Opinion – Substance misuse in older people | The BMJ

I tend to disagree rather

Development of a rational scale to assess the ...

Development of a rational scale to assess the harm of drugs of potential misuse, The Lancet, 2007 (Photo credit: Wikipedia)

strongly with this BMJ editorial.

The editorial argues that baby boomers are the population at highest risk of substance abuse. It argues that despite substantial increases in longevity over the past 20 years, contributing to a global demographic shift, the number of older people (aged over 50) experiencing problems from substance misuse is also growing rapidly, with the numbers receiving treatment expected to treble in the United States and double in Europe by 2020. It claims that in both the UK and Australia, risky drinking is declining, except among people aged 50 years and older, where there’s a strong upward trend for episodic heavy drinking in this age group. It warns that this generational trend is not restricted to alcohol, where in Australia, the largest percentage increase in drug misuse between 2013 and 2016 was among people aged 60 and over, with this age group mainly misusing prescription drugs. Meanwhile people over 50 also have higher rates than younger age groups for both past year and lifetime illicit drug misuse (notably cannabis).

Source: Substance misuse in older people | The BMJ

I was rather disappointed with this BMJ editorial. It makes various observations, based upon secondary research and then generalizes as to emerging trends and offer prescriptive solutions to practitioners.

Firstly, if Europe and Australia are following the heavily evidenced trends in North America, then opioids will quickly move from epidemic to pandemic proportions – in the US, drug abuse is by far the largest cause of death for the under fifties. But for older people, opioids have become addictive too because doctors have been over-prescribing. Opioids are already an escalating problem in the UK.

Secondly, alcohol has long been a substance abuse problem but it should not be aggregated with opiates and other drugs, which are far more dangerous ( see Lancet illustration above, viz. greater dependence and physical harm).

Thirdly, there is growing evidence linking drug abuse and long-term mental illness, which suggests that lifetime solutions are required, rather than simply more available or targeted therapy.

Fourthly, there’s a growing social and economic crisis because of substance abuse, where the probability of addicts rejoining mainstream society and working again is increasingly unlikely. Perhaps other countries should follow Australia’s lead in drug testing recipients of social welfare?

I fear that research journals, like the BMJ, are behind the curve and their evidence is too dated. This is deeply worrying because of the related public healthcare, economic and social crises in many Anglo-Saxon countries.

Surely it’s time for a systemic and multi-disciplined approach that deals with the full scope of the challenge? Perhaps, we need an independent judicial type review, with wide-ranging terms of reference?

 

Prescription opioid use is a risk factor for heroin use | National Institute on Drug Abuse (NIDA)

Logo of the United States National Institute o...

Logo of the United States National Institute on Drug Abuse, part of the National Institutes of Health. (Photo credit: Wikipedia)

NIDA confirms that prescription opioid use is a risk factor for heroin use. It reports that pooling data from 2002 to 2012, the incidence of heroin initiation was 19 times higher among those who reported prior nonmedical pain reliever use than among those who did not (0.39 vs. 0.02 percent) (citing Muhuri et al., 2013). It adds that a  study of young, urban injection drug users interviewed in 2008 and 2009 found that 86 percent had used opioid pain relievers nonmedically prior to using heroin, and their initiation into nonmedical use was characterized by three main sources of opioids: family, friends, or personal prescriptions (citing Lankenau et al., 2012).

Source: Prescription opioid use is a risk factor for heroin use | National Institute on Drug Abuse (NIDA)

Whilst it’s important that President Trump called a national emergency on Thursday, I fear that the US government is way behind the curve. More money will provide limited additional public care but surely what’s required is crisis managament intervention?

Thoughts?