Health Check: Drug abuse is no respecter of age

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NO FIELD offers a better spectacle of double standards than drug abuse. We have (so-called) grown-ups parroting about the evils of dope, coke and heroin before returning home to sink double gins into their double chins.

We have a "drugs tsar" and detox clinics, we have advertising campaigns and "Just Say No". There is a public panic about drug-taking among the young. No matter that no one has the faintest idea what to do about the problem, politicians have committed themselves to defeat the menace and there is a grand kerfuffle about the whole matter.

Compare this with the silence on drug abuse at the other end of life - among the old. I am not talking here of aged bingo-players lining up the barley wines, or retired county types downing one too many summer- evening Pimm's. They know how to enjoy themselves. No, I am talking of an altogether more sinister kind of chemical manipulation - the administration of the so-called "liquid cosh".

The liquid cosh is a cocktail of powerful sedative drugs - the kind the young would pay good money for - given to keep the residents of old people's homes quiet and easy to manage. Some doctors refer to it as a "chemical ball and chain". Why spend time and energy keeping an eye out for an Alzheimer's sufferer who is prone to wander when you can effectively lock him in his chair with a dose or two of sedatives?

Two years ago, the Royal College of Physicians drew attention to the practice of "switching the patients out with the lights". It found that mass drugging was the norm, with more than 90 per cent of residents of old people's homes prescribed drugs, and nearly half taking major tranquillisers and other sedatives. Too many of these men and women were spending their final months and years in a state of suspended consciousness occupying a half-world, waiting for death to come.

In the United States, laws governing the use of neuroleptics - powerful anti-psychotic drugs prescribed to keep disturbed elderly people under control - have been in force since the Eighties, requiring doctors first to try other measures, such as psychological treatments. A study of the prescribing of the drugs in old people's homes in Glasgow in 1996 concluded that, had the American guidelines applied, use of the drugs would have been judged inappropriate in almost nine out of 10 cases.

Harry Cayton, chief executive of the Alzheimer's Disease Society, believes that the over-medication of people with dementia amounts to abuse. Neuroleptic drugs should be used only where absolutely necessary and not as a replacement for good care, he says. He wants the Government to introduce regulations restricting the inappropriate use of the drugs in the new standards for nursing homes that are currently in preparation.

Drug abuse among the elderly is different from that among the young, not so much in its chemical content, as in the agents of its administration.

The liquid cosh is wielded by people in authority who should know better, and should show more care. Drug abuse in the young, by contrast, is sought by people eager to test the limits - physical, emotional and chemical - and is achieved in spite of efforts by those in authority to prevent it.

The only strategy likely to work against drugs is a wholesale change in social attitudes to the imbibing of mood-changing substances, but it is not one that is likely to win public support. If we cannot prevent chemical abuse of the elderly - and, moreover, implicitly sanction it - we are, I submit, unlikely to persuade the young to desist from chemically abusing themselves. The drug culture is not youth culture. It is our culture.