NYU Study Finds Adults Aged 50-59 Now Largest Age Group in Opioid Treatment Programs

Notable shifts found in demographic background including gender and ethnicity among older adults

Newswise, December 1, 2015 — Recent years have seen a change in drug use patterns, especially for older adults, with an increase in their admission to substance abuse treatment and increased injection drug use among those over the age of 50. 

Yet, there has been little research regarding the epidemiology, health status, and functional impairments in the aging population of adults accessing opioid treatment.

Of the few studies on this population to date, most have been based off of a limited dataset that only accounts for treatment admissions, and therefore may not fully capture the utilization of substance abuse treatment over time. 

Furthermore the treatment episode dataset (TEDS), defines an older adult as aged over 50 or 55, and may not fully demonstrate how the population is aging.

Given the gaps in existing data, researchers affiliated with New York University's Center for Drug Use and HIV Research (CDUHR), and NYU’s School of Medicine (NYUSoM) sought to elucidate age trends for opioid treatment programs, with an emphasis on older adults, in a new study published in the Journal of Substance Use & Misuse. 

The investigation focuses on such trends in New York City, as it has one of the largest methadone treatment systems in the U.S. and consistently provides access to treatment in the public system.

The study, “Demographic Trends of Adults in New York City Opioid Treatment Programs- An Aging Population,” used data collected by New York State's Office of Alcoholism and Substance Abuse Services (OASAS). OASAS provides more detailed information on the treatment population than what is available nationally through the TEDS dataset, allowing the NYU researchers to characterize basic demographic, self-reported other substance use, and self-reported physical impairments.

“Most notably,” says Benjamin Han, MD, MPH, an instructor at NYUSoM and the study’s principle investigator, “we found a pronounced age trend in those utilizing opioid treatment programs from 1996 to 2012, with adults aged 50 and older becoming the majority treatment population.”

Specifically, individuals aged 50-59 which made up 7.8% (N= 2,892) of the total patient population in 1996, accounted for 35.9% (N= 12,301) of the population in 2012. Patients aged 60-69, also saw a dramatic increase in numbers, originally constituting 1.5% of patients (N= 558) to 12.0% of patients (N= 4,099).

“These increases are especially striking, considering there was about a 7.6% decrease in the total patient population over that period of time, and suggests that we are facing a never before seen epidemic of older adults with substance use disorders and increasing numbers of older adults in substance abuse treatment. 

Unfortunately there is a lack of knowledge about the burden of chronic diseases and geriatric conditions or the cognitive and physical function of this growing population” says Dr. Han.

During the same period, those age 40 and below, who in 1996 accounted for 56.2% of patients (N= 20,804), were a fraction of that in 2012, responsible for 20.5% of total patients (N= 7,035).

There were also notable shifts with regards to race and ethnicity. During this period older adults over the age of 60 were increasingly white, with a 10.3% increase in representation, while there was a 13.8% decrease in the percentage of black patients. 

There was a small increase in the Hispanic constituency from 35.0% in 1996 to 38.8% in 2012. These trends, however, were different for those aged 50-59. In this age group there were smaller decreases in both the white (3.5%) and black (5.9%) populations, and a larger increase in Hispanic patients (9.2%). 

However, when looking at all age groups during this period, the overall white population remained steady (-0.4%), with a slight decrease in black patients (3.5%) and a slight increase in Hispanic patients (3.4%).

Researchers believe the increase in older adults utilizing opioid treatment programs is likely to continue into the next decade. Further studies are required to better understand the specific and unique health needs of this growing population from a geriatric perspective. 

More research is also need to understand how other substance use can complicate care and how to address the changing ethnic and racial demographics of this population in New York City.

Researcher Affiliations: Benjamin H. Han, MD, MPH1*; Soteri Polydorou, MD2; Rosie Ferris, MPH1; Caroline Blaum, MD, MS1; Stephen Ross, MD2; Jennifer McNeely, MD, MS3.
1 NYU School of Medicine, Department of Medicine, Division of Geriatrics.
2 NYU School of Medicine, Division of Alcoholism and Substance Abuse
3 NYU School of Medicine, Department of Population Health and the Department of
Medicine.

Declaration of Interest: Gail Dorn, MS1 and Dawn Lambert-Wacey, MA1 provided the aggregated dataset used in this study, and assisted in the editing of the article.

1NYS Office of Alcoholism and Substance Abuse Services
Division of Outcome Management and System Information
1450 Western Ave, Albany, NY 12203-3526

About CDUHR
The mission of the Center for Drug Use and HIV Research (CDUHR) is to end the HIV and HCV epidemics in drug using populations and their communities by conducting transdisciplinary research and disseminating its findings to inform programmatic, policy, and grass roots initiatives at the local, state, national and global levels. CDUHR is a Core Center of Excellence funded by the National Institute on Drug Abuse (Grant #P30 DA011041). It is the first center for the socio-behavioral study of substance use and HIV in the United States and is located at the New York University College of Nursing. For more information, visit www.cduhr.org

About NYU Langone Medical Center
NYU Langone Medical Center, a world-class, patient-centered, integrated academic medical center, is one of the nation’s premier centers for excellence in clinical care, biomedical research, and medical education. Located in the heart of Manhattan, NYU Langone is composed of four hospitals—Tisch Hospital, its flagship acute care facility; Rusk Rehabilitation; the Hospital for Joint Diseases, the Medical Center’s dedicated inpatient orthopaedic hospital; and Hassenfeld Children’s Hospital, a comprehensive pediatric hospital supporting a full array of children’s health services across the Medical Center—plus the NYU School of Medicine, which since 1841 has trained thousands of physicians and scientists who have helped to shape the course of medical history. The Medical Center’s tri-fold mission to serve, teach, and discover is achieved 365 days a year through the seamless integration of a culture devoted to excellence in patient care, education, and research. For more information, go to www.NYULMC.org

About New York University College of Nursing
NYU College of Nursing is a global leader in nursing education, research, and practice. It offers a Bachelor of Science in Nursing, a Master of Science and Post-Master’s Certificate Programs, a Doctor of Philosophy in Research Theory and Development, and a Doctor of Nursing Practice degree. For more information, visit www.nursing.nyu.edu/ 

Many Use Prescription Painkillers, Most See Abuse as Major Health Concern

Despite wide use, broad support seen for policies to stem epidemic of opioid misuse and abuse in U.S.

Newswise, October 8, 2015 — More than one in four Americans has taken prescription painkillers in the past year, even as a majority say that abuse of these medications is a very serious public health concern, according to new Johns Hopkins Bloomberg School of Public Health research.

Roughly seven in 10 Americans have been prescribed the medications in their lifetime and 17 percent say they have taken painkillers prescribed for someone else, the researchers found in what they believe is the first national public opinion study on this topic.

The findings, published online Oct. 7 in the journal Addiction, suggest that the public may be poised to support a number of policy measures designed to control what has become an epidemic of abuse, including instituting better medical training in controlling pain and treating addiction, requiring doctors to ensure patients don’t receive multiple painkiller prescriptions from different providers and requiring pharmacists to check identification before distributing pain prescriptions.

Over the past decade, there has been a sharp increase in the rates of prescription painkiller abuse, misuse and overdose. 

Drug overdose – the majority of which involve opioid pain relievers – was the leading cause of injury death in 2012, and among people between the ages of 25 and 64, drug overdose surpassed car crashes as the leading cause of injury death.

“This study shows that many Americans have had direct experience using prescription pain relievers and a sizable share have misused or abused these medications themselves or have close friends or family members who have done so,” says study leader Colleen L. Barry, PhD, MPP, an associate professor in the Department of Health Policy and Management at the Bloomberg School.

 “The seriousness of the issue has become salient with the American public.”

Fifty-eight percent of survey respondents ranked prescription pain medication abuse as either a very serious or extremely serious health issue, on par with other public health problems such as gun violence and tobacco use, Barry says.

The study, based on a web-based public opinion survey of 1,111 adults in the United States in February 2014, was designed to understand attitudes about prescription painkiller use and abuse. 

Among the findings: Most people blame those who abuse painkillers and the doctors who prescribe them for the current public health crisis. A majority of respondents to the survey said doctors keep patients on these medications for too long, that it is too easy for people to get multiple pain medication prescriptions and that there is a lack of understanding among patients about how easily they can become addicted.

Prescription painkillers are involved in roughly 475,000 emergency department visits a year and the economic costs of misusing these medications were estimated in 2006 at $50 billion in lost productivity, crime and medical costs.

The researchers say they found broad support for most policy recommendations put forth by leading groups such as the U.S. Centers for Disease Control and Prevention, the White House Office of National Drug Control Policy, the American Medical Association and the Trust for America’s Health. 

Except for policies to expand distribution of medications such as naloxone that can reverse opioid overdose which was supported by only 47 percent of respondents and to increase government spending on addiction treatment which was supported by only 39 percent of those surveyed, there was majority backing for all policies in the survey.

Policy proposals with the highest levels of public support were requiring pharmacies to verify patient identification before giving out prescription pain medication (84 percent), requiring medical school and physician residency programs to provide training for physicians in how to detect and treat addiction to prescription pain medication (83 percent) and requiring medical school and physician residency programs to train physicians to treat chronic pain (82 percent).

“We think this is the perfect time to work on passing policies that can truly impact the crisis of prescription pain reliever abuse,” says study co-author Emma E. “Beth” McGinty, PhD, MS, an assistant professor in the Department of Health Policy and Management at the Bloomberg School. “The issue has not yet been highly politicized like some public health issues such as the Affordable Care Act, gun violence or needle exchanges, so we may have an opportunity to stem this epidemic.”

“Understanding Americans’ Views on Opioid Pain Reliever Abuse” was written by Colleen L. Barry, Alene Kennedy-Hendricks, Sarah E. Gollust, Jeff Niederdeppe, Marcus A. Bachhuber, Daniel W. Webster and Emma E. McGinty. The collaborating researchers are from the University of Pennsylvania, the University of Minnesota School of Public Health, Cornell University and the Philadelphia Veterans Affairs Medical Center.

Funding for this study was obtained through an unrestricted research grant from AIG, Inc.