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?


Opioid Addiction, Enforcement, Treatment & Policy – Leading Scientific Evidence

As the US Department of Justice reports in a press release, Attorney General Sessions announces ‘Opioid Fraud and Abuse Detection Unit’ (OPA), the world’s media is speculating what it will take to stop an opioid epidemic from becoming a global pandemic.

As a specialist in delivery strategic change, with executive expertise in both the public and private sectors, it’s clear to me that there are three strategic pillars to this problem:

  1. Enforcement
  2. Treatment (rehab) and
  3. Policy

Readers will see that I’ve been struggling today to add my two cents worth of comment to some of today’s mainstream media articles on opioid abuse. I worry that journalists are not adding sufficient value, with ‘me too’ stories, concatenating quotes from ‘so-called’ experts, light on analysis, conclusions and recommendations.

In the hyperlinks to the above three points, I’ve summarized the scientific research literature, ranked by the number of citations.

Clearly political leaders are behind the curve of the emerging pandemic and should be exploring radical policy options for both enforcement and treatment.

Perhaps, it’s time for an international drug policy initiative, along the lines of that deployed to divert the 2008 Financial Crash ?