“Many of us think drug misuse is a problem of the young. However, older adults are experiencing an explosion in fatal opioid overdoses,” said Maryann Mason, an associate professor of emergency medicine at Northwestern University Feinberg School of Medicine in the U.S.

A new Northwestern Medicine study that analysed 20 years of fatal opioid overdose data in adults 55 and older paints a much different picture. Between 1999 and 2019, opioid-related overdose deaths increased exponentially in U.S. adults ages 55 and older, from 518 deaths in 1999 to 10,292 deaths in 2019: a 1,886% increase.

“Many are Baby Boomers who, in their youth, were using recreational drugs and, unlike in previous generations, they’ve continued using into their older age,” said senior author Lori Post, the Buehler Professor of Geriatric Medicine and professor of emergency medicine and medical social sciences at Feinberg. “That sort of flies in the face of our stereotypes of the ‘older adult.’ We don’t think of them as recreational drug users, but it’s a growing problem.”

In the 20-year span, 79,893 people in the U.S. aged 55 to 80 died by opioid overdose, with about half being between 55 and 64 years old, Mason said.

The annual overall death rate per 100,000 people 55 years and up ranged from a low of 0.9 in 1999 to a high of 10.7 in 2019 and increased annually from 2000 on, the study found.

Post said ageism is one of the contributing factors for the increase in fatal opioid overdoses among older adults, explaining that doctors often don’t screen for drug misuse during appointments with older people because “it doesn’t fit the stereotype of what it means to be old.”

“They’re invisible,” Post said. “We’re talking grandmas and grandpas doing drugs, and to the point of overdosing.

We don’t think of them seriously. Not as potential victims of domestic abuse, physical or sexual assault or drug addiction. That needs to change.”

African-American men experienced the largest increases in opioid overdose deaths among older adults since 2013, the study found. By 2019, the opioid overdose fatality rate among non-Hispanic Black or African-American males ages 55 and up was 40.03 per 100,000 population – four times greater than the overall opioid fatality rate of others of the same age.

“It’s really a big question concerning what is going on with this population that wasn’t going on with other populations,” Mason said.

The study suggested contributing factors that could include social isolation and depression; exposure to medically prescribed opioids for chronic conditions such as arthritis and cancer which increase with age; and declining cognitive function that may interfere with taking opioids as prescribed.

In addition, the body’s ability to metabolise opioids decreases with age, meaning people are more vulnerable to overdose.

“We need to inform the services that cater to older adults, such as meal-delivery or housekeeping services, about these potential issues and how to recognise the signs of drug misuse, like confusion, falls and asking for medication too often or off-cycle,” Post said.