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A surge in fatal drug overdoses driven by the opioid epidemic is taking a heavy toll on older adults.
While the crisis has had a devastating impact across all age groups, overdose deaths have risen especially sharply among seniors, a demographic particularly vulnerable to the negative health effects of substance use and one that’s rapidly growing as Baby Boomers age.
In the past twenty years, drug overdose fatalities quadrupled among Americans aged 65 and older, according to new research published in JAMA Psychiatry.
Drug overdose remains an uncommon cause of death for older Americans, and in recent years, more seniors have been receiving treatment for substance use disorders.
But the trend is nonetheless concerning and points to unique challenges older adults face when it comes to substance use.
Annual overdose deaths in this age group rose from 1,060 in 2002 to 6,702 in 2021, and stemmed from both suicides and accidental overdoses, data show. There were wide racial disparities throughout that period, with Black seniors suffering the highest rate of fatal overdoses.
Furthermore, in the two decades studied, annual alcohol poisoning deaths rose from 10 (less than 0.03 per 100,000) to 281 (0.5 per 100,000). Alcohol is the most frequently reported substance of abuse among American seniors.
The research “underscores how important it is for clinicians and policymakers to think of overdose as a problem across the lifespan,” study author Chelsea Shover, assistant professor of medicine at the David Geffen School of Medicine at UCLA, said in a statement.
There’s no exact reason behind the uptick in overdoses, but several factors likely contributed.
The increase follows a rise in drug use, explained Alexis Kuerbis, an associate professor at the Silberman School of Social Work at Hunter College.
“What we’ve seen with the baby boomers, unlike previous generations, they have vastly increased the proportion of older adults who use any substances, and I include misuse of substances in there,” Kuerbis said.
That may in part be because Baby Boomers have looser attitudes toward drinking and drug use than the generations that came before them, she said.
“So many of [the Baby Boomers] are continuing any kind of drug use into later life at proportions we’ve never seen before,” Kuerbis told Changing America.
Some seniors “may have had those disorders for a large part of their life and they’re aging with those, and some others may acquire substance use disorders in later life,” said Kathleen Cameron, the senior director of the Center for Healthy Aging at the National Council on Aging.
Meanwhile, the drug landscape has changed. The 1996 introduction of oxycontin — an opioid much stronger than anything previously on the market — was accompanied by aggressive marketing and soon became a leading drug of abuse in the country.
“Over the past 10 years, we’re seeing the wave of the results of that prescription drug use, in at least in the category of opioids,” said Kuerbis.
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A more toxic drug supply, including the rise of synthetic opioids like fentanyl, poses dangers to all users. But for older adults, any substance use can be especially risky.
As the body ages, its ability to digest drugs and alcohol decreases, “which means that there’s more substances in the bloodstream for longer and at higher doses than in earlier stages of life,” said Kuerbis.
Changes in kidney and liver function may put older adults at a higher risk of overdose at lower amounts of drugs or alcohol, Benjamin Han, an associate adjunct professor of medicine at UC San Diego, told Changing America over email.
What’s more, many seniors may be unaware of their declining tolerance.
“I think about the older adults I know and most of them don’t have any idea that their tolerance is reducing to substances,” as they age, said Kuerbis.
Multiple substance use is also a problem. For example, using alcohol on top of a prescribed opioid or benzodiazepine can make the medications’ effects stronger and vice versa.
“That is really dangerous because the combination of any of these kinds of drugs and alcohol, most people don’t understand that they potentiate each other,” Kuerbis explained.
Because older adults tend to have more chronic diseases and comorbidities, they take more medications than their younger counterparts. More than 90 percent of older people take at least one prescription in a given month, while over 66 percent use three or more each month.
This raises the risk of interactions between prescribed drugs, and between prescriptions and any other drugs and alcohol, which could make seniors more vulnerable to overdose.
Seniors may also have a false sense of how safe their prescription medications are.
“If a friend or a relative or a doctor sort of vets a medication and says ‘Hey, this really works for me for sleep or something else or pain,’ then people are more apt to take it and not necessarily educate themselves around the risk. They just assume, ‘Oh, well, this came from my physician, so it must be safe.’ And that’s not the case,” said Kuerbis.
Prescription drugs also play a role in many intentional overdoses. While nearly three-quarters of unintentional overdoses among seniors over the last two decades involved illicit drugs including synthetic opioids like fentanyl, heroine, cocaine and methamphetamine, the majority of intentional overdoses involved prescription opioids, antidepressants, benzodiazepines, antiepileptics and sedatives, the JAMA Psychiatry study found.
Self-harm is a growing concern among seniors, said Lewis Nelson, a medical toxicologist and the chair of the department of emergency medicine at Rutgers New Jersey Medical School.
“When you look at the data, it’s very clear that the prevalence, the risk of intentional self-harm in older people is increasing. It’s increasing in everybody,” he said in an interview with Changing America. Nelson also helps oversee New Jersey’s poison center.
The possibility of a fatal cancer diagnosis, Alzheimer’s or any other disease more common in old age might contribute to these trends.
So might the loss of family members or friends that comes with old age.
“We’re a youth obsessed society and so a lot of older adults struggle with a lack of purpose later in life,” Kuerbis said.
Cameron, of the National Council on Aging, said the COVID-19 pandemic may have worsened isolation for seniors, and worries suicide is going to become an even greater problem for the over-65 population moving forward.
“The pandemic has had such an impact on older adults in terms of social isolation, and loneliness that leads to things like depression and anxiety. And we certainly saw that too with increases in deaths associated with alcohol use,” she said.
Drug-related suicides remain rare, however, Nelson noted.
“Suicide attempts are pretty common with drugs, but completed suicide with medications or drugs is fairly uncommon,” he said.
Despite the evident risks of substance use, older adults may remain reluctant to seek help — and those who do may face barriers unique to their age group.
More seniors have been getting treated for substance use in recent years amid the uptick in overdose deaths. But most older adults avoid treatment and avoid telling their doctors about their issues, in part because of stigma, said Kuerbis.
“There are also virtually no treatment programs around substance use that cater to older adults. And although they do okay in mainstream treatments, they tend to avoid mainstream treatments because they’re embarrassed about dealing with this in later life,” she added.
Meanwhile, Black seniors in particular also face long-standing barriers in health care rooted in structural racism, likely exacerbating fatal overdoses in the demographic and contributing to racial disparities.
“Older racial and ethnic minorities in the United States disproportionately have lower access to and are less likely to complete evidence-based [substance use disorder] treatment while experiencing a higher burden of adverse outcomes,” said Han.
“Especially for specific populations of older adults, they have experienced lifelong discrimination, racism, and systemic injustices that are compounded over decades contributing to this disparity,” he explained.
For all older adults, retiring from their careers or losing their peer groups could also mean less visibility of their symptoms. Young people might be more visible to friends and family members who could help identify the substance misuse and push for treatment.
Other seniors may mistake their problems with normal aging or other chronic disease challenges, added Han.
On the national level, some strides have been made to address substance use among seniors.
Recently, Medicare expanded access to treatment for opioid use disorder. Just last month the FDA approved Narcan as the first over-the-counter drug for opioid overdose reversal.
In addition, the Consolidated Appropriations Act signed by President Biden last year will allow reimbursement for a broader range of providers, including marriage and family therapists, mental health counselors and professional counselors.
“Previously, those mental health providers who also treat substance use disorders could not get reimbursed under Medicare, but that is changing in January,” said Cameron. “So that’s good news.”
But experts say more action is needed to mitigate the crisis.
Educating older adults about medication interactions and the dangers of medication is crucial, along with helping them understand how important it is to monitor use for themselves and to have their loved ones help them if they need it, said Kuerbis.
The new over-the-counter availability of Narcan, an FDA-approved nasal spray that reverses the effects of opioid overdose, should also come with increased education, said Kuerbis, adding this could hopefully help those in the unintentional overdose group.
“Harm reduction interventions (including syringe services and naloxone [narcan]) often overlook older adults as there is the misconception that older adults do not use drugs, but increasingly older adults are,” said Han.
“And they must also have access to evidence-based interventions that can decrease their risk for overdose.”
Clinicians should screen all older patients for drug and alcohol use, Han added, and discuss any use in a non-judgmental way within a health context.
“Sadly, primary care providers and others…they’re not doing assessments or screening for substance use disorders among older adults,” said Cameron.
It’s important to educate providers that the senior population is at high risk for substance use disorders, she said, “and they’re not going to come to a primary care visit and talk about it with their doctor. So doctors need to ask the right questions.”
