Study reveals dramatic rise in drug overdose fatalities among older adults in the past two decades

Overdose mortality among people age 65 and older quadrupled over 20 years, suggesting the need for greater mental health and substance use disorder policies addressed at curbing the trend, a new research paper finds.

The deaths stemmed from both suicides and accidental overdoses, with nearly three-fourths of the unintended fatalities involving illicit drugs such as synthetic opioids like fentanyl, heroin, cocaine, and methamphetamines. Prescription opioids, antidepressants, benzodiazepines, antiepileptics and sedatives were used in 67% of intentional overdoses.

The dramatic rise in overdose fatalities among adults over 65 years of age in the past two decades underscores how important it is for clinicians and policymakers to think of overdose as a problem across the lifespan. Updating Medicare to cover evidence-based treatment for substance use disorders is crucial, as is providing harm reduction supplies such as naloxone to older adults."

Chelsea Shover, co-author, assistant professor of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA

The paper will be published March 29 in JAMA Psychiatry.

The researchers used the U.S. Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (WONDER) database to calculate annual overdose deaths among seniors from 2002 to 2021, comparing demographics, specific drugs, and whether the deaths were intentional, unintentional, or undetermined.

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Overall, they found that fatal overdoses quadrupled from 1060 in 2002 (3 per 100,000 population) to 6,702 (12 per 100,000) in 2021. The highest rates were among Blacks, at 30.9 per 100,000.

Among the other findings:

• By 2021, 1 in 370 senior deaths stemmed from overdoses, with 3814 of those (57%) involving opioids, 2587 (39%) from stimulants, and 1204 (18%) a combination of both
• About 13% (882) of overdoses in 2021 were intentional, 83% (5,541) were unintentional, and 4% (274) were undetermined, and 5 (0.07%) were homicide
• Females accounted for 505 489 of 882 (57%) of intentional overdoses and 1594 of 5541 (29%) of accidental overdoses
• Intentionality differed by race and ethnicity: 31 of 83, or 37%, of overdoses among Asians were intentional, compared to, 805 of 4848 (17%) among whites, and 15 of 1665 (1%) among Blacks
• Alcohol poisoning deaths rose from 10 (less than 0.03per 100,000) to 281 (0.5 per 100,000)

"Even though drug overdose remains an uncommon cause of death among older adults in the U.S., the quadrupling of fatal overdoses among older adults should be considered in evolving policies focused on the overdose epidemic," the researchers write. "Current proposals to improved mental health and substance use disorder coverage within Medicare, for example, applying mental health parity rules within Medicare, acquire greater urgency in light of this study's results."

Keith Humphreys of Stanford University and Veterans Affairs Palo Alto Health Care System was the study's co-author.