Over the past decade, there has been a substantial rise in older adults who use drugs. Largely underrecognized, this shift in the user population raises urgent questions for healthcare systems: How should care be adapted to meet the specific needs of these patients and to address the often complex substance use disorders they face?

A warning against stereotypes: The typical psychoactive substance user is not necessarily a young person seeking thrills or transgression. Since the 2000s, the share of older patients entering treatment for problematic use of illegal drugs has been increasing across Europe. Among those entering treatment, 35% are doing so for the first time — a figure that shows some people develop problematic use later in life. In Belgium, the population in treatment has been aging for many years as well, with nearly one in four patients now over 50. The prevalence of illegal drug use among older people also rose in some countries during the 2010s, and at a faster pace than among younger people. Cannabis use, for example, has increased among people aged 55 to 64 in several Western European countries.

Multiple Contributing Factors

Michaël Hogge , scientific and epidemiological project manager at Eurotox asbl, Brussels, Belgium, attributes this marked trend to several factors. "Among the hypotheses put forward are, of course, increased life expectancy and an aging population. The aging of opioid users, for example, is well documented, which is a population that is not renewing itself as quickly as other user groups," he said. Changes in social norms about what is acceptable or how dangerous a substance is perceived to be may also help explain the aging of consumers. "We are seeing cohorts that were more exposed to substance use than earlier generations," he added. A generalized sense of malaise, individualism, and a culture of performance that pushes people to exceed their limits may also partly explain the more frequent use of these substances across generations. 

A Largely Undocumented Reality

This reality remains poorly documented. "In general, we lack knowledge about this phenomenon of aging use. That is partly for methodological reasons. In most cases, the questionnaires used for reporting use at the European level do not go beyond age 64. Age-related stereotypes are probably also a factor, as are difficulties accessing online surveys," Hogge said.

Older people also tend not to report their use during contacts with health personnel, whether out of shame, fear, some forms of dementia, or social isolation. In the short term, the ARCAD survey currently being conducted by Eurotox (a French-speaking Belgian study of substance use patterns) should shed more light on some poorly documented uses in French-speaking Belgium, including among seniors. More broadly, there are practically no action plans focused on aging drug users and their specific needs. Facilities or nursing homes specialized in the care of older people with substance use disorders are likewise very rare.

Drugs and Aging: A Harmful Mix

Whether normalized or invisible, addictions in older adults nonetheless have important consequences for health, autonomy, and quality of life. Because of slower metabolism, seniors are affected by drugs differently than younger adults. Smaller amounts can have a greater impact and, for example, increase the risk of falls or injuries. Drug use is also associated with a higher risk of earlier-onset or more severe diabetes, neurological and cognitive disorders, and certain cancers. These users are particularly exposed to erosion of their social, family, or friendship networks and to loss of autonomy. They also face greater psychiatric suffering, such as depression, anxiety, and insomnia — all factors that can lead to problematic use of psychoactive substances. "The transition to retirement is a critical period," Hogge added. "It is often a stressful time that can produce boredom, a reduction in social activities, a lack of physical activity, or worsening chronic pain. It is therefore important to pay special attention to alcohol use or certain medications, especially in already vulnerable people." 

Identifying At-Risk Use

Frontline workers are well positioned to detect risky or problematic drug use and to take it into account in their interventions. Early screening can help anticipate the development of complications and influence risk. "As healthcare professionals, it is important to address consumption issues frankly and with kindness whenever a patient's substance use is suspected. Approaching the subject in the most appropriate way, however, requires at least some training or knowledge so as not to damage the therapeutic relationship," Hogge acknowledged. This concern is frequently raised by healthcare professionals. According to the Swiss Society of General Internal Medicine (SSMG), doctors are held back by a lack of time or skills, a fear of upsetting the patient and losing them, or doubts about the value and likely success of the intervention. Useful resources and training do exist, however. Some are offered by Réseau Alto (a Belgian network providing training and support for addiction care) or by the SSMG.

This story was translated from MediQuality, part of the Medscape Professional Network.