August the 31st is International Overdose Awareness Day – the largest campaign in the world to end overdose deaths, remember without stigma those who have died from overdose, and acknowledge the grief of the friends and family who are left heartbroken in its wake.
Substance overdose is one of the leading causes of death in the United States. Since 1999, 841,000 people have died, which is more than the total population of Alaska. An estimated 70,630 passed away in 2019, and this figure sadly seems poised to rise. With the equivalent of a small city dying each year, it’s clear that substance overdose is a public health crisis that needs addressing.
Not Just the Young
A common misconception is that substance use only affects the younger population. We constantly hear stories in the media of young teenagers passing away, and many of us even personally know someone who was taken before their time. This has become endemic as smartphones make accessing substances as easy as ordering takeout, and deadly fentanyl has infiltrated most of the black-market substance supply.
The opioid, fentanyl, that was once relatively rare in the world of illegal substances has exploded in recent years. Originally used to make heroin more powerful, it has now made its way into the mainstream substance market and has been detected in methamphetamine, cocaine, and illegally manufactured pharmaceutical pills.
The rapid rise of fentanyl has meant that many people are unknowingly putting themselves at an extremely high risk of overdose. By weight, it’s 50 times stronger than heroin, and an amount the size of a match head is enough to kill someone. Many users have died or needed serious medical attention after taking what they thought was one substance but in fact was fentanyl or one of its derivatives.
While each one of these deaths is an unmitigated tragedy in its own right, the scope of substance deaths is much wider and affects each age bracket in our society. Substance Use Disorder (SUD) doesn’t just threaten the young. The often-forgotten older population is also still extremely vulnerable to this condition and face their own risks in using and challenges in recovery.
Substance Use in Older Adults
Around one million adults over the age of 65 live with an SUD, according to 2018 data.  Between 2000 and 2012, the number of older adult admissions to treatment centers for SUD increased by 3.6%.  More recent data predicted that adults over the age of 50 with an SUD was set to double from 2.8 million to 5.7 million in 2020,  and around 27% of overdose deaths occur in people in this category. 
It’s important to note that the above data does not take into account the effects of the recent COVID-19 pandemic, subsequent lockdowns, and the threat of serious illness to people with a pre-existing SUD. It’s certainly not a wild assumption to think that it won’t have helped and could potentially have made it much worse.
Substance use has many ways of hooking us in. A huge number of Americans arrived at dependence not through illegal experimentation but through a doctor’s prescription. The opioid crisis was precipitated through the rampant prescription of strong painkillers and was fueled through misinformation from large pharmaceutical companies about the substance’s addictive potential.
By the time the general public became aware and prescribing guidelines became more stringent, millions of doses of highly addictive painkillers had been distributed and thousands of Americans were left dependent. As people’s supplies were cut off, many turned to heroin as a substitute.
As we age, we tend to develop adverse health conditions, which leads to older adults being prescribed more medications than any other age group. Data shows that between 4-9% of adults over 65 use opioid medications for pain relief, and between 2013 and2015, the proportion of adults over the age of 55 seeking treatment for opioid SUD increased by a staggering 54%. 
Not Just Illegal Substances
As concerning as prescription medication is for the older population, alcohol is the main culprit for older adults seeking treatment. One study found that this figure increased by 107% between 2001-2013. 
Alcohol use disorder is particularly risky for older adults and increases the risk of diabetes, congestive heart failure, liver and bone problems, mood disorders, and memory issues.  Unmedicated alcohol detoxes are also harder for older bodies to tolerate, and clinical staff should be mindful of this fact.
Recovery for Older Adults
Attempting to recover as an older adult is also fraught with challenges. The perception of SUD being primarily a young person’s problem bleeds into people’s perception of treatment, and some people worry they won’t fit in with a younger crowd. This is thankfully incorrect, with many treatment providers tailoring their programs to suit the growing need of older adults seeking sobriety.
One of the most effective routes to recovery is through professional help – whether it’s 1:1 counseling or residential treatment. There isn’t a great deal of research around optimizing treatment for older adults, but some studies have suggested that longer durations of care are the best way of maximizing the chance of successful recovery. 
Treatment providers should also be trained to identify other chronic health conditions that could present as an SUD, be aware of co-existing psychiatric conditions, and be sympathetic to the unique challenges that older adults face in finding recovery.
By recognizing that SUD is not a problem faced only by a certain demographic but is actually a public health crisis that threatens us all, we can move towards greater acceptance, reduced stigma, more people seeking help, and ultimately the power to save lives.
If you are concerned about any issues discussed in this blog, please contact Heather R. Hayes & Associates. Call 800-335-0316 or email email@example.com
- Substance Abuse and Mental Health Services Administration. (2019). Results from the 2018 National Survey on Drug Use and Health: Detailed tables. Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/
Chhatre, S., Cook, R., Mallik, E. et al. Trends in substance use admissions among older adults. BMC Health Serv Res 17, 584 (2017). https://doi.org/10.1186/s12913-017-2538-z
- Han, Beth et al. “Substance Use Disorder Among Older Adults In The United States In 2020”. Addiction, vol 104, no. 1, 2009, pp. 88-96. Wiley, doi:10.1111/j.1360-0443.2008.02411.x. Accessed 25 Aug 2021.
“Drug Overdoses – Injury Facts”. Injury Facts, 2021, https://injuryfacts.nsc.org/home-and-community/safety-topics/drugoverdoses/.
- Galicia-Castillo, M. Opioids for persistent pain in older adults. Cleveland Clinic Journal of Medicine. 2016 June 6; 83(6). Retrieved from: https://mdedge-files-live.s3.us-east-2.amazonaws.com/files/s3fs-public/issues/articles/Galicia-Castillo_OpiodsForOlderAdults.pdf
Older adults fact sheet. National Institute on Alcohol Abuse and Alcoholism. https://www.niaaa.nih.gov/alcohol-health/special-populations-co-occurring-disorders/older-adults
- Grant BF, Chou SP, Saha TD, et al. Prevalence of 12‐month alcohol use, high‐risk drinking, and DSM‐IV alcohol use disorder in the United States, 2001‐2002 to 2012‐2013: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. JAMA Psychiat. 2017; 74(9): 911‐923.
- Lehmann S, Fingerhood M. Substance-use disorders in later life, N Engl J Med. 2018 December 13; 379(24): 2351-2360. doi: 10.1056/NEJMra1805981