Illicit and nonmedical drug use among older adults: a review

Prevalence of Opioid Use in Nursing Homes Over the Last Decade: A Systematic Literature Review

Background: Despite global concerns of an opioid epidemic, there is no systematic literature review on how frequently these drugs are used in nursing home (NH) populations, including those living with dementia. Objective: This systematic review aims to describe the prevalence and incidence of opioid use in NHs. A secondary objective is to describe the use of these drugs in a subset of NH residents, namely among persons living with dementia. Methods: A systematic literature review was carried out using MEDLINE and Scopus (PROSPERO registration number CRD42021254210). Screening of title and abstract was carried out by 2 persons independently for studies published between January 1, 2011 and May 19, 2021. The main outcomes were annual prevalence, period prevalence, and duration of opioid use. Results: From a total of 178 identified studies, 29 were considered eligible for inclusion. The annual prevalence of any opioid use among all NH residents without any selection criteria ranged from 6.3% to 50% with a median annual prevalence of 22.9% (Q25-Q75: 19.5%-30.2%), based on 17 studies. Five studies measured the annual prevalence in NH residents living with dementia, finding that this ranged from 10% to 39.6%. Conclusions: More evidence is needed quantifying opioid use in NH, especially among persons living with dementia. Given that opioid use in NH is still a problem, implementation of a pain management protocol in NH or nationally would help improve clinical outcomes.

The Effects of Stigma: Older Persons and Medicinal Cannabis

Cannabis has long been stigmatized as an illicit drug. Since legalization in Canada for both medical and recreational purposes, older adults' cannabis consumption has increased more than any other age group. Yet, it is unclear how the normalization of cannabis has impacted perceptions of stigma for older adults consuming cannabis medicinally. Qualitative description was used to elucidate the experiences of older Canadians aged 60+ related to stigma and their consumption of cannabis for medicinal purposes. Data collection involved semi-structured interviews. Data analysis examined how participants managed stigma related to cannabis use. Perceived stigma was evident in many participants' descriptions of their perceptions of cannabis in the past and present, and influenced how they accessed and consumed cannabis and their comfort in discussing its use with their healthcare providers. Participants employed several distinct strategies for managing stigma-concealing, re-framing, re-focusing, and proselytizing. Findings suggest that while medical cannabis consumption is becoming increasingly normalized among older adults, stigma related to cannabis persists and continues to shape older adults' experiences. A culture shift needs to occur among healthcare providers so that they are educated about cannabis and willing to discuss the possibilities of medicinal cannabis consumption with older adults. Otherwise, older adults may seek advice from recreational or other non-medical sources. Healthcare providers require education about the use of medical cannabis, so they can better advise older adults regarding its consumption for medicinal purposes.

Association Between Cannabis Use and Subjective Cognitive Decline: Findings from the Behavioral Risk Factor Surveillance System (BRFSS)

BACKGROUND

Cannabis consumption has rapidly increased in the United States due to more states legalizing non-medical and medical use. There is limited research, however, investigating whether cannabis may be associated with cognitive function, particularly across multiple dimensions of cannabis use.

OBJECTIVE

The objective of this study was to examine whether cannabis consumption reason, frequency, and method are associated with subjective cognitive decline (SCD).

METHODS

Data were obtained from 4,744 U.S. adults aged 45 and older in the 2021 Behavioral Risk Factor Surveillance System (BRFSS). SCD was a self-reported increase in confusion or memory loss in the past year. Odds of SCD by cannabis use reason, frequency, and methods (e.g., smoke, eat, vaporize) were examined using multiple logistic regression after imputing missing data, applying sampling weights, and adjusting for sociodemographic, health, and substance use covariates.

RESULTS

Compared to non-users, non-medical cannabis use was significantly associated with 96% decreased odds of SCD (aOR=0.04, 95% CI=0.01-0.44, p<.01). Medical (aOR=0.46, 95% CI=0.06-3.61, p=.46) and dual medical and non-medical use (aOR=0.30, 95% CI=0.03-2.92, p=.30) were also associated with decreased odds of SCD, although not significant. Cannabis consumption frequency and method were not significantly associated with SCD.

CONCLUSION

The reason for cannabis use, but not frequency and method, is associated with SCD. Further research is needed to investigate the mechanisms that may contribute to the observed associations between non-medical cannabis use and decreased odds of SCD.

The association between cannabis use and subjective memory complaints in older adults in the United States

OBJECTIVE

The U.S. population is aging and increasing numbers of older adults are using cannabis. Cognitive decline is common in older age and subjective memory complaints (SMC) have been associated with increased risk for dementia. While residual cognitive effects of cannabis use at younger ages are well understood, the links between cannabis use and cognition in older adults is less clear. The present study represents the first population-level analysis of cannabis use and SMC in older adults in the U.S.

METHOD

We used the National Survey of Drug Use and Health (NSDUH) dataset to evaluate SMC in respondents over age 50 (N = 26,399) according to past-year cannabis use.

RESULTS

Results revealed that 13.2% (95%CI: 11.5%-15.0%) of those who reported cannabis use also reported SMC, compared to 6.4% (95%CI: 6.1%-6.8%) among individuals with no cannabis use. Logistic regression revealed a two-fold increase (OR = 2.21, 95%CI: 1.88-2.60) of reporting SMC in respondents who had used cannabis in the past year, which was attenuated (OR = 1.38, 95%CI: 1.10-1.72) when controlling for additional factors. Other covariates, including physical health conditions, misuse of other substances, and mental illness also significantly contributed to SMC outcomes.

CONCLUSIONS

Cannabis use represents a modifiable lifestyle factor that has potential for both risk and protective properties that may impact the trajectory of cognitive decline in older age. These hypothesis generating results are important for characterizing and contextualizing population-level trends related to cannabis use and SMC in older adults.

Age, period and cohort-related trends in prescription opioid use in the USA, 1999-2018

BACKGROUND

To provide insight into the longitudinal dynamics of opioid use throughout the overdose crisis, this study estimated the separate influences of age, period and cohort on prescription opioid use during 1999-2018 in the USA.

METHODS

Data from 10 cycles of the cross-sectional National Health and Nutrition Examination Survey were used to conduct an age-period-cohort analysis of the prevalence of prescription opioid use (n=63 500 across 1999-2018). Temporal trends were graphically visualised. The median polish approach was used to estimate age, period and cohort-related effects on prescription opioid use.

RESULTS

Prescription opioid use broadly increased across the lifespan, with steeper prevalence increases observed from young adulthood to mid-adulthood. Period-related variation was consistent with recognised nationwide declines in opioid prescribing. While there was no evidence of systematic cohort effects, compared with individuals born in 1951-1954, those born during 1963-1966 had greater prescription opioid use (prevalence ratio (PR)=1.23, 95% CI: 1.05 to 1.43), whereas the 1991-1994 and 1999-2002 cohorts had lower prescription opioid use (PR91-94=0.70, 95% CI: 0.50 to 0.98; PR99-02=0.72, 95% CI: 0.63 to 0.81).

CONCLUSION

In the USA, longitudinal trends in prescription opioid use during 1999-2018 were predominantly driven by age and period influences. The cohort of youngest baby boomers experienced greater prescription opioid use, whereas recent-born cohorts have had lower use. As the overdose crisis continues evolving, such population-level characterisations of age, period and cohort dynamics are instrumental in understanding opioid use and can inform prevention and intervention approaches by identifying population groups more likely to use opioids who, thus, may also experience related outcomes.

Substance use among older adults: a review of the literature

OBJECTIVES

To explore studies that have examined the effectiveness of possible interventions to reduce the substance use among older adults.

METHODS

From the search, 295 abstracts were identified and 200 were excluded. Ninety-five remaining articles were reviewed, and 90 were excluded after full text review. Nine articles were included after reviewing bibliographic references on the topic. A total of 14 articles, which all met the inclusion criteria, were considered in the review.

RESULTS

All 14 studies found that pharmacological and non-pharmacological interventions can reduce substance use (alcohol, cocaine, nicotine and benzodiazepines) among older adults (mean age 45 years or older).

CONCLUSIONS

There are promising possibly pharmacological and non-pharmacological interventions that can be used to reduce substance use among older adults. In addition, other studies are needed to expand the therapeutic arsenal in this population.

Stressful Life Events and Patterns of Polysubstance Use Among U.S. Late Middle-Aged and Older Adults: A Latent Class Analysis

The goals of this study were to identify patterns of polysubstance use and their associations with stressful life events among U.S. late middle-aged and older adults and examine whether gender moderates these associations. Adults aged 50 and older (N = 14,738) from the National Epidemiological Survey on Alcohol and Related Conditions-III were included. Latent class analysis was conducted to identify patterns of polysubstance use. Weighted multinomial logistic regression was estimated with a generalized structural equation model. Three different polysubstance use patterns (non-users/low substance users; cannabis and excessive alcohol users; painkiller and sedative/tranquilizer misusers) were identified. Higher levels of stressful life events were associated with patterns of polysubstance use. Gender moderated the association between stressful life events and co-misusing painkillers and sedatives/tranquilizers (p < 0.05). Substance use prevention efforts should consider aging adults' patterns of polysubstance use and associated stressful life events when designing and implementing gender-specific polysubstance use prevention interventions.

Familial Predictors of Alcohol and Drug Use-Related Problems Among Middle-Aged and Older Adults

This study evaluated whether recent family member alcohol and substance use problems (ASP) and density of family ASP (i.e., number of members with ASP) predict alcohol-related problems and drug use-related problems among middle-aged and older adults. Data were drawn from participants (age 42-93 years, n=2,168) in the longitudinal Midlife in the United States Study (MIDUS). Poisson regression models revealed that adults' alcohol- and drug use-related problems were predicted by similar problems among family members. In particular, parent and partner ASP, but not child ASP, predicted alcohol-related problems in the middle-aged and combined samples, while only partner ASP predicted participants' drug use-related problems. In addition, density of family ASP predicted alcohol-related problems, but not drug use-related problems. There were no gender interactions. Study findings highlight that understanding how adult children, spouses, and aging parents impact each other's substance use should be a priority of future aging and family research.

Understanding the preference for receiving mental health and substance use support in African Americans 50 and older

OBJECTIVE

This study aims to determine whether current tobacco and/or alcohol use is associated with setting preferences for seeking support for substance use (SU) and mental health (MH) services to African Americans ages 50 and older.

METHODS

Data from 368 African American individuals (aged 50+) who participated in a community-based needs assessment survey were used. Preferences included community-based (e.g., health centers) and traditional settings (e.g., doctor's office). SU was measured as a categorical variable detailing past-month use of conventional cigarettes and alcohol graded by risk levels. Logistic regression models tested the associations between SU and setting preference before and after adjusting for the influence of self-reported MH diagnoses.

RESULTS

Prior to adjustment for the influence of MH outcomes, high-risk use of tobacco and alcohol in the past month was associated with a lower odds of preferring MH/SU support in traditional settings (OR = 0.23, 95% CI = 0.06-0.85) compared to participants engaged in no-/low- risk substance use. This association was no longer significant after accounting for the influence of mental health symptoms and covariates.

DISCUSSION

These results provide preliminary evidence that mental health outcomes mediate the association between substance use and setting preference for seeking MH/SU support in traditional settings.

TRANSLATIONAL SIGNIFICANCE

This exploratory study encourages additional investigation of the association between substance use, setting preferences, and the likelihood of seeking treatment in community health centers using larger sample sizes. Additional opportunities to offer mental health/substance use support to African American older adults within clinical settings should be explored.

The Information-Seeking Behavior and Unmet Knowledge Needs of Older Medicinal Cannabis Consumers in Canada: A Qualitative Descriptive Study

INTRODUCTION

Older Canadians (age 60+) are increasingly using cannabis to treat their health problems, but little is known regarding how they learn about medicinal cannabis. This study explored the perspectives of older cannabis consumers, prospective consumers, healthcare professionals, and cannabis retailers on older adults' information-seeking behavior and unmet knowledge needs.

METHODS

A qualitative descriptive design was used. Semi-structured telephone interviews were conducted with a purposeful sample of 36 older cannabis consumers and prospective consumers, as well as 4 healthcare professionals and 5 cannabis retailers from across Canada, for a total sample of 45 participants. Data were thematically analyzed.

RESULTS

Three main themes characterizing older cannabis consumers' information-seeking were identified: (1) knowledge sources, (2) types of information sought, and (3) unmet knowledge needs. Participants accessed a variety of knowledge sources to inform themselves about medicinal cannabis. Cannabis retailers were identified as providing medical information to many older adults, despite regulations to the contrary. Cannabis-specialized healthcare professionals were also viewed as key knowledge sources, while primary care providers were perceived as both knowledge sources and gatekeepers limiting access to information. The types of information participants sought included the effects and potential benefits of medicinal cannabis, the side effects and risks involved, and guidance regarding suitable cannabis products. Participants' most salient unmet knowledge needs focused on dosing and use of cannabis to treat specific health conditions.

DISCUSSION

Findings suggest that barriers to learning about medical cannabis among older consumers identified in prior research remain pervasive and cut across jurisdictions. To address these barriers, there is a need for better knowledge products tailored to older cannabis consumers and their information needs, and further education for primary healthcare providers on medicinal cannabis and its therapeutic applications with older patients.

Estimating the prevalence and correlates of pain among people living with HIV who use unregulated drugs in a Canadian setting

Although prevalent among people living with human immunodeficiency virus (HIV) (PLWH) and people who use unregulated drugs (PWUD), pain and its possible links to substance use patterns and engagement in HIV treatment remains poorly characterized. We sought to evaluate the prevalence and correlates of pain among a cohort of PLWH who use un-regulated drugs. Between December 2011 and November 2018, 709 participants were recruited, and data were analyzed using generalized linear mixed-effects (GLMM). At baseline, 374 (53 percent) individuals reported moderate-to-extreme pain in the previous 6 months. In a multivariable model, pain was significantly associated with nonmedical prescrip-tion-opioid use (adjusted odds ratio (AOR) = 1.63, 95 percent confidence interval (CI): 1.30-2.05), nonfatal overdose (AOR = 1.46, 95 percent CI: 1.11-1.93), self-managing pain (AOR = 2.25, 95 percent CI: 1.94-2.61), requesting pain medication in the previous 6 months (AOR = 2.01, 95 percent CI: 1.69-2.38), and ever being diagnosed with a mental illness (AOR = 1.47, 95 percent CI: 1.11-1.94). Establishing accessible pain management interventions that address the complex intersection of pain, drug use, and HIV-infection has potential to improve quality of life outcomes among this population.

Chronic pain and substance use disorders among older sexual minority men living with HIV: Implications for HIV disease management across the HIV care continuum

HIV continues to be a critical health issue for sexual minority men (SMM) in the USA. Chronic pain is common in individuals with HIV, including older SMM, and is associated with substance use behaviors. This cross-sectional study sought to address a gap in the literature by characterizing interrelationships among chronic pain, substance use disorders (SUDs), medication adherence, and engagement in HIV care among older (≥50) SMM living with HIV and chronic pain (N = 63). The unadjusted relationship between an opioid use disorder and pain indicated that participants with an opioid use disorder reported higher pain ratings than those without. Presence of alcohol use disorder was significantly associated with missed HIV-care appointments due to chronic pain or substance use, showing that individuals with an alcohol use disorder reported more missed appointments in the past year. Higher pain was significantly associated with the same missed appointments variable, such that those reporting higher pain ratings also reported more missed appointments in the past year. These findings provide preliminary evidence of the interrelationships among chronic pain, SUDs, and engagement in HIV care among older SMM living with HIV and suggest that pain management in this population might support fuller engagement in HIV care.

The role of substance use in the lives of incarcerated older adults: A qualitative study

Background

The prevalence of drug abuse among older adults has grown over the last decade. Despite the expanding development of a body of research dedicated to studying this phenomenon, drug abuse by incarcerated older adults has been marginalized. Thus, the aim of the present study was to explore drug abuse patterns in the lives of incarcerated older adults.

Method

Semi-structured interviews were conducted with 28 incarcerated older adults, and an interpretive analysis was used to analyze the participants’ narratives.

Findings

Four themes emerged: (1) Growing up around drugs; (2) Prison onset; (3) Professionals, and (4) Lifelong substance abuse.

Conclusion

The study findings reveal a unique typology of drug-related themes in the lives of incarcerated older adults. This typology sheds light on the interplay between aging, drug use, and incarceration and the way these three socially marginalized positions may intersect.

Risk Factors for Substance Use across the Lifespan

Substance use is a perennial public health concern with associated health risks and economic impacts on society. In this article, we present a selective review of the epidemiological and clinical literatures on alcohol and substance use from a lifespan developmental perspective. We compare and contrast risk factors for the initiation of use and the development of a substance use disorder in adolescence, young adulthood, middle-age and later life. During adolescence, alcohol use experimentation is at its peak. Specific risk factors have been identified including trauma and parenting style that can increase the risk of substance use for teenagers. Emerging adults and college students are likely to experiment with other substances in addition to alcohol such as nicotine, marijuana, cocaine, and prescription medication such as Adderall. Middle-age and older adults with alcohol and substance use in their developmental histories may have an undiagnosed alcohol use disorder. Others will develop a late-onset substance use disorder in older age, possibly due to a dearth of social support, coping with bereavement, and medical complication. Based on Social Cognitive Theory, the roles of expectancies and self-efficacy are hypothesized to impact substance use and the risk of substance use disorder across the lifespan. Implications of the present review for future research on age-specific risk factors in alcohol use in relation to underlying developmental processes are considered.

Differential patterns of opioid misuse between younger and older adults - a retrospective observational study using data from South Carolina's prescription drug monitoring program

Background: Most research on opioid misuse focuses on younger adults, yet opioid-related mortality has risen fastest among older Americans over age 55.Objectives: To assess whether there are differential patterns of opioid misuse over time between younger and older adults and whether South Carolina's mandatory Prescription Drug Monitoring Program (PDMP) affected opioid misuse differentially between the two groups.Methods: We used South Carolina's Reporting and Identification Prescription Tracking System from 2010 to 2018 to calculate an opioid misuse score for 193,073 patients (sex unknown) using days' supply, morphine milligram equivalents (MME), and the numbers of unique prescribers and dispensaries. Multivariable regression was used to assess differential opioid misuse patterns by age group over time and in response to implementation of South Carolina's mandatory PDMP in 2017.Results: We found that between 2011 and 2018, older adults received 57% (p < .01) more in total MME and 25.4 days more (p < .01) in supply, but received prescriptions from fewer doctors (-0.063 doctors, p < 01) and pharmacies (-0.11 pharmacies, p < 01) per year versus younger adults. However, older adults had lower odds of receiving a high misuse score (OR 0.88, p < .01). After the 2017 legislation, misuse scores fell among younger adults (OR 0.79, p < .01) relative to 2011, but not among older adults.Conclusion: Older adults may misuse opioids differently compared to younger adults. Assessment of policies to reduce opioid misuse should take into account subgroup differences that may be masked at the population level.

Ageing and older people who use illicit opioids, cocaine or methamphetamine: a scoping review and literature map

AIMS

To provide an overview of research literature on ageing and older people who use illicit opioids and stimulants by documenting the conceptual frameworks used and content areas that have been investigated.

METHODS

We conducted a scoping review of literature relating to ageing and older people who use illicit stimulants and opioids, defining 'older' as 40 years and above. Primary studies, secondary studies and editorials were included. Searches were conducted in PubMed and Embase in July 2020 and March 2021; the Cochrane library was searched in November 2021. Charted data included methodological details, any conceptual frameworks explicitly applied by authors and the content areas that were the focus of the publication. We developed a hierarchy of content areas and mapped this to provide a visual guide to the research area.

RESULTS

Of the 164 publications included in this review, only 16 explicitly applied a conceptual framework. Seven core content areas were identified, with most publications contributing to multiple content areas: acknowledgement of drug use among older people (n = 64), health status (n = 129), health services (n = 109), drug use practices and patterns (n = 84), social environments (n = 74), the criminal legal system (n = 28) and quality of life (n = 15).

CONCLUSIONS

The literature regarding older people who use illicit drugs remains under-theorized. Conceptual frameworks are rarely applied and few have been purposely adapted to this population. Health status and health services access and use are among the most frequently researched topics in this area.

Improving the management of chronic pain, opioid use, and opioid use disorder in older adults: study protocol for I-COPE study

Background

Older adults with chronic pain, opioid use, and opioid use disorder (OUD) present complex management decisions in primary care. Clinical tools are needed to improve care delivery. This study protocol describes the planned implementation and evaluation of I-COPE (Improving Chicago Older Adult Opioid and Pain Management through Patient-centered Clinical Decision Support and Project ECHO®) to improve care for this population.

Methods

This study uses a pragmatic, expanding cohort stepped-wedge design to assess the outcomes. The study will be implemented in 35 clinical sites across metropolitan Chicago for patients aged ≥ 65 with chronic pain, opioid use, or OUD who receive primary care at one of the clinics. I-COPE includes the integration of patient-reported data on symptoms and preferences, clinical decision support tools, and a shared decision-making tool into routine primary care for more effective management of chronic pain, opioid prescribing, and OUD in older adults. Primary care providers will be trained through web-based videos and an optional Project ECHO® course, entitled “Pain Management and OUD in Older Adults.” The RE-AIM framework will be used to assess the I-COPE implementation. Effectiveness outcomes will include an increased variety of recommended pain treatments, decreased prescriptions of higher-risk pain treatments, and decreased patient pain scores. All outcomes will be evaluated 6 and 12 months after implementation. PCPs participating in Project ECHO® will be evaluated on changes in knowledge, attitudes, and self-efficacy using pre- and post-course surveys.

Discussion

This study will provide evidence about the effectiveness of collecting patient-reported data on symptoms and treatment preferences and providing clinical decision support and shared decision-making tools to improve management for older adults with chronic pain, opioid use, and OUD.

Trial registration

ClinicalTrials.gov NCT04878562.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-022-06537-w.

Opioid Use Disorder and Older Adults: Navigating Treatment Options

The intent of the current article is to highlight via a case vignette challenges faced when managing pain across care transitions in an older adult with multiple comorbidities, including, but not limited to, opioid use disorder (OUD). This case will highlight the role of different medications for OUD, namely buprenorphine/naloxone, methadone, and naltrexone. Furthermore, the case illustrates medication-related considerations in addition to action steps that are needed when working with older adults. [Journal of Gerontological Nursing, 48(7), 4-9.].

Trends in Methamphetamine Use in the Mainland of China, 2006-2015

Background

Methamphetamine is the most prevalent drug in the mainland of China, yet few studies on the non-medical use of methamphetamine nationwide have been conducted. This study aimed to examine the trends in the prevalence of non-medical methamphetamine use and to explore the flow pattern of internal migrant methamphetamine users in the mainland of China.

Methods

Data were extracted from the National Dynamic Management and Control Database for Drug Users (NDMCD). Joinpoint regressions were used to examine trends in the prevalence and population size of methamphetamine use.

Results

A total of 1,821,468 methamphetamine use cases registered in NDMCD from 2006 to 2015 were identified. The number of methamphetamine use cases presented an increasing trend in all age subgroups, and among them, the elderly increased the fastest [annual percent change (APC_2006−2015), 122.9; 95% CI, 113.0–133.3; p < 0.001]. The prevalence of methamphetamine use increased from 4.69 per 100,000 population in 2008 to 45.38 per 100,000 population in 2015 (APC_2008−2015, 36.1; 95% CI, 31.9–40.6; p < 0.001). The regions of the Pearl River Delta, Yangtze River Delta, and Beijing-Tianjin-Hebei Urban Agglomeration absorbed over 96% of all internal migrant methamphetamine use cases, and the number of migrant methamphetamine use cases presented increased trends in these three regions.

Conclusions

The increasing trends in methamphetamine use have become a threat to all age groups in China. Substance use prevention programs should focus on internal migrant drug users, especially in economically developed regions.

Study Navigation and Enrollment in a Community Sample: Does Generational Cohort Matter?

The socioecological model (SEM) was used as a conceptual framework to examine the effect of generational cohorts on study navigation and enrollment in health research. The study population was 7,370 community-dwelling Gen Xers and Baby Boomers in North Central Florida. Analyses found that Leading-edge Boomers (individuals born between 1946 and 1955) [vs Gen Xers (individuals born between 1965 and 1955)] and individuals with higher trust (vs lower trust) were 41% and 25% respectively more likely to be enrolled in health research compared to their counterparts, controlling for factors at the individual, relationship, and community levels of the SEM. We conclude the study with a summary of the findings and the recruitment implications for study enrollment.

Substance Use Disorder in Older Adults: Mini Review

With an estimated prevalence of 4%, substance abuse amongst persons who are 65 years and older is increasing. The most common substances abused are alcohol, prescription drugs such as opiates and benzodiazepines (BZD), and over-the-counter (OTC) medications. This increase is believed to be partially endorsed by the baby boomer generation, born between 1946 to 1964, who had significant exposure to alcohol and drugs at a younger age. Substance abuse is difficult to recognize in the older adults, but once identified, presents its own challenges as only 18% of substance abuse treatment programs are designed for this growing population. Substance abuse overall may increase the risk of fractures secondary to recurrent falls, memory loss, sleep disturbances, anxiety, and depression. In this article, we will review the signs and symptoms, risk factors, screening tools, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria, and challenges of treating substance abuse in the older adults.

Social isolation, residential stability, and opioid use disorder among older Medicare beneficiaries: Metropolitan and non-metropolitan county comparison

Research has shown that the prevalence of opioid use disorder (OUD) may rise substantially as society ages, but this issue receives the least attention in the literature. To address this gap, this study utilizes county-level data from multiple data sources (1) to investigate whether social isolation is associated with OUD prevalence among older Medicare beneficiaries, (2) to examine whether and how residential stability moderates the association between social isolation and OUD prevalence in US counties, and (3) to determine if there are any differences in these associations between metropolitan and non-metropolitan counties. The results show that social isolation is a significant factor for county-level OUD prevalence, regardless of metropolitan status. In addition, counties with high residential stability have low prevalence of OUD among older adults and this association is stronger in metropolitan than in non-metropolitan counties. Nonetheless, high levels of residential stability reinforce the positive relationship between social isolation and OUD prevalence. As a result, when developing policies and interventions aimed at reducing OUD among older adults, place of residence must be taken into account.

Discharge locations after hospitalizations involving opioid use disorder among medicare beneficiaries

BACKGROUND

Hospitalizations involving opioid use disorder (OUD) have been increasing among Medicare beneficiaries of all ages. With rising OUD-related acute care use comes the need to understand where post-acute care is provided and the capacities for OUD treatment in those settings. Our objective was to describe hospitalized Medicare beneficiaries with OUD, their post-acute care locations, and all-cause mortality and readmissions stratified by post-acute care location.

METHODS

We conducted a retrospective cohort study of acute hospitalizations using 2016-2018 Medicare Provider Analysis and Review (MedPAR) files linked to Medicare enrollment data and the Residential History File (RHF) for 100% of Medicare fee-for-service beneficiaries. The RHF which provides a person-level chronological history of health service utilization and locations of care was used to identify hospital discharge locations. We used ICD-10 codes for opioid dependence or "abuse" to identify OUD diagnoses from the MedPAR file. We conducted logistic regression to identify factors associated with discharge to an institutional setting versus home adjusting for demographics, comorbidities, and hospital stay characteristics.

RESULTS

Our analysis included 459,763 hospitalized patients with OUD. Of these, patients aged < 65 years and those dually enrolled in Medicaid comprised the majority (59.1%). OUD and opioid overdose were primary diagnoses in 14.3% and 6.2% of analyzed hospitalizations, respectively. We found that 70.3% of hospitalized patients with OUD were discharged home, 15.8% to a skilled nursing facility (SNF), 9.6% to a non-SNF institutional facility, 2.5% home with home health services, and 1.8% died in-hospital. Within 30 days of hospital discharge, rates of readmissions and mortality were 29.7% and 3.9%; respectively, with wide variation across post-acute locations. Factors associated with greater odds of discharge to institutional settings were older age, female sex, non-Hispanic White race and ethnicity, dual enrollment, longer hospital stay, more comorbidities, intensive care use, surgery, and primary diagnoses including opioid or other drug overdoses, fractures, and septicemia.

CONCLUSIONS

More than one-quarter (25.8%) of hospitalized Medicare beneficiaries with OUD received post-acute care in a setting other than home. High rates and wide variation in all-cause readmissions and mortality within 30 days post-discharge emphasize the need for improved post-acute care for people with OUD.

Age-related trends in cannabis use in Australia. Findings from a series of large nationally representative surveys

AIM

We examine age-related trends in past-year cannabis use in a series of nationally representative surveys in Australia.

METHODS

We analysed data from the largest nationally representative survey in Australia collected between 2001 and 2019 (National Drug Strategy Household Survey [NDSHS]; N = 157,151). Prevalence of past-year daily/occasional (non-daily)/non-use of cannabis use were estimated using weighted multinomial logistic regression and predicted marginal probabilities. Difference-in-difference analysis was used to examine if trends of cannabis use across age groups were different.

RESULTS

The youngest age group (14-17 s) witnessed the largest increase in past-year abstinence rate from 79% to 92% from 2001 to 2019 (p < .003); the increase in abstinent rate among the 18-24 and 25-39 were relatively moderate (from 68 to 76% and from 81% to 84% respectively; p < .003). The abstinent rate among the 40-54 s and 55-74 s decreased significantly from 93% to 90% and from 99% to 95% respectively (p < .003). There were similar diverging trends in occasional and daily cannabis use, with decreases in both patterns of use observed among the younger age group (14-17 s and 18-25 s) but increases among the older age group (40-54 s and 55-74 s).

CONCLUSION

There is a diverging trend in cannabis use among younger and older age groups in Australia between 2001 and 2019. Cannabis use substantially decreased among the youngest age group (14-17 s) but modestly increased among older people (55-74 s).

Opioid-involved prescription drug misuse and poly-prescription drug misuse in U.S. older adults

OBJECTIVES

Although older adult prescription drug misuse (PDM) is associated with concerning consequences, stimulant PDM and poly- PDM involving multiple medication classes each remain understudied. Our objectives were to examine PDM and poly-PDM prevalence by medication class in US older adults and to identify the mental health, SUD, and health-related quality-of-life correlates of poly-PDM.

METHOD

Data were from adults 50 and older completing the National Epidemiologic Survey on Alcohol and Related Conditions-III, (N = 14,667). Prevalence of PDM and poly-PDM by medication class was estimated. Logistic regression established odds of four SUD diagnoses, five psychopathology diagnoses and lifetime suicide attempts; linear regression evaluated health-related quality-of-life by PDM/poly-PDM status.

RESULTS

Past-year PDM abstinence increased with age (50-54 years: 80.5%; 80 and older: 96.0%), while poly-PDM declined; past-year stimulant PDM was rare (≤0.6%), except when combined with opioid and tranquilizer/sedative PDM. Compared to no past-year PDM, both past-year opioid-only PDM and opioid-involved poly-PDM were associated with poorer health-related quality-of-life and greater odds of psychopathology and SUD, with the highest odds in poly-PDM.

CONCLUSION

The presence of any opioid-involved PDM in older adults highlights screening for SUD, psychopathology, and other medical conditions, with the most significant intervention needs likely in those with opioid-involved poly-PDM.

Co-ingestion of prescription drugs and alcohol in US adults aged 50 years or older

OBJECTIVE

To examine prevalence of past-month prescription drug misuse (PDM) and alcohol co-ingestion and its correlates in adults age 50 or older.

METHODS

Data were from the 2015-2018 US National Survey on Drug Use and Health (n = 35,190). PDM-alcohol co-ingestion was defined as prescription opioid, tranquilizer/sedative, or stimulant misuse while "drinking alcohol or within a couple of hours of drinking." Co-ingestion prevalence was estimated, and logistic and negative binomial regressions examined the sociodemographic, physical health, mental health, substance use, and substance use disorder (SUD) correlates of co-ingestion.

RESULTS

Over 344,000 adults aged 50 years or older (0.3%) engaged in past-month PDM-alcohol co-ingestion, or 27.4% of those with past-month PDM. Past-month co-ingestion was linked to greater past-month alcohol use frequency and elevated adjusted odds ratios (aORs) for all examined substance use outcomes (e.g., non-PDM SUD aOR = 21.8; 49.7% prevalence rate). The aOR for suicidal ideation was 506% higher in those with co-ingestion than those without past-year PDM.

CONCLUSIONS

US adults aged 50 years or older with past-month PDM-alcohol co-ingestion are at high risk for SUD and concerning mental health symptoms. Screening for mental health and substance use treatment is warranted among aging adults with signs of PDM, especially involving co-ingestion.

Effectiveness of eHealth Technology-Based Interventions in Reducing Substance Misuse Among Older Adults: A Systematic Review

Generally considered an epidemic among young people, substance misuse has been a growing issue among older Americans for the past 40 years. Legal substances, such as alcohol, tobacco, and prescription drugs, including opioids and marijuana, are of primary concern when it comes to aging Baby Boomers. By 2050, 22% of Americans will be aged ≥65 years. Currently, eHealth interventions are receiving attention in treating substance misuse among younger Americans. The current study has two aims: to evaluate the effectiveness of eHealth interventions for older adults treated for substance misuse problems, as well as to investigate behavioral outcomes in reducing substance misuse. A comprehensive search of databases yielded 35,041 articles that examined reductions in substance misuse and problem behaviors as a primary outcome with eHealth interventions delivered to older adults. Once duplicate and irrelevant articles were removed, seven were left to be analyzed. Findings suggest use of technology to assess and intervene with older adults using various substances shows promise and, as a whole, older adults are receptive to online learning, screening and assessment, and interventions. [Journal of Gerontological Nursing, 47(10), 23-29.].

Gender Differences in Prevalence and Risk Factors Associated With Substance Use in 50- to 65-Year-Old Jamaicans

ABSTRACT

The purpose of this study was to evaluate gender-specific differences in prevalence and risk factors for alcohol, tobacco, and marijuana use among 50- to 65-year-old Jamaicans. We performed secondary analysis of the 2016 Jamaica National Drug Use Prevalence Survey. The dependent variables were self-reported use of tobacco, alcohol, and marijuana in the 30 days before the survey. The independent variables included general, socioeconomic, and community characteristics and concomitant substance use. Gender-stratified multiple Poisson regressions were conducted. The survey included 1,099 individuals aged 50-65 years; 50.3% were men. Reported use was significantly higher in men than in women: alcohol (54.9% vs. 17.8%), marijuana (22.4% vs. 2.2%), and tobacco (19.2% vs. 3.9%). High income was associated with alcohol use in women, whereas low and middle incomes were associated with marijuana use among men. Being employed was associated with tobacco use among women and with alcohol use among men. Rural residence was associated with alcohol use in women and with marijuana use in men. High neighborhood disorder was associated with tobacco use in women and alcohol and marijuana use in men. Concomitant substance use increased the likelihood of alcohol, tobacco, and marijuana use in men and women. We conclude that gender-sensitive strategies to substance use prevention and treatment are needed in Jamaica.

Problematic Opioid Use Among Older Adults: Epidemiology, Adverse Outcomes and Treatment Considerations

With the aging population, an increasing number of older adults (> 65 years) will be affected by problematic opioid use and opioid use disorder (OUD), with both illicit and prescription opioids. Problematic opioid use is defined as the use of opioids resulting in social, medical or psychological consequences, whereas OUD is a form of problematic use that meets diagnostic criteria as defined by the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Problematic use of opioids by older adults is associated with a number of pertinent adverse effects, including sedation, cognitive impairment, falls, fractures and constipation. Risk factors for problematic opioid use in this population include pain, comorbid medical illnesses, concurrent alcohol use disorder and depression. Treatment of OUD consists of acute detoxification and maintenance therapy. At this time, there have been no randomized controlled trials examining the effectiveness of pharmacological interventions for OUD in this population, with recommendations based on data from younger adults. Despite this, opioid agonist therapy (OAT) is recommended for both stages of treatment in older adults with OUD. Buprenorphine is recommended as a first line agent over methadone in the older adult population, due to a more favourable safety profile and relative accessibility. Use of methadone in this population is complicated by risk of QT interval prolongation and respiratory depression. Available observational data suggests that older adults respond well to OAT and age should not be a barrier to treatment. Further research is required to inform treatment decisions in this population.

Participation in a Substance Misuse Intervention in Post-acute Care Is Associated With More Optimal Rehabilitation Outcomes

BACKGROUND AND OBJECTIVES

Alcohol and substance misuse is prevalent among older adults, yet underdiagnosed and undertreated. More substance misuse intervention programs specifically designed for older adults and offered in various settings are needed. This project's objectives were to (a) provide a detailed description of a Geriatric Substance Abuse Recovery Program (GSARP) designed and implemented at post-acute rehabilitation units of a skilled nursing facility and (b) report findings of a study conducted to evaluate if GSARP participation among post-acute care patients with substance misuse issues can optimize rehabilitation outcomes (i.e., being discharged home vs. another setting).

RESEARCH DESIGN AND METHODS

A pretest-posttest study design with data obtained from patients' electronic medical record upon facility admission, during post-acute stay, and after discharge (N = 271). Based on Andersen's model of health care utilization, we investigated which predisposing factors (e.g., ethnicity), enabling factors (e.g., cognition and social support), and need-related factors (e.g., activities of daily living functioning), as well as health behaviors (e.g., GSARP participation) predicted likelihood of being discharged home versus another discharge setting.

RESULTS

Patients participating in the GSARP and patients who received social support from family members and friends during their post-acute stay were more likely to be discharged home. Patients with severe cognitive impairment were less likely to be discharged home.

DISCUSSION AND IMPLICATIONS

The GSARP eliminates some common barriers often encountered in the screening and delivery process of substance misuse interventions for older adults. Findings support the effectiveness of the GSARP in optimizing rehabilitation outcomes for older adults with substance misuse issues.

Binge drinking among Hispanic older adults: 2015-2019

Previous research has shown that older adults (i.e., individuals 50 years or older) show a high propensity to report unhealthy alcohol habits. Much is to be gleaned regarding these relationships among Hispanic older adults. The purpose of the present study was to examine correlates to binge drinking among a national sample of Hispanic older adults. Pooled data from the 2015-2019 National Survey on Drug Use and Health were analyzed among 4,152 Hispanic individuals. Findings revealed that a sizable percentage (17.9%) of individuals reported binge drinking in the past 30 days. Of the sample, 15.1% of individuals diagnosed with diabetes reported binge drinking and high co-morbid substance use was found. Findings can address critical gaps in Hispanic health care, prevention messaging, and harm reduction.

Cannabis use frequency, route of administration, and co-use with alcohol among older adults in Washington state

Background

The US national surveys and data from legal adult use cannabis states show increases in the prevalence of cannabis use among older adults, though little is known about their manner of cannabis consumption. Here, we examine cannabis use frequency, routes of cannabis administration, and co-use with alcohol, focusing on adults aged 50–64 and ≥65.

Methods

Data come from a general population survey conducted January 2014–October 2016 (N=5492) in Washington state. We first estimate prevalence and trends in cannabis frequency, routes of administration, and co-use with alcohol in gender by age groups (18–29, 30–49, 50–64, ≥ 65). To test associations between cannabis frequency, route of administration, and co-use with alcohol, we then use sample-weighted multinomial regression adjusted for gender, race/ethnicity, marital status, education, employment, and survey year. Sampling weights are used so results better represent the Washington state population. Regressions focus on the 50–64 and ≥65 age groups.

Results

Among men and women 50–64, the prevalence of no cannabis use in the past 12 months decreased significantly (84.2% in 2014 to 75.1% in 2016 for women, 76.8% in 2014 to 62.4% in 2016 for men). Among those who report past-year cannabis use, oral administration and vaping and other routes of administration increased by 70% and 94%, respectively each year. Almost one-third of women aged 50–64 and one-fifth of women aged ≥65 who use cannabis reported daily/near daily use, and more than one-third of men who use cannabis in all age groups reported daily/near daily use, including 41.9% of those ≥65. Among men, the prevalence of edibles, drinks, and other oral forms of cannabis administration went up significantly with age (6.6% among 18–29, 21.5% among ≥65). Vaping and other administration are more strongly related to regular and daily/near daily use than infrequent use among those ≥65. The pattern of associations between cannabis frequency and co-use with alcohol differed for women vs. men.

Conclusions

In a general population representative sample of adults living in a state with legal adult use cannabis, the prevalence of cannabis use increased among those aged 50–64 between 2014 and 2016, the prevalence of daily use is substantial, and oral administration and vaping are increasing.

Association between relationship quality and concurrent alcohol use and sedative-tranquilizer misuse in middle and later life

OBJECTIVES

Mid-life adults have notably higher rates of alcohol and other substance misuse than older adults and maintain higher levels of use over time. Social isolation has been linked to higher risk use with increasing age. The purpose of this study is to examine the associations between social relationships, drinking, and misuse of sedative-tranquilizers.

METHODS

The data for this study come from the national Midlife in the United States study wave 2 (MIDUS 2) of adults (N = 3378; 53.3% women) aged 40 and older. Past month alcohol use and past year sedative medication misuse were assessed with social support and strain. Multinomial logistic regressions evaluated the relationship of (a) support and (b) strain to use and co-use of alcohol and sedatives.

RESULTS

Of the sample, 58.4% used alcohol only, 1.7% only misused sedatives, and 3.5% co-used alcohol/misused sedative-tranquilizers. Support from friends was associated with 1.18 increased risk of co-using compared to not using either substance. Source of strain was associated with co-use for middle-aged and older adults. Familial strain was associated with increased risk of co-using for middle-aged adults. Friend-related strain was associated with increased risk of co-use for older adults.

CONCLUSION

Evidence suggests that older co-users may differ from those in midlife in terms of social risk factors. As the aging population increases, elucidating the potential mechanisms by which social factors impact concurrent alcohol use and sedative-tranquilizer medication misuse aid the development of targeted interventions and prevention programs in these groups.

Ensuring access to high-quality substance use disorder treatment for Medicaid enrollees: A qualitative study of diverse stakeholders' perspectives

BACKGROUND

Medicaid programs are vital to ensure low-income individuals have access to substance use disorder (SUD) treatment. However, shifts in Medicaid policies may alter coverage and SUD care for this population, who already face difficulties receiving high-quality SUD treatment. Using a policy implementation research approach, we sought to identify barriers and facilitators when transitioning from Medicaid fee-for-service to managed care plan structures and opportunities for improving SUD care in New York State (NYS).

METHOD

Study staff conducted semistructured, in-depth qualitative interviews (N = 40 total) with diverse stakeholders involved with different aspects of SUD treatment in NYS, including policy leaders (n = 13), clinicians (n = 12), Medicaid managed care plan administrators (n = 5), and patients (n = 10).

RESULTS

Findings from thematic analysis centered on three themes: 1) while transitions to managed care have benefited clinicians, certain policies affect patients' Medicaid enrollment and quality of care; 2) stakeholders perceived individuals with dual diagnoses, older adults, and linguistic minorities to be at higher risk for inadequate care; and 3) current quality metrics may not adequately capture treatment quality.

CONCLUSION

Policy changes should focus on promoting increased collaboration among stakeholders, expanding Medicaid coverage, and reducing stigma. Resources should be diverted to facilitate psychiatric care for patients with dual diagnoses and to build workforce capacity to adequately meet the needs of older adults and linguistic minorities. Opportunities for NYS Medicaid include adapting performance metrics to capture meaningful patient outcomes and link reimbursements to improvements in patients' quality of life.

Increasing rates of methamphetamine/amphetamine-involved overdose hospitalizations in Washington State, 2010-2017

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Methamphetamine/amphetamine-involved overdose hospitalizations are increasing.

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Rate of increase highest in patients aged ≥55 years.

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More than a third of patients had a polysubstance overdose.

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Opioid was the most frequent drug class involved in polysubstance overdoses.

Background and aims

In the United States, overdose deaths resulting from methamphetamine and other amphetamine-type stimulants (METH/AMPH) have been increasing. We describe rates and characterize patients hospitalized after a METH/AMPH-involved overdose in Washington State, to guide prevention and control measures.

Design, setting, participants

We conducted a trend analysis of hospitalized Washington State residents aged ≥15 years who received a METH/AMPH-involved overdose diagnosis in Washington’s civilian hospitals and reported in the Comprehensive Hospital Abstract Reporting System.

Measurements

We used Joinpoint regression analysis to study trends in rates of hospitalized patients who received a METH/AMPH-involved overdose diagnosis during 2010–2017. We used 2016–2017 data to describe characteristics of patients with nonfatal and fatal outcomes and used chi-square test (for categorical variables) and Wilcoxon rank-sum test (for continuous variables) to compare characteristics of patients by outcome.

Findings

During 2010–2017, 3587 patients were hospitalized and received a METH/AMPH-involved overdose diagnosis. The age-adjusted rate for METH/AMPH-involved overdose hospitalization increased from 6.3/100,000 persons in 2010 to 8.5/100,000 persons in 2017. Patients aged ≥55 years had the greatest increase in rate of overdose hospitalizations. Among these patients, 86% also had a substance use disorder diagnosis involving substances other than METH/AMPH, and 35% experienced a polysubstance overdose.

Conclusions

We observed increasing rates of METH/AMPH-involved overdose hospitalizations in Washington State, particularly among persons aged ≥55 years. Approximately a third of patients also experienced a polysubstance overdose, which can be considered when designing interventions to address increasing rates of overdose hospitalizations in Washington State.

Social Isolation Profiles and Older Adult Substance Use: A Latent Profile Analysis

OBJECTIVES

The aim of this study was to determine substance use among older adults based upon their social isolation and loneliness profiles.

METHODS

Data were derived from the New Jersey Older Adult Survey on Drug Use and Health (OASDUH). Latent profile Analysis (LPA) was used to determine the profiles of older adults (N = 801) based on five dimensions of social isolation and loneliness. Logistic and generalized ordered logistic regressions were conducted to assess the relationship between the latent profiles and substance use.

RESULTS

LPA identified five social isolation/loneliness profiles. The "connected and active" group had the lowest odds of cigarette use. The "alone but not lonely" group had the highest odds of cigarette use, alcohol use, and high-risk drinking. The "alone and lonely" group had the highest odds of non-medical drug use.

DISCUSSION

In working with older adults who are using substances, it is important to inquire about their social isolation and loneliness. Cognitive behavioral therapy for the "alone and lonely" group may be beneficial, as it has been deemed effective in reducing loneliness and enhancing social network.

Opioid painkiller dependence in a sample of elderly medical inpatients

BACKGROUND

Over the past few years, there has been a growing concern about prescription opioid misuse and dependence in the elderly. Our study aimed to investigate the prevalence of previous and current prescription opioid dependence among elderly medical inpatients recruited from a large German hospital.

METHODS

This cross-sectional study analyzed a cohort of inpatients aged 65 years and older who were assessed with a structured clinical interview. Levels of past and current dependence on opioids benzodiazepines, hypnotics, and non-opioid analgesics were assessed.

RESULTS

Of 2108 elderly inpatients admitted to the hospital during a 6-month period, 400 fulfilled the inclusion criteria and agreed to participate to the survey. Among these 400 subjects, 43 (10.8%) presented with a dependence on opioid analgesics, including 41 with current dependence and 22 (51.2%) with a de novo condition. Addiction severity was considered mild in 65.1% of cases and severe in 11.6% of cases. Tilidine and oxycodone were the most typically reported molecules.

CONCLUSIONS

Further research is warranted, to better understand the possible risk factors of prescription drug misuse, abuse, and addiction in this vulnerable population. Clinicians should be updated and informed regarding both prescription medication misuse potential and safe prescribing practices in the elderly.

Mapping of drug-related problems among older adults conciliating medical and pharmaceutical approaches

PURPOSE

To lay the fundamentals of drug-related problems (DRPs) in older adults, and to organize them according to a logical process conciliating medical and pharmaceutical approaches, to better identify the causes and consequences of DRPs.

MATERIALS AND METHODS

A narrative overview.

RESULTS

The causes of DRPs may be intentional or unintentional. They lie in poor prescription, poor adherence, medication errors (MEs) and substance use disorders (SUD). Poor prescription encompasses sub-optimal or off-label drug choice; this choice is either intentional or unintentional, often within a polypharmacy context and not taking sufficiently into account the patient's clinical condition. Poor adherence is often the consequence of a complicated administration schedule. This review shows that MEs are not the most frequent causes of DRPs. SUD are little studied in older adults and needs to be more investigated because the use of psychoactive substances among older people is frequent. Prescribers, pharmacists, nurses, patients, and caregivers all play a role in different causes of DRPs. The potential deleterious outcomes of DRPs result from adverse drug reactions and therapeutic failures. These can lead to a negative benefit-risk ratio for a given treatment regimen.

DISCUSSION/CONCLUSION

Interdisciplinary pharmacotherapy programs show significant clinical impacts in preventing or resolving adverse drug events and, suboptimal responses. New technologies also seem to be interesting solutions to prevent MEs. Better communication between healthcare professionals, patients and their caregivers would ensure greater safety and effectiveness of treatments.

Evolution of doctor shopping for oxycodone in the 67 million inhabitants in France as a proxy for potential misuse or abuse

ABSTRACT

This nationwide study aimed to compare use of oxycodone and doctor shopping for oxycodone in 2010 and 2016, and to quantify doctor shopping for oxycodone by sex, age, formulation, and dosage in 2010 and 2016. This study is a cross-sectional comparative analysis of doctor shopping based on all dispensings of oxycodone in France, in 2010 and 2016. Dispensings of oxycodone were extracted from the Système national des données de santé, which covers the 67 million inhabitants in France. Quantification of doctor shopping relies on an algorithm accounting for overlapping prescriptions, which is a proxy for potential misuse or abuse. The number of subjects who received oxycodone increased by 214% from 67,838 subjects in 2010 to 212,753 subjects in 2016, and the number of subjects with doctor-shopping behavior increased by 197%, from 1066 subjects in 2010 to 3163 subjects in 2016. For 30- to 44-year-old men, the total quantity of oxycodone obtained by doctor shopping increased by 391%, from 4582 defined daily doses in 2010 to 22,517 defined daily doses in 2016. By formulation and dosage, the total quantity of oxycodone obtained by doctor shopping increased with the dosage for both immediate-release and extended-release tablets in 2010 and 2016. The widespread extent of doctor shopping and its 3-fold increase in line with population exposure is a strong signal in the French context. These results are another argument to avoid trivializing oxycodone to prevent misuse, potential abuse, and potential oxycodone-related deaths, but it requires caution to prevent compromising effective treatment of pain.

The association between loneliness and medication use in older adults

BACKGROUND

Loneliness is common in older adults, and it is associated with unhealthy behaviours, including substance use. We evaluated the association between loneliness and self-reported use of opioids and benzodiazepines in older adults.

METHODS

We used data from the Canadian Community Health Survey's 'Healthy Aging' sub-survey and included adults 65 years or older who administered their own medications. We classified individuals as lonely if they scored 6 or more on the three -item University of California, Los Angeles's Loneliness Scale. We used multinomial logistic regression models, adjusting for demographics and self-reported comorbidities, to describe the association between loneliness and daily or occasional use of opioids, benzodiazepines and non-opioid analgesics. We also explored the association between loneliness and polypharmacy.

RESULTS

Our cohort included 15,302 older adults, of whom 2,096 (13.7%) were classified as lonely. Daily use of opioids (4.1%) and benzodiazepines (1.7%) were less common than daily use of non-opioid analgesics (33.9%). Lonely older adults had higher daily use of opioids (odds ratio [OR] 1.61, 1.31-1.98) and benzodiazepines (OR 1.66, 1.21-2.28), but not non-opioid analgesics (OR 1.05, 0.92-1.19). Loneliness was not associated with occasional use of opioids, benzodiazepines or non-opioid analgesics in older adults, but was associated with polypharmacy (OR 1.27, 1.06-1.52).

CONCLUSIONS

Loneliness in older adults is associated with increased daily use of opioids and benzodiazepines. Further research should evaluate patient- and physician-level factors that mediate this association, and develop strategies to mitigate loneliness and its attendant adverse outcomes.

Substance use disorder and the baby boom generation: Does Berlin outpatient addiction care face a sustained change?

Introduction

The ageing of baby boomers is expected to confront addiction care with new challenges. This cohort had greater exposure to psychoactive substances in youth than earlier cohorts. In this study, we aimed to investigate whether Berlin addiction care is confronted with a sustained change in its clientele initiated by the baby boomers.

Methods

Using data from Berlin outpatient addiction care facilities, we contrasted type of primary substance use disorder and number of comorbid substance use disorders in baby boomers with an earlier and a later cohort. To isolate cohort effects, two‐level random intercept regression models were applied in the overlapping age groups of the baby boomer cohort with each of the other cohorts.

Results

Compared with the earlier cohort, alcohol use disorder lost importance whereas illicit substance use disorder gained importance in the baby boomers. Baby boomers presented a higher number of comorbid substance use disorders than the earlier cohort. Comparing baby boomers with the later cohort, these relationships pointed in the opposite direction.

Discussion and Conclusions

Outpatient addiction care faces a sustained change to more illicit and comorbid substance use disorders. With increasing life expectancy and the ageing of baby boomers marked by higher substance use than previous cohorts, older clients, who had been under‐represented in outpatient addiction care, will gain relevance. Hence, addiction care has to adapt its offers to appropriately meet the changing needs of its clientele.

Racial/ethnic differences in US drug overdose mortality, 2017-2018

BACKGROUND

The year 2018 marked the first year since 1999 in which the number of drug overdose deaths in the United States (US) declined compared to the previous year. However, it is unclear whether this decline was observed across all racial/ethnic groups.

METHODS

Death certificate data from the National Center for Health Statistics were examined for drug overdoses among US residents with a race and ethnicity specified (69,764 in 2017 and 66,949 in 2018). Age-specific and age-adjusted drug overdose mortality rates for 2017 and 2018 were compared by race/ethnicity, overall, by sex, and for overdoses involving stimulants. Percentages of overdose deaths involving specific drug combinations were computed by race/ethnicity.

RESULTS

From 2017 to 2018, the age-adjusted drug overdose mortality rate significantly decreased in Non-Hispanic (NH) Whites; among Hispanics, in contrast, a significant increase was observed. Significant increases in drug overdose mortality rates from 2017 to 2018 were observed for NH Black males, Hispanic males, and NH Blacks aged 65 and older, as well as for overdoses involving psychostimulants (in all racial/ethnic groups) and cocaine (in NH Blacks and Hispanics). In 2018, the proportion of drug overdose deaths involving opioids ranged from 43.2% among NH Asian/Pacific Islanders to 70.8% among NH Whites, and the level of opioid co-involvement in stimulant-involved overdose deaths also varied by race/ethnicity.

CONCLUSIONS

The continually-evolving US overdose crisis necessitates an evolving response, not only to address changes in the drug combinations most involved in overdose deaths, but also to strengthen interventions targeting racial/ethnic minority groups.

Assessing Health-Related Outcomes of Medical Cannabis Use among Older Persons: Findings from Colorado and Illinois

OBJECTIVES

To assess health-related outcomes associated with medical cannabis use among older patients in Colorado and Illinois enrolled in their home state's medical cannabis program.

METHODS

Cross-sectional data from anonymous surveys were collected from 139 persons over the age of 60 using medical cannabis in the past year. We used structural equation modeling (SEM) to confirm the hypothesized four-factor structure that includes health-related quality of life (HRQL), health-care utilization (HCU), symptom effects, and adverse events. We then examined associations between cannabis use and self-reported outcome changes using linear regression.

RESULTS

The four-factor model was the best fitting structure (X2(df) = 81.63 (67), p> X2 = 0.108) relative to reduced structures. We also found that using cannabis 1-4 times per week is associated with 3.30 additional points on the HRQL scale (p < .001), 2.72 additional points on the HCU scale (p < .01), and 1.13 points on pain (p < .001). The frequency of use reported at 5-7 times per week is associated with 4.71 additional HRQL score points (p < .001). No significant associations were observed between the frequency of use and adverse events.

CONCLUSIONS

We observed how cannabis use outcomes fall into four independent factors, and those using more frequently reported higher values on HRQL, HCU, and pain measures. However, we are cautious about the generalizability of our findings.

CLINICAL IMPLICATIONS

Clinicians should consider how older patients using medical cannabis can experience positive and negative outcomes simultaneously or separately and assess these outcomes directly along with considering patient self-reports.

Patterns of Substance Use and Associations with Mental, Physical, and Social Functioning: A Latent Class Analysis of a National Sample of U.S. Adults Ages 30-80

Trends show increased substance use among adults, yet little research on general population samples has examined differential patterns of licit and illicit substance use that can inform prevention and treatment efforts. This study identifies distinct patterns (classes) of substance use among 30- to 80-year olds, identifies demographic subgroups with the highest probability of class memberships, and compares classes on key indicators of functioning. Method: Participants (n = 1,877) were from the RAND American Life Panel. Online survey measures included current alcohol, tobacco, cannabis, and nonmedical prescription drug use, as well as mental, physical, and social functioning. Results: Latent class analysis identified four classes: "Lighter Drinking" (46.6%), "Abstaining" (33.7%), "Heavy Drinking with Cigarette/Cannabis Use" (17.1%), and "Cigarette Smoking with Prescription Drug/Cannabis Use" (2.6%). Of these classes, "Cigarette Smoking with Prescription Drug/Cannabis Use" reported the worst mental and physical functioning, and greater loneliness than the "Lighter Drinking" class. "Heavy Drinking with Cigarette/Cannabis Use" reported worse mental and physical functioning than the "Lighter Drinking" class and less social support than the "Lighter Drinking" and "Abstaining" classes. The "Abstaining" class reported consistently worse functioning than the "Lighter Drinking" class. Both polysubstance use classes were associated with younger age, less education, and lower income, and heavy drinking polysubstance use was associated with being male and unmarried. Conclusions: Although lighter drinking was the most common pattern, 20% of adults were classified into two polysubstance use classes associated with poorer functioning. Targeted efforts may be needed to reach certain subgroups of adults who are particularly susceptible to polysubstance use.

Functional Limitations Mediate the Relationship Between Pain and Depressive Symptoms in Former NFL Athletes

The objective of this study was to analyze data from the National Football League Player Care Foundation Study of Retired NFL Players to understand potential risks for depressive symptoms in former athletes by investigating the relationship between pain and depressive symptoms in a multivariate context, while simultaneously exploring the potential connection with functional limitations. Descriptive statistics were used to describe the study sample and to conduct bivariate comparisons by race and age cohort. Linear regression models were conducted in the subsample of respondents reporting on depressive symptoms using the PHQ-9. Models examine the relationship of bodily pain, injury as a reason for retirement or not re-signing with a team, length of NFL career, sociodemographic characteristics, chronic conditions, and functional limitations to depression. Interaction terms tested whether race and age moderated the effect of bodily pain and functional limitations on depressive symptoms. Bivariate associations revealed no significant differences between younger and older former players in indicators of pain and only slightly higher functional limitations among younger former players. In the multivariate models, pain was significantly associated with depressive symptoms (β = 0.36; p < .01), net of a range of relevant controls. Adding an index of functional limitations reduced this association by nearly half (β = 0.20; p < .01) and functional limitations was significantly associated with depressive symptoms (β = 0.40; p < .01). No statistically significant interactions were found. Overall, bodily pain was strongly associated with depressive symptoms. After accounting for the effects of functional limitations, this association was notably reduced. These results may be useful in identifying aging-related physical declines in relatively younger adult men who may be at the greatest risk for depression. They highlight how physical functionality and activity may mitigate the risk of depression, even in the presence of significant bodily pain.