Drug overdose deaths among US adults aged 65 and older quadrupled over roughly the last 20 years, show new findings that have policy implications for the ongoing overdose epidemic.
"Current proposals to improve mental health and substance use disorder (SUD) coverage within Medicare — for example, applying mental health parity rules within Medicare — acquire greater urgency in light of this study’s results," note investigators from the Stanford University School of Medicine and the David Geffen School of Medicine at UCLA, both in California.
"It’s also important to shift the way we think about overdose. It's not just a problem for younger people. There is concern for older adults, too," study investigator, Chelsea Shover, PhD, told Medscape Medical News.
The study was published online March 29 in JAMA Psychiatry.
The researchers used data from the US Centers for Disease Control and Prevention (CDC) to calculate annual overdose deaths from 2002 to 2021 among people aged 65 and older.
Overall, they found that fatal overdoses quadrupled from 1060 in 2002 (three per 100,000) to 6702 (12 per 100,000) in 2021, with the highest rates in Blacks (30.9 per 100,000).
"I expected that overdoses would have gone up among older adults, just as we've seen pretty much across the population. But the magnitude of the increase — quadrupling over 20 years — is pretty surprising," said Shover.
By 2021, one in 370 deaths among seniors was caused by an overdose. More than half (57%) of the overdose deaths involved opioids, 39% involved stimulants, and 18% involved a combination of both.
"As clinicians or public health practitioners, we want to make sure that we are providing targeted education and resources, including naloxone, to older adults who might be using opioids whether those are prescribed or illicitly," Shover said.
During the study period, the share of all-cause mortality attributable to drug overdose in seniors jumped 359%, from 0.06% to 0.27% during the study period (P < .001).
In 2021, about 13% of overdoses were intentional, 83% were unintentional, 4% were undetermined, and less than 1% were homicide. Older women accounted for 57% of intentional overdoses and 29% of accidental overdoses.
By race/ethnicity, 37% of overdoses among Asians were intentional, compared with 17% among Whites and 1% among Blacks.
Most unintentional overdoses (74%) involved illicitly made drugs (synthetic opioids, heroin, cocaine, and methamphetamine); about one in five (19%) involved both prescription and illicit drugs.
Most intentional overdoses (68%) involved prescription opioids, antidepressants, benzodiazepines, or antiepileptics and sedative-hypnotics.
The investigators note that safer prescribing initiatives — such as addressing opioids and benzodiazepines — underway in many healthcare systems may help reduce the risk of overdose among older adults.
Support for this research was provided by grants from the Veterans Affairs Health Services Research and Development Service and the National Institute on Drug Abuse. The authors report no relevant financial relationships.
JAMA Psychiatry. Published online March 29, 2023. Full text.
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Cite this: Sharp Rise in Drug Overdose Deaths in Seniors - Medscape - Mar 30, 2023.