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• Posted January 13, 2022

Opioid Misuse Keeps Rising Among Older Americans

The opioid addict you know might not be the college kid who has always dabbled in alcohol and drugs.

It could be your grandparent.

Opioid misuse doesn't discriminate by age -- and rates are rising steadily among adults aged 55 and up, new research shows.

"You can still use recreational drugs at an older age. You can have STDs at an older age, but we don't think about it, I think, because of stereotypes about what it means to be an older adult," said researcher Maryann Mason. She is an associate professor of emergency medicine at Northwestern University's Buehler Center for Health Policy and Economics, in Chicago.

Mason and a team from Northwestern's Feinberg School of Medicine took a closer look at opioid use and deaths in older Americans, breaking the issue down by age, gender, race and ethnicity.

The researchers found that between 1999 and 2019, nearly 80,000 Americans aged 55 and older died of an opioid overdose, with a low of 0.9 per 100,000 in 1999 and a high of 10.7 per 100,000 in 2019. That's an increase of 1,886% in just 20 years.

Among those who died during those years, nearly 59% were men and nearly 80% were aged 55 to 64 years, according to the report published online Jan. 11 in JAMA Network Open.

By 2013, trends began to diverge by race. By 2019, it meant opioid overdose deaths for non-Hispanic Black men were about four times the overall rate for others the same age.

Mason said the context is important. Black Americans have traditionally been under-medicated for their pain because of discriminatory medical practice. And they disproportionately live in communities with less access to treatment programs and are offered less access to effective medication-assisted care.

The trend may also owe in part to the fact that this age group includes people exposed to drugs while serving in the Vietnam War, Mason suggested.

Dr. Lawrence Brown Jr., who leads START, a nonprofit organization that is New York's largest independent drug treatment agency, reviewed the study findings.

He pointed out that Black Americans are a diverse group and that treatment solutions may vary quite a bit depending on individual perspectives. The average age of START's clients is 55 and most are from minority groups.

Brown noted that older adults may also be more likely to be prescribed painkillers because of medical conditions that are more common as they age, including cancer. So they may be more exposed to addictive opioids through "legitimate pathways" than younger people, he said.

Because START offers primary medical care, it is able to keep an eye on treatment of multiple diseases, not just substance abuse, he added.

"I would say to our counselors, 'To what extent are you having your treatment plan address the other co-occurring medical problems that our senior population may have related and unrelated to their substance use disorder?'" Brown said. "So, in other words, if they don't have a primary care provider, how are we helping to connect them to a primary care provider?"

Mason said older adults are at higher risk for bad outcomes from opioid use because people metabolize drugs differently as they age. They may die from a lower dose than they would have as a younger person.

The researchers said their findings suggest a need for increased screening of older adults for substance use disorder. The study recommends adapting outreach and treatment models to this age group.

"This actually comes at a good time with Medicaid expansion, being able to maybe offer health care insurance to those in the pre-Medicare age, like 55 to 64," Mason said.

With the ability to see more people in health care settings, she said it is also important to do more screening for substance misuse.

More information

The U.S. National Institute on Drug Abuse has more on opioids.

SOURCES: Maryann Mason, PhD, associate professor, emergency medicine, Northwestern University-Buehler Center for Health Policy and Economics, Chicago; Lawrence Brown Jr., MD, MPH, chief executive officer, START Treatment & Recovery Centers, Brooklyn, N.Y.; JAMA Network Open, Jan. 11, 2022, online