The letter to the medical advice column in the newspaper was from a granddaughter of a 73-year-old widow. “Sarah” was worried that Grandma “Jewels” had gotten hooked on pain relievers following surgery to repair a broken leg. She was also concerned about where Jewels was now obtaining her drugs and wanted to know what she could do.
The Cleveland Clinic physician for the column responded by noting that “unfortunately, yours is not the only family facing this problem these days.” He went on to cite National Center for Health Statistics data showing that the number of seniors dying from drug overdoses has tripled since 2000, when 5,000 people age 65 and older died from drugs such as opioids, fentanyl, and others. “Among seniors,” the doctor wrote, “women age 75 and older have the highest overdose death rate.” He added that some get addicted following use of prescribed meds while others look to alcohol or street drugs to alleviate emotional issues or to dull physical pain.
A snapshot of Colorado’s substance use/abuse
The statistics in Colorado are no less concerning. A Substance Abuse Trend and Response Task Force authorized by the Colorado General Assembly issues periodic comprehensive reports on the status of substance abuse in the state. Its mission includes examining drug use trends, evaluating practices for preventing abuse, and assisting local communities with implementation of the most effective prevention models. Another goal is to increase public awareness of emerging concerns.
In one of the Task Force’s recent reports, based on information from the Colorado Department of Public Health and Environment and the Office of Behavioral Health in the Department of Human Services, a study showed the following trends in substance use/abuse over an 8-year span as measured by the percent of the state population needing “treatment admissions” related to using each substance:
Alcohol use by Coloradans age 55-64: admissions doubled; for age 65+: admissions also doubled
Marijuana use age 55-64: admissions doubled; for age 65+: admissions quadrupled
Prescribed opioids for 55-64: admissions almost doubled; for 65+: admissions quadrupled
Methamphetamine use by 55-64: admissions quadrupled (65+ held steady)
Cocaine use by 55-64: admissions more than doubled; for 65+: admissions were up sixfold
Most of the actual percentages themselves were not high, generally ranging from .1% to .4% of the population. But the percentages for treatment admissions due to alcohol and cocaine use were notably higher, reaching 9.3% for alcohol. And in all cases, it was the trend—the growth of probable abuse—thatwas concerning.
Aging as a vulnerability factor in Substance Abuse
The National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, states that while illicit drug use typically declines after young adulthood, nearly 1 million adults aged 65 and older live with a substance use disorder (SUD), according to 2018 data. And the proportion of SUD admissions to treatment facilities over a 12-year reporting period increased from 3.4% to 7.0% for older adults, a significantly higher increase than for the population as a whole.
NIDA suggests aging itself may lead to social and physical changes that increase vulnerability to substance misuse. “Little is known about the effects of drugs and alcohol on the aging brain,” the Institute says. “However, older adults typically metabolize substances more slowly, and their brains can be more sensitive to drugs.” Some older adults may take substances to cope with big life changes such as retirement, grief and loss, declining health, or a change in living situation. Also, any abuse or addiction from earlier years can also exacerbate symptoms in later life.
Here is how NIDA assesses risks with various types of meds and other substances.
Due in part to chronic health conditions, older adults are often prescribed more medicines than other age groups. This heightens the rate of exposure to potentially addictive medications. In one study more than 80% of older participants used at least one prescription medication daily, with nearly half using more than five medications or supplements, “putting at least 1 in 25 people in this age group at risk for a major drug-drug interaction.” Other risks could include accidental misuse of prescription drugs, and possible worsening of existing mental health issues, underscoring the need for careful screening before prescribing these medications.
Opioid pain meds
Persistent pain may be more complicated in older adults. Majority percentages of patients with advanced cancer or heart disease report significant pain. From 1995 to 2010, NIDA notes, opioids prescribed for older adults during regular office visits increased by a factor of nine. And while the U.S. population of adults 55 and older increased by about 6% from 2013 to 2015, the proportion of people in that age group seeking treatment for opioid use disorder increased nearly 54%. The proportion of older adults using heroin—an illicit opioid—more than doubled in that same period, partly because some people misusing prescription opioids switch to the cheaper heroin.
Nine percent of adults aged 50-64 reported past year marijuana use in 2015-2016, up from 7.1% in 2012-2013. The use of cannabis in the past year by adults 65 years and older increased sharply from 0.4% in 2006 and 2007 to 2.9% in 2015 and 2016.
One U.S. study suggests that close to a quarter of marijuana users age 65 or older report that a doctor had recommended marijuana in the past year. Research suggests medical marijuana may relieve symptoms related to chronic pain, sleep hygiene, malnutrition, depression, or to help with side effects from cancer treatment. But since marijuana has not been approved by the Food and Drug Administration (FDA) as a medicine, its potential benefits must be weighed against its risks, particularly for individuals who have other health conditions or take prescribed medications. These risks include possible adverse respiratory conditions, depression, impaired memory, adverse cardiovascular functions, and altered judgement and motor skills.
The Centers for Disease Control and Prevention (CDC) reports that in 2017, about 8 of every 100 adults aged 65 and older smoked cigarettes, increasing their risk for heart disease and cancer. While this rate is lower than that for younger adults, research suggests that older people who smoke have increased risk of becoming frail. Although about 300,000 smoking-related deaths occur each year among people who are age 65 and older, the risk diminishes in older adults who quit smoking. Within a year of quitting, most former smokers reduce their risk of coronary heart disease by half.
There has been little research on the effects of vaping nicotine (e-cigarettes) among older adults, but certain risks exist in all age groups. While e-cigarettes might be less harmful than regular cigarettes, research on this is mixed. There is also evidence that many people continue to use both delivery systems to inhale nicotine, which is a highly addictive drug.
Alcohol is the most used drug among older adults, with about 65% of people 65 and older reporting high-risk drinking, defined as exceeding daily guidelines at least once a week. Of particular concern, more than a tenth of adults age 65 and older currently binge drink, which is defined as drinking five or more drinks on the same occasion for men, and four or more drinks on the same occasion for women. In addition, research published in 2020 shows that increases in alcohol consumption in recent years have been greater for people aged 50 and older relative to younger age‐groups.
Risk factors for substance use disorders in older adults
Substance abuse by older adults can result in chronic pain, physical disabilities or reduced mobility, needed transitions in living situations, forced retirement or change in income, poor health status, and other risks, including psychiatric factors and mental illness. Alcohol abuse in particular can put older people at greater risk for diabetes, high blood pressure, congestive heart failure, liver and bone problems, memory issues and mood disorders.
What are the best treatments for substance abuse disorders?
Many behavioral therapies and medications have been successful in treating substance use disorders in older adults, but little is known about the best models of care. Research does show that older patients have better results with longer durations of care. “Ideal models include diagnosis and management of other chronic conditions,” NIDA says, “and re-building support networks, improving access to medical services, improved case management, and staff training in evidence-based strategies for this age group.”
NIDA cautions that health care providers may confuse substance abuse symptoms with those of other chronic health conditions or with natural, age-related changes. “Research is needed to develop targeted SUD screening methods for older adults. Integrated models of care for those with coexisting medical and psychiatric conditions are also needed.”
NIDA emphasizes it is never too late to quit using substances. Quitting can improve quality of life and future health. For treatment resources, see the Colorado Behavioral Health Administration at https://bha.colorado.gov/behavioral-health. Other sources to consider are state-funded rehab centers https://www.addictionresource.net/state-funded-rehab-centers/colorado/ and www.findtreatment.gov (where you can search for treatment providers based on your geographical location.)