When Grandma Is a Drug Addict

Say “drug addict,” and most people picture a tattooed, unemployed bum hanging out on a street corner or a prostitute whose revenue is quickly reinvested in a hit. Yet there is a large group of individuals whose inadvertent pushers are doctors and who never would consider themselves at risk from or dependent on the medications they take. You and I are probably more at risk from the effects of their drug use than from that of the more stereotypical users. Let me tell you about one such addict.

She was a charming little old lady whose mild dementia had been worsened by a prescription she’d received from her doctor for a bout of insomnia. The pills she’d been given, a class of drugs called benzodiazepines, worked so well that she kept right on using them, and pretty soon she just couldn’t get to sleep without one. Her daughter, noticing that mom was slipping, moved her across the state to live close by. Soon after the involuntary relocation, the daughter brought her in for a thorough medical evaluation. The daughter’s chief worry was the fact that her mom had somehow qualified for a renewal of her driver’s license.

Well, the daughter’s anxiety was certainly not groundless. Research some 15 years ago demonstrated that younger drivers who were given 10 milligrams of a benzodiazepine called Diazepam (also known as Valium) experienced a decrease in open-road driving performance equivalent to the ingestion of enough alcohol to cause legal intoxication. It’s also been shown that the impairment caused by benzodiazepines actually increases with age. Throw a touch of dementia into the mix, and you’ve got a recipe for a highway catastrophe.

Though we were able to make arrangements to wean our senior citizen off her medication and provide alternate transportation for her, she is just one person. There still are many older drivers out there who don’t have relatives quite so concerned as my patient’s daughter was. A recent study in the Journal of the American Medical Assn. of more than 200,000 older drivers who collectively had more than 5,000 injurious crashes showed that drivers on long-acting benzodiazepines had 50% more of such accidents when compared with elderly drivers not taking the drugs. Remember that persons over 60--roughly one-sixth of our population--receive one-third of the prescriptions written for these drugs.

Yet benzodiazepines are only a part of the problem. Other medications also compromise the older driver’s already diminished reaction time, and to this mix must be added the deleterious effects of the aging process itself. I’m reminded of a spunky, arthritic lady who told me that she had no trouble getting to the clinic: Her legally blind husband drove, and she warned him when he was about to hit something.

In fact, drivers over 65 have more auto accidents per miles driven than any other age group except for teenagers. Manufacturers of large luxury cars know this. They make a point of targeting affluent seniors with the suggestion that purchasing their behemoths will insure a reduced risk of injury in a crash. Alcohol use is also increasingly a problem in the elderly. A small amount of alcohol packs a big wallop in an older person.

So what do we do about our elderly addicts, alcoholics and Alzheimer’s victims? They’re a menace on our highways, that’s for sure. And they constitute a growing percentage of our zero-population-growth society. But they themselves are in a terrible bind. In many cases, their independence rides on their wheels; the only alternative to driving themselves where they need to go, however impaired they may be, often is assisted living or the nursing home.

I don’t propose it as the only solution, but perhaps a focused media blitz warning the elderly of the potential risks of alcohol and overmedication, combined with increased Department of Motor Vehicles vigilance for impaired older drivers, may help to protect the lives of the elderly--and of everyone else in the bargain.