Rising Number of Older Americans Admitted for Treatment for Heroin Use

The number of adults over 55 admitted for substance use treatment for the first time nearly doubled between 2008 and 2018, according to a report in The Journal of Geriatric Psychiatry.

“The decade since 2008 has resulted in a marked escalation of heroin and methamphetamine use among older adults seeking treatment for the first time, driving illicit substances overall to be more common than alcohol as the reason older adults seek treatment,” wrote Andrea Weber, M.D., of the University of Iowa’s Carver College of Medicine and colleagues.

Using the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Treatment Episode Data Sets (TEDS), which include information about patients admitted for substance use treatment, the researchers compared the rate of first-time admissions for publicly funded substance use treatment by 453,598 adults 55 years or older with those by more than 3 million adults aged 30 to 54 years.

TEDS include demographic data and substance use characteristics regarding patients admitted to substance use treatment facilities in the United States that receive any public funding. Treatment agency staff interview individuals, recording their primary, secondary, and tertiary problem substances. Individuals report the following demographic information: age, race, ethnicity, age at which substance was first used, frequency of substance use, and the source of referral for treatment.

Weber and colleagues found that the percentage of older adults admitted for substance use treatment increased every year between 2008 and 2018. In 2008, 9.04% of all admissions were for adults 55 years or older; in 2018, the percentage rose to 15.64%. The number of older adults’ admissions increased 190%, from 35,787 to 67,872 over the 10-year period.

Older adults’ admissions for illicit drug use also increased every year by 1.91 percentage points, while admissions for alcohol use decreased 1.61 percentage points, and alcohol and drug admissions remained relatively stable (-0.28 percentage point change per year). First-time admissions for older adults with heroin as the primary substance rose from 10% in 2008 to 22% in 2018. Methamphetamine use also increased 0.61 percentage points per year in the older group.

“[T]he increase in heroin use among older adults seeking first-time substance use treatment increases the need for geriatricians, geriatric psychiatrists, and other primary care providers to offer evidence-based medications for opioid use disorder (MOUD) and other forms of risk mitigation, such as naloxone prescribing,” the researchers wrote. “In addition to ongoing access to MOUD throughout the age spectrum, this increasing use of heroin and methamphetamine among older adults seeking treatment increases the need to include older adults in studies evaluating the safety, tolerability, and effectiveness of any and all treatments for [substance use disorder].”

For related information, see the Psychiatric News article “Methamphetamine Involved in Rising Number of Heroin Treatment Admissions.”

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Methamphetamine Involved in Rising Number of Heroin Treatment Admissions

Methamphetamine is involved in an increasing number of treatment admissions for heroin, especially among adolescents, a study in Addiction has found.

“The phenomenon of increasing methamphetamine use among people using opioids is of great concern,” Christopher M. Jones, Pharm.D., Dr.P.H., M.P.H., of the Centers for Disease Control and Prevention and colleagues wrote. “Methamphetamine use carries its own risks, including a range of physical and mental health consequences such as psychosis and other mental disorders; cognitive and neurologic deficits; cardiovascular and renal dysfunction; transmission of HIV, viral hepatitis, and sexually transmitted infections; and increased mortality.”

The researchers analyzed data from more than 3.5 million treatment admissions for heroin between 2008 and 2017. The data came from the Treatment Episode Data Set, a national database that provides information on the admissions of people aged 12 years and older to federally funded substance use treatment centers. The percentage of primary heroin treatment admissions reporting methamphetamine use rose each year from 2.1% in 2008 to 12.4% in 2017, an increase of 490%.

In 2017, individuals aged 12 to 24 had the highest rates of admissions for heroin use involving methamphetamine of all the age groups examined: 27.8% of heroin treatment admissions for adolescents aged 12 to 17 years involved methamphetamine, and 17.4% of heroin treatment admissions for young adults aged 18 to 24 involved methamphetamine.

“Not only do these findings highlight a need to focus intervention and treatment efforts aimed at reaching younger age groups, but together with the finding that early age of heroin initiation was associated with methamphetamine use at treatment admission, these findings underscore the importance of expanding policies, programs, and practices that can prevent initiation of these substances in the first place,” the researchers wrote.

Among women, 15.1% of heroin treatment admissions involved methamphetamine in 2017, compared with 10.8% in men. The researchers noted that prior research suggests that females use more methamphetamine and transition from recreational use to dependence more quickly than males.

“Given the increase in risk for negative health outcomes among people using both substances, comprehensive prevention, treatment, and harm-reduction strategies that address the poly-substance nature of opioid use and are appropriately tailored to specific demographic groups and at-risk populations are needed,” Jones and colleagues wrote.

For related information, see the Psychiatric Services article “Use of Drug Treatment Services Among Adults With Opioid Use Disorder: Rates, Patterns, and Correlates.”

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