Addressing the Opioid Epidemic in Older Adults

The opioid crisis has resulted in staggering costs to American society estimated at $1.5 trillion in 2020 alone. The continuing rise in fatal overdose deaths suggest that the total costs to society may accelerate for years to come. Drug overdose deaths continue to be a main cause for mortality in the United States, and most overdose deaths involve opioids such as fentanyl, synthetic opioids, and prescription opioids.

In 2017, the United States Department of Health and Human Services (HHS) declared the opioid crisis a public health emergency (HHS, 2022) due to high rates of opioid misuse in the country. In 2022, nearly 82,000 drug overdose deaths involved opioids. Opioids include prescription drugs such as oxycodone and hydrocodone, synthetic opioids such as fentanyl, and illegal drugs such as heroin. The declaration of this emergency was recently renewed in September 2024 due to its continued impact on American society (HHS, 2024).

Over the last decade, a substantive body of research indicated that individuals affected by the opioid epidemic are on average becoming older, and there is an increasing trend among older adults who engage in non-medical prescription opioid use (Husain-Krautter, 2019; West & Dart, 2016). This coincides with a rise in first-time substance use treatment admissions for older adults due to the prescription opioid epidemic (Huhn, Strain, Tompkins, & Dunn, 2018).

Older adults, prescription opioids & mental health

An emerging body of research has identified older adults as a population of concern in understanding and addressing the consequences of the opioid epidemic. Although rates tend to decrease with age, the prevalence of substance use disorders and mental illness remains relatively high in later life. Specifically, non-medical prescription opioids use (NMPOU) may be higher in older adult populations compared to younger age cohorts (West & Dart, 2016). Older adults typically are less likely to seek out substance use-specific treatment, compared to other services related to health and mental health (Edlund, Booth, & Han, 2012). In addition, research has found that most individuals with opioid use disorders do not receive treatment (Choi, 2019). For these reasons, older adults who are affected by the opioid epidemic may be particularly at risk for adverse mental health outcomes.

Why are Older Adults Vulnerable?

Older adults may have specific risk factors for opioid use from increased risk for poverty, poorer health, new and/or chronic pain, higher rates of prescription medication use, or comorbid health issues related to the aging process. Although prescriptions have decreased since 2009 through Prescription Drug Monitoring Programs, the prevalence of NMPOU and opioid-related deaths continued to rise (Han, Compton, Jones, & Cai, 2015). Older adults are a high use group for pain management, and they are often treated with prescription opioids which are associated with increased risk for symptoms of depression (Mazereeuw, Sullivan, & Juurlink, 2018; Scherrer et al., 2014; Sullivan, 2018). Increasing rates of NMPOU among older adults (West & Dart, 2016) suggest that there are factors specific to later lifestages which may explain the disproportionate odds of NMPOU among this population.

Implications for Practice and Policy

The opioid epidemic has been highlighted as a dire issue in the U.S. and globally, and has resulted in immense costs to society. Although older adults have lower rates of substance use and mental illness, findings suggest that they may be more vulnerable to the effects of NMPOU with serious mental health problems.

Clinicians can be more aware of the disproportionate odds of NMPOU on psychological distress for older adults. Given the abuse potential of prescription opioids and the prevalence for older adults who experience chronic pain, it is recommended that health care providers conduct more comprehensive mental health screenings with older adult patients who are prescribed opioids, or have a past history of NMPOU. Substance-related problems are one of the main causes of health and mental health decline for older adults. There is a need for services and supports that are tailored for older adult populations, who are often overlooked and undertreated for addiction and mental health issues. Public policy responding to the opioid epidemic can include allocation of resources for mental health treatment targeting older populations.

Given the strong association of NMPOU with SMI for older adults (Chan et al., 2020), greater awareness is needed among the professional community and the community at large to strengthen prevention efforts. Older adults are likely different from younger age cohorts in their life stressors and motivations for medical and non-medical use of prescription opioids. Some older adults engage in NMPOU to manage pain and physical decline related to their aging process (Musich et al., 2019), and may not perceive their non-medical use of prescription opioids as an addiction. Across disciplines, there may be different providers who are already working with older adults and can play an integral role in connecting them to much needed recovery efforts and interventions. Interprofessional collaboration is needed among disciplines from medicine, social work, nursing, psychology, and others who specialize in geriatric services to effectively address the impact of the opioid epidemic on older adults.

References

Chan, K., Moller, M., Marsack-Topolewski, C., Winston, P., Jennings, R., & Prifti, A. (2020). Age differences in non-medical opioid use and psychological distress. Substance Use and Misuse, 55 (11), 1808-1806. https://doi.org/10.1080/108260...

Centers for Disease Control and Prevention. (2017). Opioid overdose. Retrieved from https://www.cdc.gov/drugoverdo...

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Choi, N. G., DiNitto, D. M., Marti, C. N., & Choi, B. Y. (2019). Adults who misuse opioids: Substance abuse treatment use and perceived treatment need. Substance Abuse, 1-9. doi: 10.1080/08897077.2019.1573208

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Huhn, A. S., Strain, E. C., Tompkins, D. A., & Dunn, K. E. (2018). A hidden aspect of the U.S. opioid crisis: Rise in first-time treatment admissions for older adults with opioid use disorder. Drug and Alcohol Dependence, 193, 142–147. doi: 10.1016/j.drugalcdep.2018

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