Mixing Alcohol with Pharmaceuticals

Elderly Australians are being prescribed drugs that, when consumed with alcohol, represent a considerable risk of harm from multiple drug toxicity – including death.

As we have written previously here in GrogWatch, older people are more likely to consume alcohol daily than younger people. Research also tells us that they are using prescription drugs for conditions such as dementia and chronic pain. Alzheimer’s Australia report that about half of people in residential aged care facilities and up to 80 per cent of those with dementia are receiving psychotropics such as olanzapine and risperidone. Since 2006, there has been a marked increase in the rate of prescriptions for fentanyl, a pharmaceutical opioid drug used for relieving pain, among Australians aged 80 and over.

In one sense, the medicated life that elderly people experience is not unlike the broader Australian population. Our country has a strong attachment to ‘legal’ drugs available over-the-counter and with a prescription. Between 1992 and 2012, the number of times opioids were dispensed through the pharmaceutical benefits scheme increased 15-fold (500 000 to 7.5 million). In 2013 alone, codeine (both prescription and OTC) accounted for two thirds of all pack sales across Australia (29% prescription codeine and 37% OTC codeine).

Australians use prescription drugs with alcohol too – data from the National Coronial Information System tells us that the overall rate of codeine-related deaths increased from 3.5 per million in 2000 to 8.7 per million in 2009. Most of these deaths were the result of multiple drug toxicity, with alcohol being present in 25.9% of cases.

The effects of drinking and over-the-counter or prescribed medications can be unpredictable and dangerous. They can lead to decreased heart rate, blurred vision, slower reaction times, nausea and others.

But for older Australians, it’s reasonable to argue that their risks and experiences of harm associated with alcohol and prescription drugs are greater than the rest of the population. They’re more likely to take medication, their tolerance for alcohol decreases, falls become an issue, and so on. Their general life circumstances mean that recovering and/or managing a health issue is more difficult – for example, having sufficient income, adequate and safe housing, and a physical environment that facilitates independence and mobility.

Given that prescribing for the drug Fentanyl has increased, and the life conditions of elderly people generally, pharmaceutical opioids represent a major issue for elderly people. The risks linked to opioids become greater again when opioids are taken in higher doses – including slowed breathing and death. For more information on pharmaceutical opioids:

There are few programs or services that are specifically designed to respond to the alcohol treatment needs of older people, and fewer still that have been evaluated.  Also, few practitioners feel able to speak with authority on this issue.

Older people need the best health advice just as much as younger people. Older people are living longer, and it is in their interest, and the interest of everyone else, that they remain healthy as long as possible.

We look forward to more research being undertaken into how alcohol issues affect older people and how older people can ensure that any drinking they do does not compromise their health or their enjoyment of life.

Written by Dr Ben O’Mara