Drug Deaths - Ages 65+

Drug Deaths - Ages 65+ in California

California

The United States continues to face a drug overdose epidemic with fatal consequences. Provisional Centers for Disease Control and Prevention (CDC) data show drug overdose deaths continued to surge during the COVID-19 pandemic. Drug overdose deaths increased more than 56% between 2013 and 2019, largely attributed to synthetic opioids, such as illicitly manufactured fentanyl. 

Drug overdoses among older adults generally occur due to unintentional misuse of prescription medications. One in 4 Medicare Part D beneficiaries received a prescription for an opioid in 2019. Deaths involving opioids increased among older adults between 2017 and 2018, despite a decrease in opioid-involved deaths among younger adults. Drug abuse is particularly dangerous among older adults because of their reduced ability to metabolize medications due to age-related changes in the liver. Older adults are more likely to be taking one or more prescription medications. They may also be taking non-prescription medications and dietary herbal supplements, which can further complicate drug interactions and lead to drug-induced death. Other risk factors that can lead to substance use among older adults include forced or unexpected retirement, social isolation, transitions in living situations, substance use earlier in life, physical and mental health issues and deaths of loved ones.

A 2019 report estimated that the opioid crisis cost the U.S. at least $631 billion between 2015 and 2018. Mortality accounted for approximately 40% of these costs, while excess health care spending accounted for nearly one-third.

According to data from CDC WONDER, the prevalence of drug deaths is higher among:

• Older men compared with older women.
• Older non-Hispanic Black adults compared with those in all other racial or ethnic groups. 
• Adults ages 65-74 compared with those ages 75 and older.

Identifying addiction in older adults can be challenging due to similarities between symptoms of drug addiction and diseases such as diabetes, depression, dementia and other mental health disorders. Although limited addiction treatment programs exist specifically for older adults, some agencies provide age-appropriate resources and support for older adults struggling with addiction. Strategies to prevent overdose deaths and reduce harm among older adults with opioid addiction include:

• Pain management techniques without the use of medications. Individuals can work with their doctors to safely and effectively manage their pain and avoid the risk of opioid abuse.
• State-based prescription drug monitoring programs. These programs track opioid prescription and dispensation and help reduce opioid addiction.
• Abuse-deterrent formulations (ADFs). These are promising medications that have been shown to reduce prescription drug abuse and its many consequences.
• Regular review of medication lists by health care providers, also referred to as medication reconciliation, to avoid adverse drug events.

The CDC has developed a Guideline for Prescribing Opioids for Chronic Pain and a prescription checklist to encourage safe prescribing practices for primary care providers. The National Institute on Drug Abuse offers resources and advice about what to do if someone you know has a problem with drugs. 

Reducing drug-induced deaths is a Healthy People 2030 goal.

Davenport, Stoddard, Alexandra Weaver, and Matt Caverly. “Economic Impact of Non-Medical Opioid Use in the United States: Annual Estimates and Projections for 2015 through 2019.” Society of Actuaries, 2019. https://www.soa.org/globalassets/assets/files/resources/research-report/2019/econ-impact-non-medical-opioid-use.pdf.

Dowell, Deborah, Kathleen R. Ragan, Christopher M. Jones, Grant T. Baldwin, and Roger Chou. “CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022.” MMWR. Recommendations and Reports 71, no. 3 (November 4, 2022): 1–95. https://doi.org/10.15585/mmwr.rr7103a1.

Kuerbis, Alexis, Paul Sacco, Dan G. Blazer, and Alison A. Moore. “Substance Abuse Among Older Adults.” Clinics in Geriatric Medicine 30, no. 3 (August 2014): 629–54. https://doi.org/10.1016/j.cger.2014.04.008.

Mallet, Louise, Anne Spinewine, and Allen Huang. “The Challenge of Managing Drug Interactions in Elderly People.” The Lancet 370, no. 9582 (July 2007): 185–91. https://doi.org/10.1016/S0140-6736(07)61092-7.

Marek, Karen Dorman, and Lisa Antle. “Medication Management of the Community-Dwelling Older Adult.” In Patient Safety and Quality: An Evidence-Based Handbook for Nurses, edited by Ronda G. Hughes. Rockville, MD: Agency for Healthcare Research and Quality, 2008. https://www.ncbi.nlm.nih.gov/books/NBK2670/.

Martin, Crescent B., Craig M. Hales, Qiuping Gu, and Cynthia L Ogden. “Prescription Drug Use in the United States, 2015–2016.” NCHS Data Brief No. 334. Hyattsville, MD: National Center for Health Statistics, 2019. https://pubmed.ncbi.nlm.nih.gov/31112126/.

Mattson, Christine L., Lauren J. Tanz, Kelly Quinn, Mbabazi Kariisa, Priyam Patel, and Nicole L. Davis. “Trends and Geographic Patterns in Drug and Synthetic Opioid Overdose Deaths — United States, 2013–2019.” MMWR. Morbidity and Mortality Weekly Report 70, no. 6 (February 12, 2021): 202–7. https://doi.org/10.15585/mmwr.mm7006a4.

McLachlan, Andrew J., and Lisa G. Pont. “Drug Metabolism in Older People—A Key Consideration in Achieving Optimal Outcomes With Medicines.” The Journals of Gerontology: Series A 67A, no. 2 (February 1, 2012): 175–80. https://doi.org/10.1093/gerona/glr118.

“Opioid Use in Medicare Part D Continued To Decline in 2019, but Vigilance Is Needed as COVID-19 Raises New Concerns.” Data Brief. Washington, D.C.: U.S. Department of Health and Human Services, Office of Inspector General, August 2020. https://www.oversight.gov/sites/default/files/oig-reports/OEI-02-20-00320.pdf.

Qato, Dima M., G. Caleb Alexander, Rena M. Conti, Michael Johnson, Phil Schumm, and Stacy Tessler Lindau. “Use of Prescription and Over-the-Counter Medications and Dietary Supplements Among Older Adults in the United States.” JAMA 300, no. 24 (December 24, 2008): 2867–78. https://doi.org/10.1001/jama.2008.892.

Simon, Kyle, Stacey L. Worthy, Michael C. Barnes, and Benjamin Tarbell. “Abuse-Deterrent Formulations: Transitioning the Pharmaceutical Market to Improve Public Health and Safety.” Therapeutic Advances in Drug Safety 6, no. 2 (April 2015): 67–79. https://doi.org/10.1177/2042098615569726.

Wilson, Nana, Mbabazi Kariisa, Puja Seth, Herschel IV Smith, and Nicole L. Davis. “Drug and Opioid-Involved Overdose Deaths — United States, 2017–2018.” MMWR. Morbidity and Mortality Weekly Report 69, no. 11 (March 20, 2020): 290–97. https://doi.org/10.15585/mmwr.mm6911a4.