Trends in abuse and misuse of prescription opioids among older adults
Introduction
Dramatic increases in the prescriptive use of opioid analgesics during the past two decades have been paralleled by alarming increases in rates of abuse, misuse, and use with suicidal intent of these drugs (Institute of Medicine, 2011, Volkow et al., 2014). Further, prescription opioid analgesics have played a key role in driving increases in drug-related deaths over the last decade (Jones et al., 2013, Warner et al., 2011). Overdose deaths involving opioid analgesics now exceed deaths involving heroin and cocaine combined (Center for Disease Control and Prevention, 2011).
Abuse of prescription opioids in older adults occurs when the medication is taken specifically for a psychotropic effect, rather than for treatment of a medical condition. Individuals born between 1946 and 1964 (the baby–boomer generation) are more likely to report use of psychoactive drugs compared to earlier cohorts (Johnson and Gerstein, 1998). Substance abuse is expected to continue as that generation ages into older adulthood (Gfroerer et al., 2003, Han et al., 2009).
The increasing prevalence of chronic pain in the U.S. has been accompanied by an upsurge of therapeutic opioid utilization (Franklin, 2014). Chronic pain has an extremely high prevalence, affecting 100 million adult Americans, and is among the most common reasons for taking medications (Institute of Medicine, 2011). Chronic pain is one of the most prevalent symptoms among older adults and affects this population more than any other age group (Weiner, 2007). A nearly 9-fold increase in opioid prescriptions from office-based medical visits by older adults occurred between 1995 and 2010, suggesting that physicians have pursued greater pain control in this population (Olfson et al., 2013). Due to the greater prevalence of chronic pain, older adults potentially may be more vulnerable to misuse of prescription opioids, such as taking higher than prescribed doses or taking for a longer duration than prescribed for management of chronic pain or other diagnosed medical conditions.
Another important hazard of prescription opioid misuse is suicide by self-poisoning. Suicide rates are particularly high among the elderly (Parks et al., 2014). Aging is associated with an increased prevalence of many common illnesses, which, in turn, is associated with an increased risk of suicide (Juurlink et al., 2004). In addition, the coexistence of multiple illnesses confers a marked increased risk of suicide in the older age group. During 2000–2009 in the U.S. there was a 15% increase in suicide mortality rates with the highest rate observed among individuals 75 years and older (Rockett et al., 2012). Self-poisoning has been reported to be a frequent mechanism of suicide among elderly patients (Juurlink et al., 2004).
The size and current age of the baby-boom generation, coupled with the continued rise in life expectancy, are rapidly increasing the percentage of older adults in the U.S. population. Greater rates of drug abuse among the baby-boom generation, the increasing prevalence of chronic pain associated with an aging population, and increasing suicide rates among older adults portends increasing rates of prescription opioid abuse and misuse among the older adult population. In this study we analyzed recent trends (during 2006–2013) in abuse, misuse, and use with suicidal intent of prescription opioids and associated fatal outcomes among older aged adults and compared these patterns to trends among younger aged adults.
Section snippets
Data source
This study is based on data from the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS®) System Poison Centers Program. Poison centers in the U.S. receive spontaneous calls from the general population, caregivers, and healthcare providers regarding potentially toxic exposures, including exposures to prescription opioids. Poison center specialists are nurses and pharmacists trained in toxicology who assist in the care of the individual and document clinical and demographic
Results
We identified 184,136 calls reporting abuse, misuse, or use with suicidal intent relating to prescription opioids among adults during the 8-year time period. Table 1 shows the intentional exposure calls by age group. There was a similar proportion of calls made by females among both the age groups. Compared to younger adults, older adults had a lower average annual rate of calls during the time period (3.4 vs 14.9 calls per 100,000 population), a lower proportion of calls identified as abuse,
Discussion
Population rates of abuse and misuse of prescription opioids, as reported to the RADARS System Poison Center Program, were lower for older adults (aged 60+ years) than for younger adults (aged 20–59 years) throughout the 8-year time period; however, rates specific to use with suicidal intent and fatal outcomes among the older age group followed a significantly increasing linear trend. Of note, death rates among older adults associated with intentional exposures surpassed rates for younger
Role of funding source
This work was supported by the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS®) System, which is part of Denver Health and Hospital Authority. The RADARS System is supported by subscriptions from pharmaceutical manufacturers of prescription opioid analgesics, which use these data for pharmacovigilance activities and to meet regulatory obligations. None of the subscribers had any role in the study design; collection, analysis and interpretation of data; writing of the
Contributors
N. West and J. Green designed the study. N. West and S.G. Severtson conducted the statistical analyses. All the authors were responsible for the interpretation of the data. N. West wrote the first draft of the manuscript. All authors contributed vital information for completion of the manuscript and all have approved the final manuscript.
Conflict of interest
The authors are affiliated with the RADARS System, an independent nonprofit postmarketing surveillance system that is supported by subscription fees from pharmaceutical manufacturers. None of the authors have a direct financial, commercial, or other relationship with any of the subscribers.
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