Prescription Drug Misuse in Older Adults: A Population Often Overlooked

An older adult has become sleepier during the day, is requesting refills earlier, or has fallen more than once. The medication list includes treatment for pain, anxiety, or insomnia. These observations deserve assessment, but they do not establish prescription misuse or a substance use disorder. Medication side effects, dosing confusion, an acute illness, and other medical conditions may produce similar changes.

Prescription drug misuse in older adults means taking a medicine in a way other than prescribed, taking someone else's prescription, or using it for its effects rather than its intended purpose. A substance use disorder is a separate diagnosis requiring a clinical assessment. Physical dependence can develop during prescribed use and does not, by itself, mean that someone has a use disorder.

For primary care clinicians, therapists, and referral partners, the useful next question is not “Is this person addicted?” It is “What is happening with medication use, safety, and daily functioning, and who needs to be involved?” This article offers a practical assessment and referral framework, not individualized prescribing advice.

Why medication-related concerns can be missed in later life

Older adults may be taking several prescriptions alongside nonprescription medicines and supplements. Changes in how the body processes medications, other health conditions, and interactions can increase vulnerability to adverse effects. The National Institute on Drug Abuse's overview of substance use in older adults describes these overlapping risks and the importance of recognizing prescription medication concerns.

Changes in alertness, balance, memory, or self-care can be attributed too quickly to aging. Conversely, a clinician may assume misuse when the actual issue is an unclear label, difficulty opening a container, a recently changed prescription, or difficulty remembering whether a dose was taken. Both shortcuts can delay the right care.

Retirement, bereavement, isolation, and persistent pain may also shape how someone uses medication. These circumstances are reasons to ask about coping and support, not evidence of a diagnosis. An older adult can have legitimate pain or anxiety and still need a safer, more coordinated treatment plan.

Separate adverse effects, misuse, and physical dependence

A useful assessment keeps several possibilities open. Adverse effects can occur even when medication is taken exactly as directed. Unintentional dosing errors may reflect confusing instructions or practical barriers. Intentional misuse may involve taking additional doses, using another person's medication, or taking a medicine to manage distress outside the prescribed plan.

Physical dependence describes the body's adaptation to regular medication exposure. Withdrawal may occur when certain medicines are reduced or stopped. It is not interchangeable with compulsive use or a substance use disorder. The distinction matters because a person who followed a prescription should not be told that dependence proves wrongdoing.

The FDA's benzodiazepine safety communication distinguishes risks of misuse, addiction, physical dependence, and withdrawal. It warns that abrupt discontinuation or rapid dose reduction can produce serious withdrawal reactions. A concern about medication safety calls for prescriber involvement, not an instruction to stop immediately.

Start with a medication history that reflects actual use

Medication reconciliation should compare the documented list with what the person actually takes. Ask about prescriptions from all clinicians, over-the-counter sleep or allergy products, supplements, alcohol, cannabis, and other substances. With the person's permission, a pharmacist or involved caregiver may help clarify discrepancies.

Specific questions often reveal more than “Are you taking everything correctly?” Consider asking:

• “Walk me through what you take from waking up to bedtime.”

• “What do you do when pain, anxiety, or sleep is worse than usual?”

• “Has the label or dose changed recently, and what instructions were you given?”

• “Have you run out early, missed doses, or been unsure whether you already took one?”

• “Have you noticed changes in balance, alertness, memory, or driving?”

• “Who helps you contact the prescriber when something is not working?”

Ask without implying that a particular answer will automatically lead to medication removal. Explain that the goal is to understand benefits, risks, and practical needs. Early refills or multiple prescribers warrant clarification; they are not proof of deception. Specialist care, travel, insurance changes, and communication gaps can also complicate a medication history.

Pay particular attention to opioids, benzodiazepines, and combinations

Opioid pain medicines and benzodiazepines deserve careful review because sedation, interactions, dependence, and misuse may affect safety. Alcohol or other sedating substances can add risk. The FDA warns that combining benzodiazepines with opioids or other central nervous system depressants can cause serious breathing problems and death.

A useful review considers why each medicine was prescribed, current benefit, recent changes, actual use, and who is monitoring the plan. Do not assume that a long-standing prescription remains appropriate without reassessment, or that a prescription should be discontinued simply because the person is older.

When benzodiazepine dependence is a concern, Waterview's discussion of prescriber-supervised tapering and clinical support explains the coordination issues in more detail. It does not provide a do-it-yourself taper schedule. Medication changes require an individualized medical plan.

Decide whether the concern needs urgent medical attention

An outpatient behavioral health referral is not a substitute for evaluating an acute change. New confusion, a significant fall, or rapidly worsening sedation may require prompt medical assessment. Severe breathing difficulty, inability to wake the person, a seizure, or another immediately life-threatening situation requires emergency help through 911.

Possible withdrawal, intoxication, unstable medical conditions, or inability to remain safe should be assessed before assuming routine group treatment is appropriate. Clinicians should follow their setting's medical and emergency procedures. If a prescription interruption may create withdrawal risk, coordinate promptly with the responsible prescriber rather than asking the person to wait for a routine intake.

For a nonurgent concern, identify who will review medication safety, how soon follow-up should occur, and what changes should trigger a faster response. A clear handoff is more useful than an open-ended recommendation to “get help.”

Match behavioral health support to the whole clinical picture

Some people need clearer instructions, pharmacist support, closer primary care follow-up, or a prescribing review rather than an intensive program. Others may benefit from outpatient therapy addressing grief, anxiety, sleep-related concerns, or coping with pain. A diagnosed substance use disorder may require addiction treatment and coordination with medical care.

An intensive outpatient program, or IOP, may be considered when mental health or co-occurring concerns require more structure than routine weekly care and can be managed safely without round-the-clock supervision. Age or a prescription concern alone does not establish that level of care. Medical stability, cognition, mobility, hearing, transportation, group participation, and support outside program hours all matter.

When substance use and mental health symptoms interact, co-occurring disorders care can address both within a coordinated plan. That does not mean every medical or addiction service is available in one setting. Confirm what the receiving program can provide and which needs remain with primary care, a specialist, or another treatment service.

Make the referral specific, collaborative, and consent-based

Describe observations rather than assigning motives. “Increasing daytime sedation and uncertainty about dosing” gives the next clinician a starting point. “Noncompliant” or “drug-seeking” can obscure the assessment question and damage trust. Include the person's own goals, such as being more alert, managing pain, or keeping an independent routine.

A focused handoff can identify:

• The reason for referral and the pattern or timeline of concern.

• The medication list, known discrepancies, and responsible prescribers.

• Relevant medical, withdrawal, cognitive, fall, and functional concerns.

• Current supports and practical barriers to attending care.

• Who will manage prescriptions and follow-up while the referral is assessed.

Share only necessary information through approved secure clinical channels and with appropriate consent or other applicable authorization. Do not put medication histories or identifying treatment details into a general website form. Clarify communication responsibilities so that the person is not left between services.

Include family support without replacing the person's voice

Family observations can help establish changes over time, but involvement should respect the older adult's preferences, decision-making rights, and applicable privacy requirements. When appropriate, invite the person to choose what support would be useful: transportation, help preparing questions, or assistance understanding written instructions.

Families should not be expected to diagnose a use disorder, enforce medication changes, or design a taper. If a caregiver reports safety concerns, listen and follow an appropriate clinical response while maintaining confidentiality. Cognitive or capacity concerns require qualified assessment, not assumptions based on age.

Discussing program fit with Waterview Behavioral Health

Waterview Behavioral Health provides adult mental health IOP in Wallingford, Connecticut, including care for co-occurring mental health and substance use concerns when appropriate. Current program information describes group treatment, individual therapy, psychiatric care, and transition planning based on assessment. Medication management within IOP may support a coordinated plan; it does not replace necessary medical evaluation or emergency withdrawal care.

For referral partners, the next step is a consultation about clinical needs and practical fit, not an assumption of admission. Confirm current availability, accessibility, insurance requirements, medical coordination, and whether another service should come first. No older-adult-specific track, detoxification service, or particular prescribing arrangement is implied here.

To discuss an appropriate referral pathway, contact Waterview's care team or call (860) 421-6829. Keep identifying clinical information out of the initial general inquiry and ask how to coordinate securely. This article is general professional education, not a diagnosis or an individualized medication recommendation.

Frequently asked questions

Does needing more medication always mean a substance use disorder?

No. Worsening symptoms, tolerance, dosing confusion, or other changes may contribute. A clinician needs to review the pattern, benefits, adverse effects, and functioning rather than diagnosing from a refill request alone.

Can an older adult have medication-related impairment without misuse?

Yes. Side effects and interactions can occur during prescribed use. The assessment should consider medical causes and the full medication list rather than assuming intentional misuse.

Should a referral wait until the person agrees with an addiction label?

No label is needed to discuss medication safety or request an assessment. Use the person's concerns and goals to explain the referral while respecting consent and clinical responsibilities.

What should be clarified before an IOP referral is completed?

Clarify immediate medical safety, who manages prescriptions, outpatient suitability, practical participation needs, and secure communication between services. The receiving team determines program fit after assessment; a referral does not guarantee admission.