#geriatric medicine

Study: Rise of Psychoactive Substance Use Among Older Adults Poses Risks

Drug and alcohol use among older Americans has increased sharply over the past decade, as Baby Boomers use psychoactive substances at a higher rate than previous generations. This creates a growing public health problem: rising numbers of older adults at risk for harm from drug use, including substance use disorders. Older adults are often more susceptible to the harms of psychoactive drug use due to age-associated physiological changes, social factors such as increased isolation, increases in comorbidity and the use of medications that may interact with a range of drugs.

Benjamin Han, MD, MPH, is a geriatrician, addiction medicine physician and clinician-researcher in the Division of Geriatrics, Gerontology and Palliative Care in the Department of Medicine at UC San Diego School of Medicine. Along with UC San Diego medical student Jason Leddy, UC San Diego undergraduate student Francisco Lopez and Joseph J. Palamar, PhD, an associate professor at the New York University Langone Medical Center, he recently published a new study in JAMA Ophthalmology that found an association between severe visual impairment in older adults and a higher prevalence of cannabis use as well as substance use disorder, including alcohol use disorder and nicotine dependence.  

In this Q & A, we’ve asked Han to break down some key points of this study:

Question: How prevalent is the issue of older adults using psychoactive substances and how does this compare to substance use in other age groups?

Answer: While psychoactive substance use is lower among older adults compared to younger adults, its use has increased sharply among people age 65 and older. Past-year cannabis use has increased from 0.4% in 2006 to 4.2% in 2018 among people age 65 and older, according to an analysis of the National Survey on Drug Use and Health data that I published with Dr. Palamar in 2020. Additionally, a study I conducted along with Dr. Palamar and Dr. Alison Moore, chief of Division of Geriatrics, Gerontology and Palliative Care here at UC San Diego found sharp increases in unhealthy alcohol use.

Q: What types of health or mental health issues are older adults using drugs for?

A: There are many reasons older adults use psychoactive substances, including to treat undertreated chronic symptoms such as insomnia, chronic pain and anxiety. It is also important to note that increasing isolation can be a risk factor for risky psychoactive substance use, which is relevant to this paper because vision impairment, particularly among older adults, can increase isolation, lead to significant psychological stress and loss of independence.

Q: Has the COVID-19 pandemic caused an increase in use?

A: The pandemic has been particularly difficult for many older adults, often increasing their isolation. Some studies suggest that drug use and drug-related overdose deaths have increased among older individuals during the pandemic, but data on this currently remains limited.

Q: What signs should loved ones and physicians be on the lookout for?

A: Due to physiological changes due to aging, the presence of chronic disease and increased use of prescription medications, older adults — especially those with impairment (such as visual impairments) — are at risk for harm related to use of psychoactive substance use. Intoxication can potentially lead to marked deficits in coordination, leading to an increased risk of injury or worsening of chronic diseases. Unhealthy psychoactive drug use can often be difficult to detect among older adults, so it’s important that clinicians ask all of their older patients about drug and alcohol use.

— Corey Levitan