Alarming Increase in Opioid Overdose Deaths Among Older Adults

Older patients are also sometimes simultaneously prescribed multiple medications, which can lead to dangerous drug interactions. (A 2015 study of Medicare Part D claims found that opioid users filled an average of 52 prescriptions per year from approximately 10 drug classes, and more than 20 percent of opioid users took more than 10 medicines concurrently.)

Then there’s cognitive decline, which can lead to drug problems in two ways. Poor cognitive functioning may make it difficult for patients to take opioids as prescribed, for one. Meanwhile, says Mason, “some of the markers for cognitive dysfunction are also markers for opioid misuse, so the two can often get confused” and lead to misdiagnosis. What’s more, aging interferes with the body’s ability to metabolize opioids efficiently, increasing the risk of adverse reactions, a potential contributor to fatal overdoses.

Other potential issues are psychological. Social isolation and depression, associated with aging — particularly during the COVID crisis — may be risk factors for opioid use and abuse in older adults. And then there’s the stigma of substance use disorder, which may make older patients less likely to report any drug dependency to their physicians.“Some of that comes from a perception of ‘I’m an older adult — I should have my stuff together. I’m at a point in my life where I should be controlling things,’ ” Mason says. “It makes people feel ashamed when they do have an issue.”

Black men at risk

Black men are particularly vulnerable. By 2019, the opioid overdose fatality rate among Black men 55 years and older was 40.03 per 100,000 population, four times the overall opioid overdose fatality rate of 10.70 per 100,000 for people of the same age, according to a Jama Open Network report published this month. Experts note that this may in large part be due to what is known as social determinants of health. For example, Mason says, Black men are more likely to live in low-resource communities, where violence and interactions with the criminal justice system are commonplace.

“These sorts of things can create a trauma which can be related to people seeking relief in substances,” Mason says. “This is also a population that is underinsured and has limited access to health care and drug treatment programs.”  

But experts point to another possible reason behind the surge. Black Americans were less affected by the opioid epidemic in the 2000s because they have historically been underprescribed opioids for pain — in part because providers may have biases in how they perceive pain among minority patients.  (A 2016 study from Princeton University found that 40 percent of medical students believed black patients were less sensitive to pain.) The rate of opioid overdose deaths among Black men began to rise around 2013, when the potent synthetic opioid fentanyl, 50 to 100 times more powerful than morphine, found its way into the illicit drug market — a period the CDC has identified as the third wave of the opioid epidemic.

Says Mason, “Some of these deaths may be among people who were not regular opioid users who perhaps had a long-standing issue with different types of illicit drugs, such as cocaine.”

Looking for solutions

Mason says there’s lots of work needed to reverse this disheartening trend. That might include:

• Increased screening to detect unhealthy drug use among this older demographic.
  
  
• Modifying treatment to suit the needs of older adults — for example, making treatment centers accessible to people who may have mobility issues as well as adapting treatment to people who have vision or hearing impairments.
  
  
• Training support people, from visiting nurses to those who deliver Meals on Wheels, to recognize the signs of an opioid misuse in older adults.
  
  
• Increasing outreach to older adults in the Black community, and enlisting people within the community to encourage people to get the treatment they need.

As grim as the situation may be, there is reason to be optimistic, Mason adds. Older adults possess a wealth of attributes that bode well for treatment success, including the wisdom and self-awareness that come from decades of life experience, decision-making skills and the ability to manage emotion. “If this age group gets treatment for substance use, it can turn out very well,” she says. “In some ways, we expect them to be more successful [than younger people], if they get to treatment.”

Barbara Stepko is a longtime health and lifestyle writer, and former editor at Women’s Health and InStyle. Her work has appeared in The Wall Street Journal, Parade and other national magazines.