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Are There Racial Differences in Opioid Misuse Among Seniors?

New research finds older Americans, Black or White, misuse opioids equally.

Victor Moussa/Shutterstock
Source: Victor Moussa/Shutterstock

Prescription opioid misuse is a very serious problem in the United States. The misuse of prescription opioids is typically defined as: (a) use of a prescription opioid without a prescription of one’s own; (b) use in greater amounts, more often, or longer than one was told to take them; or (c) use in any other way not authorized by a physician. Prescription opioids used for pain relief are generally safe when taken for a short time and as prescribed, but they are prone to misuse because they can cause euphoria, pain relief, and extreme relaxation. About 9 million Americans report misusing a prescription opioid at least once in the past year. This is concerning because misuse of prescription opioids carries a significant risk of adverse health outcomes.

Misuse of prescription opioids has been linked to accidental overdose, hospitalizations, criminal justice involvement, and mental health issues, among other problems. Prescription opioid misuse among older adults, however, may be an area of particular concern. For example, one study found that prescription opioid misuse more than tripled (.3-1 percent) between 1992-2002 among Americans age 55+. More recent data show that rates continued to rise among that same age group, increasing from 1-1.7 percent between 2003-2013. Another concerning trend is that poison control center call data show an increase (from 2006 to 2013) among older adults in opioid-related deaths and opioid use with suicidal intent. Collectively, these studies show a clear upward trend.

These increases are of particular concern because older adults are more vulnerable to the adverse effects of prescription opioids than younger age groups. Not only do older adults experience a variety of age-related pharmacokinetic changes and a greater tendency toward poly-pharmacy (i.e., the simultaneous use of multiple prescription medications), they are at elevated risk due to social problems (e.g., financial difficulties and social isolation), psychological issues (depression and loss of memory), and physical ailments (e.g., lack of mobility and general ill health). Older adults also tend to have access to large amounts of prescription opioids as they are one of the largest demographics of Americans prescribed opioids for pain management. These unique risk factors make older adults vulnerable to prescription opioid misuse and the associated consequences of such use.

What is unclear, however, is whether rates are higher among White older adults than Black older adults. Generally speaking, rates have historically been higher among White adults than Black adults, but it’s not clear whether these differences persist into older adulthood. Also, research on older adult prescription opioid misuse is rare, and there hasn’t been a study on this topic in several years.

Fortunately, a recent study that used nationally representative data sought to compare prevalence rates among White and Black older adults. This study found that rates of prescription opioid misuse were actually equal among Black (2.5 percent) and White (2.5 percent) older adults. This result is somewhat surprising, given that numerous other studies have found prescription opioid misuse to be generally higher among White people than Black people. Equal prevalence challenges the notion of prescription opioid misuse as solely a ‘White problem.’

Since the start of the opioid crisis in the late 1990s, the problem has been framed as an issue that Black Americans have been largely insulated from. However, this result provides evidence to the contrary and suggests that a demographic shift in the U.S. opioid crisis has taken place. Behavioral health providers should be aware of this demographic shift and be mindful that White and Black older adults are now equally at risk of prescription opioid misuse. This means prevention and treatment efforts need to be targeted equitably at both Black and White older adults.

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