Lethargic behavior. Slurred words. Unusual sleep patterns. Nausea and vomiting. Begging a doctor not to change a certain medication. All can be signs of misuse of fentanyl and other opioids, a hot-button concern for older adults who are more vulnerable to the lethal drug in various ways.
At the same time, older adult usage and abuse of the drug is getting far less attention than usage and abuse by younger adults and teens, a disadvantage to those who are 55 plus.
Dr. Tommie Richardson, a psychiatrist specializing in drug and alcohol addiction treatment in Smyrna, said the growth in the supply of fentanyl from China and Mexico has fundamentally changed the nature of the opioid crisis when compared to 10 or 15 years ago. “It’s more potent, more unpredictable, and far more lethal particularly for elderly adults,” he said.
The National Center for Drug Statistics shows that Fentanyl/stimulants is the cause of 69.3% of drug overdose deaths in the U.S. and that nearly 73,000 such deaths were recorded in 2023. Putting it another way, the center says that fentanyl overdoses are 1,750% higher than those for heroin.
Despite that, both research and treatment programs frequently don’t put older adults at the front of the line.
An exception to that is a program in Maryland. Marik Moen at the University of Maryland said their treatment program has a registered nurse experienced in addiction matters and a peer recovery specialist on board. They go directly into apartment complexes to provide NARCAN training, advice on leaving fentanyl (and other drug) issues behind and social connection.
Like many programs, they employ a Medicare Addiction Treatment (MAT) program, consisting of the use of methadone and other drugs as an aid to tapering off fentanyl. That’s combined with intensive therapy. But, “We need more programs that are age-friendly,” Moen said.
A researcher who presented findings at an American Society of Anesthesiologists conference thinks along the same lines. “A common misconception is that opioid overdoses primarily affect young people,” said Gab Pasia, lead author of a study presented last year at the American Society of Anesthesiologists’ meeting in San Antonio.
In a news release, he said “Our analysis shows older adults and stimulant involvement has become much more common in this group.”
Those in the field say stimulants have come into play with more addicts becoming tolerant of fentanyl and needing an extra boost.
Drugs educators say the opioid epidemic has unfolded in four waves since the late 1990s: prescription drugs, then a resurgence of heroin, the rise of synthetic opioids and, more recently, fentanyl laced with such drugs as cocaine, methamphetamine and even prescription drugs.
Medical professionals say that the fourth wave is very dangerous for those suffering from Opioid Use Disorder and at risk of overdosing. “It’s more potent, more unpredictable and far more lethal, particularly for older adults,” Richardson said.
A researcher in the field said she spotted the same trend about four years ago. Dr. Bethea (Annie) Kleykamp serves as an assistant professor of psychiatry at the University of Maryland and a substance abuse researcher. She has found that older and more vulnerable populations were increasingly overdosing on fentanyl/stimulants. In particular, she said older African American men were impacted.
She began work on the issue “and I had to create a working group in terms of older adults having this issue, because it was very difficult to find experts, let alone people doing research in that area.”
Dr. Dan Ciccarone, the Justine Miner Professor of Addiction Medicine in the Department of Family and Community Medicine at UCSF, agreed. He senses that not many studies are being done on fentanyl, its prevalence among seniors, and ways of mitigating the issue. He has seen nothing that addresses it.
And there could be equally little in the future.
“Sorry to get political, but you couldn’t put in (for such) a study right now. It would not pass political filter,” Ciccarone said, noting that any drug studies surrounding the disparity wouldn’t get funded. “The mortality and morbidity of drug-using older people needs further investigating because of the stimulant angle.”
He and others working in the field said the illicit fentanyl/stimulant combination puts tremendous strain on the heart and circulatory system, particularly in older adults whose bodies are much less equipped to handle such substances than, say, a 25-year-old.
There are multiple dangers.
“There are a couple of studies that look at how an overdose event is largely a hypoxic event affecting cognitive function and brain health,” Kleykamp said.
In addition, older adults have less body water and slower metabolic rates, making them more susceptible to the drug’s potentially deadly impact, experts say. Overall frailty is another issue. And tobacco use can further depress the respiratory system, enhancing negative impacts on breathing.
Chronic challenges are another issue potentially hampering help, say researchers, such as chronic pain and reduced mobility.
And the circumstances in which many of the elderly now live can also play a role in the addiction picture.
Patty Slattum works with a Virginia Commonwealth University outreach program that sends a mobile clinic to low-income senior housing, to provide care coordination and primary care.
“You show up and somebody has stuck a brick in the back door of the building and there’s free access and it’s supposed to be secure living,” she said.
Slattum said that makes seniors vulnerable to drug dealers and their wares, particularly those living alone, who are depressed and struggling to cope with aging.
The drugs are readily available, Slattum said, and some of those residents are selling opioids to buy food.
Not only is the drug a constant presence in senior housing, but more than one client she knows has gone to a methadone clinic for treatment and then been offered fentanyl while riding a bus on the way home.
Slattum said she’s seen the results play out in outreach work.
“Someone comes into an appointment and all of a sudden their eyes are rolled back, and their heads are slumped onto the table,” she said.
That calls for the rapid administration of Naloxone, one of the brighter spots in a very mixed picture. The Centers for Disease Control and Prevention says the drug works by replacing opioids with naloxone in brain receptors.
Medical practitioners say the drug used to counter overdosing is widely available over the counter at pharmacies and other locations. And there’s a push to make Naloxone even more available and utilized.
Data from the CDC showed that 76% of drug overdose deaths in 2023 involved opioids and that in nearly 43 percent of the cases, a bystander was present, someone who could quickly administer the drug. They say anyone who knows someone using fentanyl and plagued by Opioid Use Disorder should carry Naloxone.
Another promising development: while fentanyl abuse and overdoses surged during the pandemic, both have been declining since in all demographics, although the 65-and-older category showed the lowest percentage of decrease.
There are signs that fentanyl and older adult issues may be getting, at the least, more attention.
Ciccarone said an opioid epidemic that started out plaguing mainly white, male and younger victims has become more black, female and older in nature.
“The average age of either people entering treatment or dying has gotten older every few years,” he said. He adds that the statistics throw a spotlight on those older consumers, whether they’re intentional or unintentional consumers of the drug.
A year-long New York Times and Baltimore Banner study published last year said that black men from their 50s to early 70s were hardest hit in terms of overdose deaths in the Maryland city. While they constituted just seven percent of the overall population, they accounted for 30 percent of overdose deaths.
The joint study also pointed the finger at subsidized senior complexes, saying the majority of overdose deaths happened there, in an environment the investigation labeled as “awash” in drugs.
Grappling with the issue throws a spotlight on some of the barriers to making progress.
“As someone who was trained as a substance abuse researcher in the early two-thousands, people over 55 would be excluded [from studies] because they are medically complex. And if we’re trying to look at the impact of drugs, that can add variability,” Kleykamp said.
Another is the stigma sometimes attached to drug abuse and addiction, with both the addicts and their families feeling the sting. Experts in the field counter with education for both opioid addicts and their families.
Still another is that some treatment centers don’t accept Medicare, particularly the inpatient variety. Others are not set up to deal with mobility and cognitive issues that can plague older adults, Moen said. Seniors are having a tough time with programs structured around daily attendance.
The statistics are grim: the study on fentanyl and older adults presented at last year’s anesthesiologist conference painted a 9,000 percent increase in older adult deaths linked to the fentanyl and stimulant combinations between 2015 and 2023.
But on a more hopeful note, “We are getting some increased attention,” Kleykamp said. “But it’s still shockingly absent from the literature.”
This article was written with the support of a journalism fellowship from The Gerontological Society of America, The Journalists Network on Generations and The Silver Century Foundation.
