Substance abuse is increasing among the elderly

Many aging baby boomers have long histories with drugs, cannabis and alcohol. "The field wasn't ready for this," said one expert.

When geriatrician and addiction specialist Dr. Benjamin Han meets new patients at Medical School at the University of California, San Diego, he talks to them about the common health issues seniors face: chronic illnesses, functional ability, medications and how they work.

It also asks about their use of tobacco, alcohol, cannabis and other over-the-counter drugs. "Patients tend not to want to divulge this, but I put it in a health context," Dr. Han said.

He tells them, "In As you age, there are physiological changes and your brain becomes much more sensitive. Your tolerance decreases as your body changes. This can put you at risk."

C This is how he learns that a person complaining of insomnia might use stimulants, possibly methamphetamines, to get going in the morning. Or that a patient who has been on an opioid for chronic pain for a long time ran into trouble with an extra prescription for, say, gabapentin.

When a patient 90-year-old woman, a woman fit enough to take the subway to her old hospital in New York, began to report dizziness and falls, it took Dr Han a while to figure out why: she drank her prescribed pills, increasing numbers as she got older, with a glass of brandy.

He had older patients including heart problems, liver disease and cognitive impairment was most likely exacerbated by substance use. Some overdosed. Despite his best efforts, some have died.

Until a few years ago, even as the opioid epidemic raged, health care providers health and researchers paid limited attention to drug use by older people. ; concerns focused on the youngest, working-age victims who were hardest hit.

But as baby boomers hit 65 years, the age at which they are generally eligible for Medicare, substance use disorders among the elderly population have risen sharply. "Cohorts have habits of drug and alcohol use that they carry on throughout their lives," said Keith Humphreys, a psychologist and addiction researcher at Stanford University School of Medicine.

Aging boomers "still use far more drugs than their parents, and the field wasn't ready for that."

The Evidence of a growing problem has accumulated. A study of opioid use disorders in people over 65 on traditional health insurance, for example, showed a threefold increase in just five years – to 15.7 cases per 1,000 in 2018, compared to 4.6 cases per 1,000 in 2013.

Tse-Chuan Yang, study co-author and sociologist and demographer at the University at Albany, said the stigma of drug use may lead people to underreport it, so the true rate of disease may be even higher.

Fatal overdoses have also increased among the elderly. From 2002 to 2021, the overdose death rate quadrupled from 3 per 100,000 to 12, Dr. Humphreys and Chelsea Shover, a co-author, reported in JAMA Psychiatry in March, using data from the Centers for Disease Control and Prevention. These deaths were both intentional, such as suicides, and accidental, reflecting drug interactions and errors.

Most substance use disorders in the elderly involve prescribed drugs, not illegal drugs. And since most Medicare beneficiaries take multiple medications, "it's easy to get lost," Dr. Humphreys said. “The more complicated the diet, the easier it is to make mistakes. And then you have an overdose."

The numbers so far remain relatively low - 6,700 drug overdose deaths in 2021 among people aged 65 and over - but the rate of increase is alarming.

"In 1998 this is what people would have said about overdose deaths in general - the absolute number was weak," Dr. Humphreys said. "When you don't respond, you...