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Saturday, May 18, 2024

Rising Rates of Substance Abuse Among the Elderly

At the University of California San Diego School of Medicine, geriatrician and addiction medicine specialist Dr. Benjamin Han discusses with patients typical health that older face, chronic conditions, ability, medications well they are working.

That’s how he finds out that someone who’s complaining of sleeplessness may be utilising drugs like methamphetamine to wake up. Or that a patient who has been using an opioid for chronic pain has developed tolerance to the drug after being prescribed another medication, such as gabapentin.

Dr. Han didn’t immediately understand why one of his 90-year-old female patients, who was otherwise well enough to take the tube to his former hospital in New York City, started experiencing dizziness and falls: she washed down her prescription medicines, which were becoming more numerous as she got older, with a glass of brandy.

Some of the elderly patients he has treated have had cognitive impairment, liver illness, and cardiac issues that were likely aggravated by their drug use. Others have taken too much. He tried his best, yet some people still passed away.

Until recently, health professionals and academics focused mostly on younger, working-age victims of the opioid crisis rather than those of older ages.

However, drug use problems among the elderly have risen dramatically as baby boomers have reached Medicare eligibility at age 65. According to Keith Humphreys, a psychologist and addiction researcher at the Stanford University School of Medicine, “cohorts have habits around drug and alcohol use that they carry through life.”

The signs of a worsening situation have accumulated. For example, the rate of opioid use disorder among those 65 and older who are enrolled in conventional Medicare has increased from 4.6 instances per 1,000 in 2013 to 15.7 cases per 1,000 in 2018.

Co-author and University at Albany sociologist/demographer Tse-Chuan Yang speculated that the disorder’s real prevalence may be much greater than reported due to the stigma associated with drug use.

Overdose deaths have also increased dramatically in the elderly population. Dr. Humphreys and co-author Chelsea Shover used data from the CDC to show that the incidence of overdose fatalities doubled from 2002 to 2021, publishing their findings in JAMA Psychiatry in March. Suicides and medication interactions and mistakes both contributed to their fatalities.

Prescribed pharmaceuticals, not street narcotics, are the primary cause of substance abuse problems among the elderly. “It’s easy to get confused,” Dr. Humphreys added, since most Medicare recipients take more than one medication. Mistakes increase in proportion to the complexity of the regimen. The result is an overdose.

In addition, opioids, most often prescription pain medicines, were linked in 8.6 percent of problems, marijuana in 4.3 percent, and non-opioid prescription pharmaceuticals, such as tranquillizers and anti-anxiety meds, in 2 percent. William Parish, the study’s primary author and a health economist at RTI International, a non-profit research agency, said that “people often use multiple substances,” thus the categories are intertwined.

Overdose deaths are relatively uncommon among those who struggle with drug abuse, but the resulting injuries, cognitive decline, malignancies, heart disease, and renal failure are all very real.

However, they have greater challenges than younger generations. Dr. Parish saw an increase in patients concerned about “stigma,” such as what others may think. He said that “we see more logistical barriers,” including things like lack of transportation, lack of knowledge about where to go for assistance, and inability to pay for treatment.

Inroads have been made by advocates. Since the year 2020, Medicare has paid for methadone clinics and other opioid treatment programmes. After legislative action in January, it will pay for “intensive outpatient treatment,” which generally involves nine to 19 hours of counselling and instruction each week, and treatment by a wider spectrum of health specialists. The pandemic has also contributed to the growth of telemedicine services.

However, getting access to more intense care may be challenging, and residential therapy is seldom if ever paid. Medicare Advantage plans are significantly more restricted than traditional Medicare because of their smaller provider networks and mandatory pre-authorization procedures.

It may be difficult for individuals of a certain age group to see how vulnerable they have become, especially when they come from a generation whose adolescent drug usage has occasionally produced humorous tales.

Jonathan James
Jonathan James
I serve as a Senior Executive Journalist of The National Era
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