Why are adults over 65 increasingly dying of overdose?

CATHY WURZER: You may have heard the news that opioid overdose death rates came down in 2023. Data shows that's true across the country and here in Minnesota but not for older adults. Overdose deaths have increased by 9% among folks over the age of 65. That's according to one nationwide analysis by the health research and journalism outfit, KFF.

Joining us right now to explain what could be going on is Dr. Bob Levy. He's an associate professor of family medicine and community health at the University of Minnesota. And he created a tool kit to help doctors recognize opioid use disorder in their older patients. Doctor, thank you for taking time over the lunch hour. We appreciate it.

ROBERT LEVY: Thank you, Cathy, for having me.

CATHY WURZER: When you saw these figures, what did you make of them?

ROBERT LEVY: Well, at first, I was very excited that the overall overdose rate has declined. That has been something that we have been trying very hard to achieve over many years. And I was a little disheartened to see that it had gone up in older patients. I thought we could do better.

CATHY WURZER: I see. So what do you think is going on here?

ROBERT LEVY: I think there's a couple of reasons why this is the case. I think first, in Minnesota, in particular, and the nation as a whole has done a very good job of increasing access to medications for opioid use disorder, particularly medications, such as methadone, buprenorphine, and naloxone, or naltrexone.

And we've also done a pretty good job of getting harm reduction supplies to people who use drugs, meaning Narcan availability, clean using supplies, wound care kits, and this sort of thing. However, there remains a stigma around opioid use disorder.

And I think that hits particularly hard in older patients because they don't-- people don't think of them as the classic, quote, "person with an opioid use disorder." They think of them as having a medical reason to take these medications and thus may not require the same prevention and care when using medications like opioids, which is clearly not true. And I think that this is one of the major reasons why opioid overdose deaths have increased in the older population.

CATHY WURZER: Do you find doctors being more apt to write prescriptions out to older patients because of various maybe chronic illnesses, I mean, severe arthritis perhaps or immunosuppressive diseases that some folks may have? Is that the avenue that leads older adults to opioid addiction?

ROBERT LEVY: Great question. I believe so. I think Medicare data in 2008 showed that about 15% of adults over the age of 50 in the United States has at least one prescription for opioid medications from a physician or a health care provider.

It is complicated. Especially as people get older, they have more chronic illnesses that can cause pain and also make it so that certain medications that are not opioids that we would use for pain are more dangerous. And I think physicians are placed or providers are placed in this position where they have a certain amount of time to talk about multiple illnesses, including chronic pain.

And patients really want relief. And so what we are somehow shoehorned into in the current medical system is prescribing something that will work quickly. And if patients have contraindications to classic acetaminophen and nonsteroidal anti-inflammatory medications, like ibuprofen, then I think physicians are more likely to reach for opioid medications, which can appear to be safer for older people but really aren't.

CATHY WURZER: And I wonder because as we get older, our body chemistry changes a lot. Things obviously change. How can I say this? Because of those changes, do older patients become hooked faster, if that makes sense?

ROBERT LEVY: Sure. No, there isn't data to support that older patients get or develop opioid use disorder faster than younger patients. What there is evidence for, though, is because of these medical comorbidities, the risk of overdose and death is higher in older people.

So in particular, it may take a much lower dose of a medication to cause a problem and overdose or death than it would in a younger patient because of all the other medications they take and all the other medical problems they have.

CATHY WURZER: I see. So it's more difficult to diagnose older patients. Is that why you created the toolkit?

ROBERT LEVY: Yes, in particular, again, physicians or providers don't typically think about older patients having an opioid use disorder, so part of this is to increase awareness that it is indeed a problem.

Part of it is also to point out that older patients can be more difficult to diagnose because they have other mental health problems or other physical health problems that can mimic and complicate the diagnostic process and also to increase awareness among patients themselves that there can be problematic use of medications that are prescribed legitimately for legitimate medical reasons that can cause serious, potentially fatal problems.

CATHY WURZER: By the way, if someone's listening right now and has an older adult in their lives and they're wondering, are there signs that there might be a problem here for my older friend or my mom or dad?

ROBERT LEVY: Yes, absolutely. There are definitely signs. In particular, one of the major signs of somebody who's older developing an opioid use problem is more medical complications. What do I mean by that? I mean things like more confusion, more falls, more doctor visits, more time spent thinking about opioids, thinking about the pain medications, talking about their pain, things like that. Those are certainly some of the first signs.

CATHY WURZER: Wow. The confusion in falls, that could be almost anything else, though, too.

ROBERT LEVY: Yes, that's part of the problem, is that-- in medicine, we would say these are very sensitive but not specific, meaning that falls and confusion are caused by many, many things, including multiple very simple medical causes that are easy to fix but also can be a sign of opioid use disorder. If you get down into worsening opioid disorder, it becomes clearer. But that's always the trick, is how to diagnose something in its early stages.

CATHY WURZER: I'm wondering, when you talk to older patients who might be surprised they have a problem, maybe don't want to recognize they have a problem, or maybe they have given up and don't think there's enough time in their lives to get better, what do you say to them?

ROBERT LEVY: That's a conversation that I have more often than I would like to. I would say that it's never too late. It doesn't matter how old you are. People with suffering from opiate disorder are really suffering. There's a lot of pain and hurt and just generalized discontent.

And it doesn't matter how much longer you expect to live. You don't have to live like this anymore. And that help is available. It works. And you can get better. And for however long have left, which no one really truly knows, you can live a life that is not mired in so much pain and suffering.

CATHY WURZER: Does that message get through?

ROBERT LEVY: Sometimes. It depends on the patient and the situation that they're in. I would also like to point out that the more times that you bring this up to somebody, the more likely they are to hear what you're saying.

So it might not be the first, second, or third time that someone talks to them about it, but maybe the fourth or fifth. And you can't have the fourth or fifth time without the first or second time. So just keep at it. And I would encourage anybody who thinks that somebody in their life that has a problem, regardless of their age, frankly, continue to discuss it with them and inform them that there is treatment, treatment works, and people recover.

CATHY WURZER: And by the way, if there are physicians listening that are interested in the toolkit, where can they find that?

ROBERT LEVY: It's online. It's part of the GWEP program at the University of Minnesota. I don't have the exact web address in front of me. I'm sorry.

CATHY WURZER: That's OK. We'll find that. We'll find that and post it. It's all right.

ROBERT LEVY: Absolutely. Thank you.

CATHY WURZER: Doctor, I appreciate your time here this afternoon. Thank you so much.

ROBERT LEVY: Of course. It's a pleasure. Thank you.

CATHY WURZER: Dr. Bob Levy is an associate professor of family medicine and community health at the University of Minnesota.