By Cornelis P. de Joncheere
President, International Narcotics Control Board
More than a year into the COVID-19 pandemic, the severe impact on older people is, sadly, plain to see. Not only are older people highly vulnerable to suffering severe illness with COVID-19, they are often also isolated from family members and the wider community, as a result of measures to prevent the spread of the virus.
However, there is also a hidden epidemic affecting older people: drug use. Often undiagnosed by health professionals, drug use and drug-related deaths have increased among older people over the last 10 years. The number of older people seeking treatment for drug dependence has also increased.
The pattern of drug use among older people varies: there are ‘maintainers’, who have unchanged drug use patterns over the course of their lives and somehow live with it; ‘survivors’, who have long term “problem” use of drugs; and ‘reactors’, who take up or increase drug use later in life.
Development of drug use later in life may be connected with prescription of pain relief medication, which poses a risk for misuse if not appropriately administered. Increasing tolerance to opioid analgesics due to use of other substances can also impact on adequacy of pain relief. A lack of health insurance can force older people to obtain substances for pain relief from illicit sources. The widespread prescription of benzodiazepines among older people and the risk of overuse is also a well-known problem. Polypharmacy – the mixing of five or more medications per day, whether obtained by prescription, over the counter or through illicit channels – is an increasing problem among older people. In addition, the ageing process can trigger problems of a psychological, social or physiological nature that can increase the risk of substance use, as well as aggravate pre-existing problems.
As a result of drug use, older people can become more vulnerable to developing health problems, such as respiratory problems, degenerative diseases, liver disease, diabetes and chronic mental health challenges, as well as face a higher risk of falls and road accidents. Drug use among older people is also associated with financial problems, unemployment, homelessness, isolation and loneliness. Stigma associated with drug use may prevent people from seeking care, and thus the problem remains hidden and untreated.
With the ageing of the global population, it is crucial to address this worrying trend of drug use among older people. The International Narcotics Control Board is drawing attention to it in its 2020 Annual Report. We have identified three areas that need to be addressed by governments and the international community to improve the situation.
Firstly, the extent of drug use among older people is largely unknown. Drug monitoring systems usually only look at levels of drug use among people aged 15 to 65. We recommend that the age range included in drug use surveys be expanded and that prescription-monitoring systems be established or improved, so as to measure the nature and extent of drug use, including misuse of prescription and over-the-counter medications, among older people.
Secondly, existing evidence-based prevention strategies should be used to prevent and reduce drug use by older people and prevent stigmatization. This means addressing older people in any messaging to combat stigma.
Thirdly, there is a need for integrated, holistic and age-appropriate care focused on the needs of individuals, their families and communities. Governments need to develop effective service responses for older people who use drugs, which should include the co-treatment of multiple issues relating to physical health, mental health and drug dependence. Outreach services for people who use drugs should be developed and further expanded to include home-based and mobile services, and to serve as an entry point for older people who use drugs. Services for early detection, screening and assessment need to be available for older people who use drugs.
A year into the COVID-19 pandemic, we know that prolonged physical and social distancing and the associated social isolation place a great emotional strain on older people, particularly those with mental health problems and substance use disorders.
As the world works to build back better from the COVID-19 pandemic, we need to take action to offer a more positive future for one of the most marginalized groups of society – older people who use drugs.