Opioid misuse and overdose in the aging population needs increased attention

OREXO NEWS ARTICLE:

Uppsala, Sweden, September 12, 2024.

Substance use disorders among older adults in the US rarely make the headlines, despite being a significant and growing public health concern, with rising rates of opioid overdose. [i] This article considers the reasons some older adults are misusing opioids and what needs to change.

The baby boom generation, born between 1946 and 1965, are aging. Adults over the age of 62 now make up over 20% of the general population in the US.[ii] By 2030, they will contribute to an overall 72.1 million older adults in the US.[iii] While stereotypical views of adults over the age of 65 might include afternoon tea, day trips to the coast or reading books, the reality can be very different. Results from the 2021 and 2022 National Surveys on Drug Use and Health (NSDUH) show that 1 in 8 older adults aged over 60 years used illicit drugs between 2021-2022, and 1 in 11 had a substance use disorder.[iv] The NSDUH data also shows that around 1 in 9 older adults aged over 60 years were classified as needing substance use treatment, while fewer than 1 in 3 received it.[v] The rate of fatal drug overdoses among people aged 65 years and over quadrupled from 1060 deaths in 2002 to 6702 deaths in 2021.[vi] Most of the unintentional overdoses (74%) involved illicitly manufactured drugs, including synthetic opioids, heroin, cocaine and methamphetamine.[vii] Opioid-involved overdose deaths in the US, across the whole population, have increased annually between 2019 and 2022, from 49,860 to 81,806 respectively.[viii] The opioids responsible include legal prescription medications and illicit synthetic drugs, mainly fentanyl. The US Department of Health and Human Services (HHS) reports that overdose deaths caused by synthetic opioids increased 103-fold between December 1999 and June 2023.[ix]

Opioid misuse can arise through incremental reliance on prescription medications

If a person takes a prescribed medication in a way that it isn’t intended, for example taking too much or too often, gradually they can feel the need to take more to achieve the same benefits. As a person’s tolerance to a drug increases, they develop a dependency that leads to changes to the brain’s reward system. These brain changes drive a person to take more to avoid withdrawal symptoms. The opioid epidemic across the US grew out of the over-prescribing of drugs by physicians. There is greater awareness now of the dangers of patients becoming addicted to prescription painkillers, however the American Medical Association states that approximately 3%-19% of people who take prescription painkillers become addicted to them.[x]

Older adults often experience multiple physical and mental health needs

Complex health needs, such as chronic pain, make this population more likely than younger people to take prescribed opioid medication.[xi] Around 80% of adults aged over 65 years are living with two or more chronic conditions, yet opioid misuse in older adults is not always fully recognized.[xii] If an older adult is taking several different drugs at the same time, they may experience overlapping side-effects, with some patients at risk from polypharmacy (5 or more drugs).[xiii] They may be under the care of several healthcare professionals for a number of needs, which can make them vulnerable to ingesting medications that interact with each other or cause unwanted side effects.

Previous, or existing, mental illness is a known risk factor for opioid use, with up to half of people diagnosed also having a substance use disorder during their lifetime.[xiv] Older adults are at risk even when taking opioids as prescribed, for example from falls, fractures and alterations in metabolism linked to aging.[xv] Some drugs can impair a person’s decision-making abilities, coordination or reaction time, which can lead to accidents and injuries.[xvi] An additional consideration for older adults is that they may already experience the effects of cognitive impairment, which can impact self-awareness. Furthermore, older adults are more likely to face complications after surgery, and these may become more serious as people age.[xvii] If surgery is needed, such as to repair any injuries sustained through slips, trips or falls, there are health risks to consider, such as blood clots, infections, and respiratory complications. While these risks must be balanced with the benefits of increased mobility, independence, and comfort that pain relief offers, the importance of safety cannot be overestimated.

Some older adults may choose to use opioids and alcohol recreationally

Misuse of drugs or alcohol among people in this age group could be missed by providers with uninformed or stigmatized perceptions about lifestyle and behaviors.[xviii] Marijuana use, for example, is becoming increasingly accepted, both recreationally and medicinally, and is known to cause a number of health risks, including problems with short-term memory.[xix] A history of drug taking or alcohol use, or misuse, can also place older adults at risk, as well as mental illness, social isolation or previous trauma. Many of today’s older people were young adults during the 1960s and 1970s, which were times associated with greater freedoms and experimentation with drugs and alcohol. They are increasingly carrying on the drug habits from their youth into later life.[xx] However, the drug landscape has changed significantly since then, with highly potent illicit fentanyl now widely available. It is up to 100 times stronger than morphine and a tiny amount can be enough to cause an overdose.

Older adults need access to non-stigmatized and inclusive care

Access to specialist screening services is essential in order to provide patients with impartial and evidence-based information about the risks of substance abuse. This empowers individuals to recognize and address high-risk behaviors as well as gain access to the right treatment to minimize negative health outcomes. The right services can give people the time, support, and treatment they need to manage mental and physical health needs and optimize health outcomes. Taking a holistic approach is key to understanding a person’s unique situation, feelings and needs and to tailoring their treatment accordingly. Creating a joined-up approach to patient care is essential to safeguard older adults, who may be living in vulnerable circumstances, and to help prevent more untimely deaths caused by opioid overdose.

Written by Georgina Hoy