A look at alcohol, marijuana, and opioid use in the elderly population

Granny and Granddad don’t ordinarily come to mind when the general public or health professionals think about addiction. Indeed, rates of substance use generally decline in middle age. However, epidemiological data suggests that the number of older adults with substance use disorders will rise from approximately 3 million in the early 2000s to nearly 5 million by 2020.1

Alcohol use and cognitive decline

Survey data indicated that 3.4 million American seniors reported binge alcohol use and 750,000 reported heavy alcohol use (5 or more binge drinking days in the past month).2

Chronic alcoholism is clearly associated with cognitive decline. Additionally, an inverse-U relationship has been established between alcohol use and cognitive decline, linked to cardiovascular health, with implications that light use of alcohol is cardio and cognitive protective.3 Review of risk factors for late-onset alcohol use disorder suggests that role change, stress, and social reinforcement of drinking are implicated, while retirement and death of spouse do not necessarily increase risk.4

Marijuana use

Nearly 500,000 older adults reported other drug use (primarily marijuana) in the past month. With the legalization of medical and recreational cannabis in increasing numbers of states and rapidly shifting public opinion on the acceptability of use, increasing health concerns are emerging. A Colorado survey indicated that the rate of marijuana use in seniors doubled from 2014 to 2017.5

Concerns about overdose, falls, cardiovascular impact, and mental status changes coexist with enthusiasm about treatment of chronic pain, sleep, and a myriad of other purported health benefits.

Opioid use

Rates of opioid prescriptions in older adults are high, related to chronic pain and multiple comorbid medical conditions. Migration to over-use and abuse is all too common.

Jena and colleagues report that 35% of Medicare recipients taking an opioid are receiving prescriptions from more than one prescriber.7 As in younger individuals, older adults who develop opioid addiction obtain drugs from multiple providers, by theft, or by street sales.8

With exposure to prescribed opioids at high levels, health consequences take a variety of forms, with falls, overdose, and compromise of other health conditions as common events. Data from the Nationwide Emergency Department Sample indicated a four-fold increase in opioid-related emergency admissions from 2006 to 2014, with opioid dependence associated with a 40% greater odds of hospital admission.9

How cognitive assessment can help

Amidst the other challenges of aging, behavioral, cognitive, medical, and social consequences of senior substance use can be formidable.

Assessment of current substance use is a vitally important component of routine or problem-focused medical visits. The cognitive consequences of substance use are readily assessed with rapid, user-friendly assessment tools like BrainCheck. Cognitive re-assessment following intervention (e.g., education, rehab, deprescribing) can assist the physician in judging the patient’s response to treatment.

References

  1. Kuerbis, A., Sacco, P., Blazer, D.G., & Moore, A.A. (2014). Substance abuse among older adults. Clinics in Geriatric Medicine, 30(3), 629-654. https://doi.org/10.1016/j.cger.2014.04.008
  2. Mattson, M., Lipari, R.N., Hays, C., & Van Horn, S.L. (2017). A day in the life of older adults: Substance use facts. Retrieved from https://www.samhsa.gov/data/sites/default/files/report_2792/ShortReport-2792.html
  3. Emiliussen, J., Nielsen, A.S., & Andersen, K. (2017). Identifying risk factors in late-onset (50+) alcohol use disorder and heavy drinking: A systematic review. Substance Use & Misuse, 52(12), 1575-1588. https://doi.org/10.1080/10826084.2017.1293102
  4. Rodgers, B., Windsor, T.D., & Anstey, K.J. (2005). Nonlinear relationships between cognitive function and alcohol consumption in young, middle­-aged and older adults: The PATH through life project. Addiction, 100(9), 1280-1290. https://doi.org/10.1111/j.1360-0443.2005.01158.x
  5. Behavioral risk factor surveillance survey (BRFSS): Monitoring trends in marijuana use. (n.d.) Retrieved from https://www.colorado.gov/pacific/cdphe/adult-marijuana-use-trends
  6. Reynolds, I.R., Fixen, D.R., Parnes, B.L., Lum, H.D., Shanbhag, P., Church, S., Linnebur, S.A., & Orosz, G. (2018). Characteristics and patterns of marijuana use in community-dwelling older adults. Journal American Geriatric Society, 66(11), 2167-2171. https://doi.org/10.1111/jgs.15507
  7. Jena, A.B. (2014). Opioid prescribing by multiple providers in Medicare: Retrospective observational study of insurance claims. The BMJ, 348, g1393. https://doi.org/10.1136/bmj.g1393
  8. Gold, S.L., Powell, K.G., Eversman, M.H., Peterson, N.A., Borys, S., & Hallcom, D.K. (2016). High-risk obtainment of prescription drugs by older adults in New Jersey: The role of prescription opioids. Journal American Geriatric Society, 64(10), e67-e71. https://doi.org/10.1111/jgs.14430
  9. Carter, M., Yang, B., Davenport, M., & Kabel, A. (2018). The impact of the opioid crisis on older adults: Insights from the emergency department. Innovations in Aging, 2(1), 437. https://doi.org/10.1093/geroni/igy023.1638