I am pleased to introduce a guest blog written by Dr. Donna M. Lisi, Clinical Pharmacist. who writes about an often over looked population being affected by the opioid crisis; older adults. Donna offers special insight, as in addition to her training as a pharmacist, she also is the chair of Somerset County’s Local Advisory Council on Alcohol and Drug Abuse and is a member of the Franklin Township Municipal Alliance. 

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Overdose Deaths in Older New Jersey Adults
Donna M. Lisi, PharmD, BCPS, BCGP, BCPP, BCACP, BCMTMS
Clinical Pharmacist and Chair of Somerset County LACADA

For a variety of reasons, it seems easy to assume that those most being harmed by the opioid epidemic are younger people. An analysis of the fatal overdoses on the national and state level clearly demonstrate the need to focus greater attention on the harmful effects on older adults.

• Based on data from the CDC from 2002 to 2021, the nationwide rate of fatal drug overdoses among those aged 65 years or older quadrupled from 3.0 deaths per 100,000 to 12.0 deaths per 100,000. More than one-half (57%) of these deaths involved an opioid.
• In New Jersey in 2023, 22% (55/243) of suspected drug overdose deaths occurred in those aged 55-64 years. When this range was expanded to include those aged 55-84 years, 30% (74/243) of fatal outcomes were in this older age group. Data from NJ for 2022 (the latest data available) on non-fatal opioid overdose-related hospital visits revealed that the highest statewide specific rate was in those aged 55-64 years at 171.0 per 100,000.  
• More recent data as from January 29 to February 4, 2024 indicates that of the 32 suspected drug overdose deaths in NJ during this period, 38% (13/34) of fatalities occurred in those aged 55-84 years.  Based on data from EMS and law enforcement in 2017 19.9% of naloxone deployments occurred in those aged 55-75+ years. By 2023, this number had risen to 34.8%.

According to AARP, older adults have been ignored during the opioid crisis and it is encouraging individuals to take part in a survey that deals with this issue. The time is passed due to give this growing problem the attention that it so urgently requires.

Geriatricians and other health professionals need to recognize signs and symptoms that an older adult may have a substance use disorder. This may be more subtle among older adults because they may no longer be working and absenteeism is not an issue. Family may be out of state, friends may have died, or there may be issues with social isolation. What might have started as a way to numb physical pain may morph into a way to numb emotional pain as well. Geriatricians should familiarize themselves with Medications for Opioid Use Disorder (MOUD) programs and how to refer their patients to treatment. Geriatricians and other health professionals need to feel comfortable having these discussions, talking about substance use, talking about having naloxone on hand, talking about suicide prevention and the 988 suicide and crisis lifeline. It is not an easy conversation to have, but it is a necessary one. More needs to be done to address caregiver burden, especially for older adults who are taking care of an ill spouse.

Faith and community-based leaders can lead the effort in moving towards a stigma-free society. When older adults feel that they will be a victim of stigma, they will be less likely to seek out care. I call that external stigma. However, in some of the older generation, self-stigma exists where they feel shame or guilt to seek out mental health services because they have a misconception that it means that they are weak or they feel that it may lead to nursing home placement.  Faith and community leaders can normalize seeking mental health care just as they may offer wellness or health fairs to identify physical ailments early. So too, they can help identify those who are suffering and need referral to services.

As chair of Somerset County’s Local Advisory Council on Alcohol and Drug Abuse and a member of the Franklin Township Municipal Alliance Coalition, I see that most substance use and prevention resources are geared toward youth. While that it is extremely important, equally important is being able to provide age-appropriate mental health and substance use treatment services for older adults. I am also especially concerned about older adults who are using cannabis and opioids. We need to educate them on risk and on how to stay safe. Opioid settlement monies can be used to help develop such programs. My town did a health needs assessment and gap analysis. Based on interviews and focus groups, the township leadership learned that the residents want specialized emotional and social services for older adults.

Since substance use disorders are often hidden, opioid settlement monies can also be used for outreach into the older adult community, such as:

• educating older adults on safe medication use, especially central nervous system acting drugs and drugs of abuse.
• educating staff at assisted living facilities, senior housing, health professionals, and those that provide services to older clients on how to recognize signs and symptoms of addiction in this vulnerable population and how to refer to help.
• conducting educational sessions like the opioid workshop that I am doing on April 30^th at my township senior center where we will discuss this growing issue and safe and appropriate opioid use as well as alternatives to pain management- both nonpharmacological and pharmacological.
• increasing access to naloxone among older adults

Notice: This article reflects the opinion of the author and does not necessarily reflect the opinion of the Partnership for a Drug-Free New Jersey (PDFNJ). This information should not be construed as legal advice from the author or PDFNJ. Please consult your own attorney before making any legal decisions.