Dramatic Rise in Older Adults Seeking Opioid Addiction Tx

Liam Davenport

December 14, 2015

The proportion of adults aged 50 years and older seeking treatment for opioid addiction has increased dramatically in recent decades, US researchers have discovered in findings that suggest healthcare programs will need to be tailored to meet the health needs of this growing patient population.

In a study of adults in New York City, investigators found that the proportion of adults aged 50 to 59 years who are in opioid treatment increased almost fivefold from 1996 to 2012, to more than 35%.

During that period, the proportion aged 60 to 69 years increased eightfold, to 12%, whereas the proportion aged 40 years or younger more than halved.

"These increases are especially striking, considering there was about a 7.6% decrease in the total patient population over that period of time, and suggests that we are facing a never-before- seen epidemic of older adults with substance use disorders and increasing numbers of older adults in substance abuse treatment," lead author Benjamin Han, MD, MPH, Division of Geriatric Medicine and Palliative Care, New York University School of Medicine, New York City, said in a statement.

"Unfortunately, there is a lack of knowledge about the burden of chronic diseases and geriatric conditions or the cognitive and physical function of this growing population."

The study was published in the December issue of Substance Use and Misuse.

Age, Ethnicity Shifts

To assess the usage of opioid treatment services by older adults in New York City, the researchers examined data from the Client Data System, an administrative dataset of the New York State Department of Health that collates information on admissions, discharges, and the updated annual status of patients in licensed drug treatment programs.

To determine age trends, participants were divided into five age groups: those aged 40 years and younger; those aged 41 to 49 years; those aged 50 to 59 years; those aged 60 to 69 years; and those aged 70 years and older. Information on sex, race and ethnicity, primary and secondary substance used, and impairments was also collected.

In 1996, 37,038 adults received opioid therapy, primarily consisting of methadone maintenance treatment. The population peaked at 40,328 adults in 2003, and then declined to 34,270 in 2012.

There was a marked age trend during the study period. The proportion of adults aged 50 to 59 years who were receiving treatment increased from 7.8% in 1996 to 35.9% in 2012. A similar trend was seen for adults aged 60 to 69 years years, in whom the proportion receiving treatment increased from 1.5% in 1996 to 12.0% in 2012.

In contrast, the proportion of adults aged 40 years and younger who were receiving opioid treatment decreased from 56.2% in 1996 to 20.5% in 2012. The proportion of adults aged 40 to 49 years who were receiving treatment decreased from 34.4% in 1996 to 30.5% in 2012.

The proportion of adults aged 70 years and older who were receiving opioid treatment remained relatively stable, at 0.2% in 1996 and 1.1% in 2012.

During the study period, there was an increase in the proportion of female adults receiving treatment between 1996 and 2012: the proportion of women aged 50 to 59 years who were receiving treatment increased by 10.7%; the proportion of those aged 60 years and older increased by 3.8% increase.

There were also shifts in ethnicity between 1996 and 2012. For example, the proportion of white patients aged 60 years and older who received treatment increased by 10.3%, whereas the proportion who were black decreased by 13.8%. The trends were different among those aged 50 to 59 years, for whom the proportion of Hispanic adults increased by 9.2% during the study period.

"Missing" Population

The age shifts seen in the study suggest there may have been a "bubble" of individuals aged 40 years or younger seeking opioid treatment in 1996 who aged during the course of the study.

Dr Han pointed out that on the basis of the current data, that supposition cannot be confirmed, and he is currently investigating it in a further analysis.

However, Wilson M. Compton, MD, MPE, deputy director, National Institute on Drug Abuse, Bethesda, Maryland, who did not take part in the study, believes it is likely that that is the case.

"When you look at the way the population has shifted in their figure in the paper, it basically shows a single cohort aging. What it tells us is that, when patients are in methadone and undergoing treatment, that they can live long lives," he told Medscape Medical News.

"We're seeing what I think is actually a sort of a good find, in that people are living longer, and so we're seeing an ageing of this cohort in their treatment system," he added.

Dr Compton noted that there is a population "missing" from the dataset.

"This doesn't include any information about those that may receive opioid treatment outside of the methadone clinic population," he said.

Referring specifically to buprenorphine and naltrexone, Dr Compton noted that both of these medication-assisted treatments "are offered in general medical settings, from primary care and similar clinical practices, so they wouldn't show up in these administrative datasets in the methadone treatment system.

"That's why I'm a little sceptical about concluding much about the younger group, because they may be the ones who are most open to accessing treatment in these new settings."

Growing Trend

Dr Han and Dr Compton agree that the findings suggest that current treatment programs will need to be updated to accommodate the needs of older patients.

"My experience is that most opioid treatment programs in general do not, and are not well suited to, address comprehensive primary care issues, including geriatric issues, such as falls, cognitive impairment, and physical impairments," said Dr Han.

"When we have an ageing clinical population, we need to be paying attention to all the general health issues that everyone who's aged 60 and older may experience ― so, more hypertension, more cardiovascular disease, greater concerns about cancer risks, and all these other health conditions that are so typical in an ageing population," Dr Compton added.

Explaining that these issues may not have been so readily apparent when the individuals were in their 40s, he said: "Now that they are aging, they'll be attended to much more carefully [and are] certainly going to need quite a bit of general healthcare in addition to their addiction treatment."

However, Dr Han noted that "adults with substance use disorders often have multiple barriers to engaging in traditional primary care settings and often receive fragmented primary care.

"My current research examines models of care on how to better integrate substance abuse treatment with geriatric-based clinical care and understanding what setting this may be best delivered in," he said.

Another trend that will need to be taken into account by healthcare planners is the increase in drug use among the ageing population, as is evident from surveys of the general population.

"While this [study] is very specific around heroin addiction, we have seen some evidence for the ageing baby boomers showing increasing rates of drug use as they age into their middle age and beyond," said Dr Compton.

This will have implications for geriatric care, Dr Han explained. "While many geriatric specialists traditionally have not had to care for many patients with substance use disorders or a history of such disorders, this will certainly change with the baby boomer generation," he said.

"It is important for all providers to recognize the shifting patterns of substance use among older adults."

The authors and Dr Compton report no relevant financial relationships.

Subst Use Misuse. 2015;50:1660–1667. Abstract

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