Opioid Abuse Is Down Among Younger Americans, but Is Up Among Older Adults
by Lynn Hetzler
Opioid abuse has dropped among younger people living in the United States, according to a new government report, but opioid abuse is up among older adults.
Opioid abuse has previously been greater among younger people. In the new study, published July 2017 by the Substance Abuse and Mental Health Services Administration (SAMHSA), shows the problem is now more common among older adults.
The report shows rates of opioid abuse among people aged 18 to 25 dropped from 11.5 percent in 2002 to 8.1 percent in 2014. In those same years, however, opioid abuse doubled from 1 percent to 2 percent in adults aged 50 and older. More than 9.5 million adults abused opioids in the past year.
While the proportion of older Americans who misuse opioids is relatively small in comparison to young adults, misuse among older adults is increasing. People aged 65 and older make up only about 13 percent of the nation’s population, yet they account for more than one-third of outpatient spending for prescription drugs, according to the National Institute on Drug Abuse (NIDA). Chronic conditions associated with aging are often painful; physicians help older Americans deal with pain through prescription painkillers. Older patients are more likely to receive long-term and multiple prescriptions, and some experience cognitive decline – these factors could lead to the improper use of medications.
SAMHSA used information gathered in the 2014 National Survey on Drug Use and Health.
Opioids are drugs that produce morphine-like effects. Opioids have the same chemical structure as opiates, which are derivatives of the opium poppy plant but are much stronger.
Opioids serve an important function in medicine – they relieve severe pain caused by serious illness or injury. The painkillers work by attaching to opioid receptors, somewhat like a boat docking at a slip. Binding to the opioid receptor activates the receptor, which sends a message to the brain to block pain, slow breathing, and imparts a general calming and antidepressant effect.
These effects make opioids a target for recreational drug use.
Medical specialists define opioid abuse as the use of heroin or the use of prescription opioid painkillers outside their intended use. That is, opioid abuse includes taking dosages higher than prescribed, more frequently, or longer than intended by the prescribing physician. Doctors refer to this type of misuse as “non-medical use.”
Using very high doses of opioids, or using them for more than a few weeks, can cause physical dependence and addiction. Physical dependence is a condition where the body becomes accustomed to having opioids in the system in order to feel normal; allowing opioids to fall below a certain level causes the body to experience detoxification and withdrawal symptoms that can be quite uncomfortable and difficult to manage.
Opioids include heroin and prescription painkillers, such as:
- Hydrocodone (OxyContin, Percocet)
- Hydromorphone (Dilaudid)
- Meperidine (Demerol)
The American Society of Addiction Medicine (ASAM) defines addiction as “a primary, chronic and relapsing brain disease characterized by an individual pathologically pursuing reward and/or relief by substance use and other behaviors.”
Substance abuse includes the abuse of alcohol and drugs. Of the 20.5 million Americans with a substance abuse disorder in 2015, two million had a substance abuse disorder involving prescription painkillers, including opioids. Another 591,000 abused heroin.
With 52,404 lethal drug overdoses in 2015, drug overdose is the leading cause of accidental death in the nation. Of these deaths, 20,101 were related to prescription pain relievers and 12,990 were related to heroin.
The rates of abuse and deaths have paralleled narcotic sales. In 2012, doctors wrote 259 million prescriptions for opioids, which is more than enough to give every adult in the nation their own bottle of pills.
Prescription pain relievers are a gateway to heroin. Four out of five new heroin users started by misusing prescription painkillers. ASAM says that 94 percent of respondents to a 2014 survey of people undergoing opioid addiction treatment said that they switched to heroin because prescription opioids were more expensive and more difficult to obtain.
In addition to the potential to lead to heroin abuse, non-medical use of opioids can cause negative outcomes for older adults. Research shows that using opioids increases the risk of injury from the sedating side effects or lowered blood pressure. In that study, fractures were the most common injury associated with opioid use, and the use of codeine was associated with the highest risk for injury.
The new SAMHSA study underscores the need to address the increasing misuse of opioids among older adults.
“These findings highlight the need for prevention programs for all ages, as well as to establish improved evidence-based treatment, screening and appropriate referral services,” Dr. Kimberly Johnson, director of the Center for Substance Abuse Treatment, said in a SAMHSA news release.
“The high rates of [multiple] illnesses in older populations and the potential for drug interactions has profound implications for the health and well-being of older adults who continue to misuse opioids,” Johnson said.
Reducing Opioid Abuse Rates Among Older People
The U.S. Department of Health and Human Services has identified five strategies to manage the nation’s opioid crisis:
- Improving access to treatment services, including those that offer medication-assisted treatment
- Promoting availability and distribution of drugs, such as Narcan, which can reverse the deadly effects of opioids
- Strengthening the public’s understanding of the opioid epidemic by improving public health data and reporting
- Providing support for innovative research into pain management and addiction
- Improving pain management practices to reduce prescribed use of opioid medications
The Substance Abuse and Mental Health Services Administration provides a number of resources for addressing opioid misuse among people of all ages.