Opioid overdose deaths for older Americans are reaching unprecedented numbers.
The number of Americans 55 and older who died from an opioid overdose surged 1,886% from a little over 500 deaths in 1999 to more than 10,000 deaths two decades later.
More disturbing still is that older non-Hispanic Black men were found to be four times more likely to die from an opioid overdose than other older adults.
Those are the findings of a new report from Northwestern Medicine released this week.
Maryann Mason, associate professor of emergency medicine at Northwestern University Feinberg School of Medicine, is one of the report’s authors.
Mason says the report explodes the stereotype that older Americans are less likely to abuse drugs.
“Older adults are like other Americans who are using opioids in that they’re at growing risk of overdose deaths,” says Mason. “This generation of older adults — baby boomers — use substances at a higher prevalence than the generations that have gone before them. This is a group that has continued its substance use into older age.”
As people age the way the body metabolizes opioids changes, says Mason. On top of that, “we have just issues of being an older adult” and the number of health risks and conditions that are associated with that.
Social isolation and depression that may come with being an older adult can also contribute to opioid addiction. They are also factors that have been widespread amid the COVID-19 pandemic. Mason says that although the study period covers the 20 years just prior to the pandemic, 2020 data shows that the number of overdose deaths in older adults has continued to climb.
The high rate of deaths among older Black men is likely associated with the rise of fentanyl being mixed with other illicit drugs, according to Mason. Fentanyl is up to 100 times more powerful than morphine according to the Centers for Disease Control and Prevention and even tiny amounts can trigger an overdose.
“We see the huge uptick in these deaths among Black men beginning in 2013. There’s a rapid increase at that point,” says Mason. “And that’s the point the CDC has identified as the third wave of the opioid epidemic, which is associated with increased presence of fentanyl in fatal overdoses. In some ways it looks like black men have been more exposed to fentanyl, which is more deadly.”
Other adults have been exposed and become addicted to opioids through legal prescriptions for drugs such as Oxycontin which were overprescribed for many years as drug makers downplayed the risks of addiction.
“There’s probably a stream of people coming in from prescription opioids and they may have other medical issues,” says Mason. “And so figuring out the profiles of people coming in from those different vectors is really important because it all ties to what we do regarding prevention.”
One change she would like to see is more routine screening of older adults for substance abuse by health care providers.
“We know older adults see health care providers more often. And so if there was routine screening for substance use among that population, it’s very likely they could be connected to treatment resources,” says Mason. “But if health care provider sees an older person and they have a stereotype in their mind of grandma and grandpa not being a drug user or substance misuser they’re not going to screen.”
She says that if more older people are abusing drugs, then treatment — and the accessibility of treatment — needs to adapt to that change.
“We need treatment that can be adapted to older adults needs. And that may be as simple as making the treatment location accessible for someone with mobility issues. That might mean making materials and resources available to people who are hearing or vision impaired. It might mean tailoring services that are more culturally acceptable to older generations,” says Mason.
But the stigma that still remains attached to substance abuse also needs to be dispelled.
“Substance misuse is not a moral failing,” says Mason. “And the more we can change people’s thinking on that, the more we can reduce the shame and reluctance to get services.”
And when older people are connected to treatment they often do very well.
“This isn’t all doom and gloom,” says Mason. “Older people tend to do better in treatment. We often look at the weaknesses associated with aging, but actually the wisdom and critical thinking of older adults is really helpful to them in treatment. So there’s reason to believe if people are offered high-quality treatment in the right amounts, they can really turn things around.”