1. Sretta Clark
Independent Research in Gerontology
GERO 490 - Fall 2013
Dirty Deeds: How Grandma Became a Drug Dealer
“Dottie Ratliff Neeley, age 94, [of] Hueysville…passed away Tuesday, July 3, 2012, at
her residence. She was a retired social worker.” (Doty, 2013) It is always bittersweet when a
loved one passes; those left behind are filled with pleasant memories, as well as a sense of
emptiness. I imagine that the officiate presiding over her funeral gave comfort to the family by
reminding them that she was no longer in pain, something perhaps her physician tried to ensure
as well, during her last years on Earth. Of course, I cannot be certain, but it would seem logical
that the hydrocodone seized at the time of her arrest came from a legitimate source and to treat a
legitimate condition. You see, five years prior to her death, “Dottie Neeley…was fingerprinted,
photographed and thrown in jail, imprisoned as much by the tubing from her oxygen tank as by
the concrete and steel around her”. (AP, 2009)
“[Dottie] is among a growing number of Kentucky senior citizens charged in a
crackdown on crime authorities say is rampant in Appalachia: Elderly people are reselling their
painkillers and other medications to addicts.” (AP, 2009) Between 2004 and 2008, Kentucky’s
anti-drug task force, Operation UNITE, had charged more than 40 seniors over the age of 60
with selling prescription drugs in the mountains. Some believe that this practice results from the
need to supplement an extremely fixed Social Security income, but task force officials are
hesitant to agree, offering another explanation: “Most of the elderly we arrest are merely

2. continuing a family tradition. It has been part of their culture for a long time”. (AP, 2009) Still
others, feel that this problem could be greatly diminished if physicians would use more caution
in their prescribing habits.
It is easy to shine a sympathetic light on Dottie, at least until you know that
Commonwealth Attorney Brent Turner requested recusal from the case after the Kentucky State
Police produced an audiotape in which Ms. Neeley “threatened his life” along with that of one of
her co-defendants. (Music, 2009) Dottie is not alone in the “grandparent gone gansta’”
phenomena; John Slingland, age 69 of Graves County was brought up on federal charges of
possession of methamphetamine with intent to distribute. How much methamphetamine? So,
glad you asked; that would be 53 pounds of the substance, with an estimated street value of
$2,400,900.00 and then there was the matter of the $88,000.00 in cash that was seized along with
the drug. (Local6, n.d.) I would propose that this might be a glaring example of a continuation of
existing behavior, as it far exceeds the “supplementing of income” notion. And before one
assumes that these are the behaviors of the scourge of the Senior Citizen Center, we must
consider another subject, Ronnie Lane, age 73 and the Magistrate of Garrard County. Mr. Lane
was apprehended as he was eating breakfast as his usual haunt, the Rocky Top Shell Station on
U.S. 27. He was charged in Jessamine County with first-degree trafficking of a controlled
substance and while out on bond was “arrested on six new felony charges for allegedly selling
the prescription painkiller oxycodone…to an undercover Kentucky State Police trooper.”
(Mojica, 2013) A review of court records in both counties yielded no previous arrests that would
label this case to be one of continued behavior, and given the fact that magistrates do receive a
salary and full benefits in the state of Kentucky, it is hard to toss this in the supplemental income
category.

3. During my preliminary research, three potential causes of seniors turning to drug dealing
emerged: 1) To supplement their limited income, which is generally only from Social Security;
2) As a continuation of lifelong behavior; and 3) As a result of a new addiction to or careless use
of a medication caused by the overprescribing or poor monitoring on the part of their physician. I
will therefore address all three of these potentialities, with the intent to provide a better
understanding of the information we have and hopefully to identify avenues of future exploration
in the search for a solution to this growing problem.
Seniors Living in Poverty
“America’s population is aging rapidly. More than one-in-eight individuals, or 13% of
the population, is older than 65. By 2050, 88.5 million Americans, one-in-five, will be at least 65
years old…” (Wider Opportunities for Women, 2013) With the greying of America and the
subsequent decline in the birth rate, seniors are increasingly finding themselves with fewer loved
ones to rely on as the end of life nears. Women, left behind as the husband traditionally is the
first to pass on, are at particular risk for living in poverty. Fending for themselves and their
spouses, is the selling of medications a viable alternative, at least in the eyes of the men and
women engaging in this practice? “In Bellaire, Ohio, for example, one 65-year-old man was
arrested in November after authorities said he sold undercover officers $350 worth of Percocet
pills. The man, who is currently in jail pending a court hearing, said he was just looking for a
way to pay for his wife's medical bills. His wife has multiple sclerosis. But, despite their age and
struggles, seniors convicted of drug trafficking could face years in prison.” (Unknown, 2005)
To obtain a better understanding of the rationale behind this choice, I interviewed a
gentleman who is currently very active in a 12-step program, whom I will refer to as “Bill” to
maintain his anonymity. Bill’s explanation was quite simple: “If I got a prescription for my hip

4. pain and it’s for two Oxycontin a day, and those are 80 mg pills, that means I get 60 pills a
month. I can sell those for $50.00 a piece and that means $3,000. I only get a little over $400 on
my Social Security check and that ain’t paying nothing. Heck, didn’t make that kind of money
when I was working, ya know.” I asked Bill if he thought his actions were illegal and if he
should have gone to jail, to which he replied, “These are my medicines that I got from my
doctor. I didn’t steal them and I wasn’t selling marijuana or anything like that.” ((Bill), 2013)
Although, I can see the illegality in Bill’s actions, I was not convinced that he could. Bill had
been court ordered to a treatment program after being arrested for selling his prescription pain
medication to an undercover detective. His demeanor throughout the interview suggested that he
did not see this punishment as befitting his actions.
“The National Alliance to End Homelessness predicted that homeless rates among the
elderly would climb by 33 percent – or about 14,000 people – within a decade.” (Eichler, 2013)
Though few of us would support the elderly selling medications that they presumably need, to
ensure that they are not among the homeless, it is clear that we must look for a lasting solution to
compensate for the loss of income, the loss of independence, and moreover the loss of concerned
caregivers to protect this at-risk population.
Once an Addict, Always an Addict
“I can’t say I believe that it is a continuation of lifelong behavior because users don’t
make it to old age. You build up a tolerance and take more and more; either your heart is just
going to finally give out, or you’re going to OD, either way, you’re not going to be on a front
porch in a rocking chair at 90, you will be long gone before that.” ((Bob), 2013)
Perhaps the single most concise and informative piece of work I uncovered during my
research, was a report entitled, “Substance Abuse Among Older Adults: A Targeted Response

5. Initiative”. This work comprised input from 166 individuals who participated in either focus
groups on qualitative interviews in 8 locations throughout the state of Ohio. 84 of these
individuals were either active drug users, recovering drug users or non-users who had substantial
knowledge of persons who were active drug users. The remaining 82 individuals were service
providers, working directly with active and recovering users.
Subjects covered in the focus groups and qualitative interviews included: patterns of
abuse; reasons for abuse; negative consequences of abuse; and treatment issues specific to
seniors. Illicit use of prescription medication was viewed as the second most common substance
abused by older American (the first being alcohol). Within this, opioids and benzodiazepines
were the most common drugs of abuse and these were most frequently abused by women. With
regards to street drugs, marijuana was the most commonly used and like younger users, seniors
tend to see this as a “safe” drug. Not surprisingly, the elderly generally obtain this substance
from younger family members. Though most view crack cocaine as dangerous, and bringing
with it negative effects on health as well as a perilous lifestyle, it is not completely absent from
the elderly cohort. It does however tend to reside in communities where it is already a prevalent
drug of abuse and is used mostly by men who are sexually involved with younger female users.
Still more rare is Heroin, but when found in the elderly population, it is used by African-
American males having been addicted for years.
Though reason given by the current and recovering drug users tended towards, loneliness
and boredom from social isolation; lack of family involvement or support; or death of a spouse,
service providers offered that “lifetime history in a common factor. Individuals simply carry their
substance abuse habits into old age.” (Carlson, et al., 2007)

6. Are Physicians Causing or Contributing to Addiction
One common theme found in nearly all the peer reviewed research I conducted, was the
lack of a screening or assessment tool available for identifying or diagnosing drug misuse or
abuse in the older population. Additionally, service providers in the Ohio study, felt that the lax
practices of the physicians in giving out controlled substances to seniors, was a serious
contributing factor to this matter and pointed out that over-prescribing and “doctor shopping” are
the most common methods used by seniors to obtain drugs. (Carlson, et al., 2007)
“These older people just do what their doctors tell them to do. I see a ton of older people,
not seniors, but older, come through here that are linked to the V.A. Hospital, including me. The
doctors there, just keep handing out the pills. I guess for them it is a win-win situation, I mean
the patient doesn’t have to pay for their medications, the doctors know they are getting paid by
the government, so they aren’t out anything and I would imagine that the drug companies are all
for it, considering they are making a profit. My medications were coming directly in the mail to
me, I didn’t even have to leave the house to get them.” ((Bob), 2013)
Having spent my life in healthcare, it was hard for me to believe that a physician, sworn
to do no harm, would intentionally ignore warning signs. That was before my interview with Dr.
Jack Perry. Dr. Perry formerly had a private practice in Lexington, Kentucky, but today works as
a freelance physician in emergency rooms throughout Kentucky and Florida. When questioned
about his experience with oversights or outright negligence, he recounted the following incident.
“I did have a 77 year old female present at the ER who had OD’d on opiates. The doctor that
wrote the prescription was my neighbor, so I called him. He said he had suspected that she was
abusing them, but he didn’t talk to her about it.” I inquired as to whether or not he had time to
have a meaningful discussion with patients, when he was in private practice. “…there just isn’t

7. always enough time.” The interview then turned to how an ideal discussion would go. “You need
to start with observation. I would expect to find certain things in a patient who was truly in
pain…increased heart rate, elevated blood pressure, perspiring…the clinical picture needs to be
congruent with the complaint, and asking probing questions such as ‘does anyone help you
manage your medications’. There are other red flags too, such as the patient requesting early
refills, frequently presenting at the ER for routine issues, or using multiple doctors, hospitals and
pharmacies. You really have to look at the entire picture.” (Perry, 2013)
“In a study of primary care patients in a Veterans Affairs facility who were receiving
opioids for the treatment of pain (average age 59), 78% reported at least one indicator of
medication misuse during the prior year, with significantly more of those who misused pain
medications reporting a comorbid substance use disorder. After alcohol, opiates were the second
most commonly reported primary substance of abuse by adults aged 50 and older admitted to
substance abuse treatment programs…” (Blazer & Wu, 2009)
Still yet, the provision of healthcare has a system of check and balances built into it to
some degree. Certainly, the physician diagnoses the problem and prescribes the appropriate
treatment, but other professionals assist in carrying out the ordered treatments. To what extent
are these individuals culpable in this matter? “The pharmacist is a party to this overconsumption
when he or she dispenses medication without a prescription (i.e. treatment “in advance”).
Patients tend to self-medicate and overconsume BZD [benzodiazepines]/equivalents beyond the
prescribed dose, seeking to obtain treatment by alternate ways bypassing the prescription. This
should encourage everyone involved in the prescribing and dispensing of prescriptions to modify
their practices.” (Landreat, et al., 2010)

8. Continuing my interview with Dr. Jack Perry, I inquired as to why elderly patients would
tend towards the overconsumption of benzodiazepines and if this class of medication presents a
potential higher risk than opioids. “Most fatal overdoses result in a combination of opioids and
benzodiazepines. The majority of elderly [patients] admitted to the hospital are on
benzodiazepines.” This class of medication is generally used to treat anxiety disorders and
includes short acting varieties such as Xanax and Ativan, as well as long acting formulas such as
Klonopin. Short acting benzodiazepines peak and leave the body quickly, about six hours, start
to finish. “…at this point, the patient feels the panic return (dysphoria) and thinks, “okay, I need
to take another pill to make this [feeling] go away”. The [medication] doesn’t “fix” the anxiety
like they think, it simply raises their threshold and they are able to deal with more anxiety
without the negative symptoms. Worse still, this continuous ‘take another one’ mindset results in
a cumulative effect, their bodies are not eliminating the substance at the same rate a younger
adult would.” (Perry, 2013)
Many seniors take a variety of medication, making it difficult for providers and
caregivers to identify cases of abuse. It would then seem that the issue cannot be resolved unless
it is approached in a holistic manner. “The prescribing physician should become concerned if a
patient describes a tolerance to his/her treatment and asks for higher doses, and should question a
patient on their quantitative and qualitative ways of consuming BZD. The pharmacist should also
be concerned if a patient asks for drugs without a prescription. Patients should be clearly
informed about prescription conditions, how to stop treatment as well as the risks related to
consumption and especially the addiction risks. Here therapeutic education of the patient is
probably one of the keys to prevent addiction.” (Landreat, et al., 2010)

9. In the Reid, et al. study, the population consisted of 133 seniors. The mean age of the
participants was 82 and an overwhelming 45% of participants had a psychiatric comorbidity of
/depression. 44% of the participants were prescribed Oxycodone and 59% were prescribed their
medication on a PRN basis. I include this information, because I question the soundness of
prescribing any medication to an elderly person on a PRN basis, particularly without a detailed
explanation of how the older body metabolizes these medications, and offering extreme words of
caution to the patient on the potential overuse of medication, as well as life-threatening
complications arising from the mixing of medications.
Conclusion
“So, who is buying drugs from senior citizens? Anyone from first-time-user high school
students to hardened drug addicts desperate for a fix, investigators say. More and more elderly
Kentucky residents are being arrested due to Operation UNITE, an Appalachia-based antidrug
initiative launched in 2003, according to the Lexington Herald-Leader newspaper.” (Unknown,
2005) Regardless of the individual hows or whys that seniors are abusing or misusing drugs, the
potential negative consequences are universal. Increased potential for falls, drug to drug
interactions, poor nutrition and deteriorating pre-existing health conditions are almost guaranteed
and the risk for increased social isolation, family conflict and an increased risk in the likelihood
of victimization are significantly elevated.
With the “silver tsunami” on the horizon, I had anticipated my future in gerontology to be
filled with exciting opportunities to devise ingenious ways to improve the quality of life for
seniors. My thoughts were fixated on the positives; people taking better care of themselves and
advances in medical technology would be adding healthy and hope-filled years to all. To be

10. certain, we all must eventually bid farewell to this life, but the notion of compressed morbidity,
was a fair trade-off I surmised, for the gift of precious time. My Pollyanna attitude dreamed of
hi-tech senior citizen centers, merchants designing their stores to accommodate those who would
dominate the population, and a jolly goodbye to passé nursing homes and a hearty ‘how-do-you-
do’ to continued living campuses. A utopia, as it were, in honor of societies sages. Through my
research, I found this to be a sadly naïve approach. Each generation in fact, brings with it its own
baggage, and the abuse or misuse of drugs, legal or otherwise, will be among the bags we must
unpack for these timely travelers. “As the ‘baby boomer’ cohort ages, the extent of alcohol and
medication misuse is predicted to significantly increase because of the combined effect of the
growing population of older adults and cohort-related differences in lifestyle and attitudes.”
(Culberson & Ziska, 2008)
“There is a gap in our understanding of the reason why older people misuse alcohol and
other drugs. What are the cultural habits and meanings associated with alcohol and drug use in
older people? Are they self-medicating to deal with underlying mental health concerns or social
isolation? Do older people change the way they interact with and consume drugs and alcohol as
they age? Where are they likely to seek help for problematic use? There are many unanswered
questions about alcohol and drug use in this vulnerable, forgotten population. It’s time to start
talking about it.” (Landreat, et al., 2010) I allow myself a humorous moment, to envision sing-a-
longs being replaced by karaoke with grandma belting out her favorite Janis Joplin lyric, braids
flowing down her back and a wreath of daisies in her hair; the children of the summer of love
have arrived. Legalized marijuana being passed around the dayroom, while elder hippies engage
in macramé and bongo lessons. The smile however fades from my lips when I look at the
seriousness of the situation. Elderly individuals are being arrested and jailed, along with the

11. heroine dealer from the street corner. I wonder who takes their vital signs, manages the
incontinence, and makes certain that they are ambulating fifty feet three times a day. I suppose
medical records are replaced with arrest records, but is the criminal justice system prepared to
manage the other needs of this special population? Certainly, if possible, this is a case where
prevention is truly the best medicine. It appears from the existing research, as well as my
interviews with Dr. Jack Perry, and Bill and Bob that dialogue and education are the most
important tactics to employ. “We can’t sit and wait for seniors to show up for treatment. They
don’t like to open up, it takes a very active approach…we need to teach professionals how to talk
to seniors.” (Carlson, et al., 2007) We must begin by confronting and challenging these
unhealthy new “norms” of aging.

12. Works Cited
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13. Mojica,S. (2013, September12). Garrard magistratefacesmorechargesforalleged drug dealing .
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