have these sorts of problems. Well, they do.”
(BEGIN TEXT OF INFOBOX / INFOGRAPHIC)
A Caution on Drugs
A panel of experts in geriatrics and pharmacology has identified drugs considered generally inappropriate for patients older than 65 because safer and equally effective drugs exist. They include 15 drugs the experts believe should be entirely avoided by the elderly. Doctors stress that patients should always consult their doctors before making changes in prescription medication. The 15 drugs to be avoided:
Drug: Amitriptyline
Brand Name: Elavil
Use: Treat depression
Reason to Not Use: Other antidepressants cause fewer side effects.
****
Drug: Carisoprodol
Brand Name: Soma, Rela
Use: Relieve severe pain caused by sprains and back injury
Reason to Not Use: Minimally effective while causing toxicity; possible toxic reaction is greater than potential benefit.
****
Drug: Chlordiazepoxide
Brand Name: Librium
Use: Tranquilizer or anti-anxiety
Reason to Not Use: Shorter-acting benzodiazepines are safer alternatives.
****
Drug: Cyclobenzaprine
Brand Name: Flexeril
Use: Relieve severe pain caused by sprains and back injury
Reason to Not Use: Minimally effective while causing toxicity; possible toxic reaction is greater than potential benefit.
****
Drug: Diazepam
Brand Name: Valium
Use: Tranquilizer or anti-anxiety medication
Reason to Not Use: Shorter-acting benzodiazepines are safer alternatives.
****
Drug: Flurazepam
Brand Name: Dalmane
Use: Sleeping pill
Reason to Not Use: Shorter-acting benzodiazepines are safer alternatives.
****
Drug: Indomethacin
Brand Name: Indocin
Use: Relieve rheumatoid arthritis pain and inflammation
Reason to Not Use: Other non-steroidal anti-inflammatories cause fewer toxic reactions.
****
Drug: Meprobamate
Brand Name: Miltown, Equinal
Use: Tranquilizer
Reason to Not Use: Shorter-acting benzodiazepines are safer alternatives.
****
Drug: Methocarbamol
Brand Name: Robaxin
Use: Relieve severe pain caused by sprains and back injury
Reason to Not Use: Mnimally effective while causing toxicity; potential for toxic reaction is greater than potential benefit.
****
Drug: Orphenadrine
Brand Name: Norflex
Use: Relieve severe pain caused by sprains and back injury
Reason to Not Use: Minimally effective while causing toxicity; potential for toxic reaction is greater than potential benefit.
****
Drug: Pentazocine
Brand Name: Talwin
Use: Relieve mild to moderate pain
Reason to Not Use: Other narcotic medications are safer and more effective.
****
Drug: Pentobarbital
Brand Name: Nembutal
Use: Sleeping pill, reduce anxiety
Reason to Not Use: Safer sedative-hypnotics available.
****
Drug: Phenylbutazone
Brand Name: Butazolidin
Use: Relieve rheumatoid arthritis pain and inflammation
Reason to Not Use: Other non-steroidal anti-inflammatory agents cause fewer toxic reactions.
****
Drug: Propoxyphene
Brand Name: Darvon
Use: Relieve mild to moderate pain
Reason to Not Use: Other analgesic medications are more effective, safer.
****
Drug: Secobarbital
Brand Name: Seconal
Use: Sleeping pill, reduce anxiety
Reason to Not Use: Safer sedative-hypnotics available.
Source: U.S. General Accounting Office, California Medical Review Inc.