Monday, June 5, 2023
Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™
ABIM Diplomates - maximum of 0.25 ABIM MOC points
Nurses - 0.25 ANCC Contact Hour(s) (0 contact hours are in the area of pharmacology)
Pharmacists - 0.25 Knowledge-based ACPE (0.025 CEUs)
Physician Assistant - 0.25 AAPA hour(s) of Category I credit
IPCE - 0.25 Interprofessional Continuing Education (IPCE) credit
This activity is intended for psychiatrists, family medicine/primary care clinicians, internists, public health and prevention officials, nurses, pharmacists, physician assistants, geriatricians, and other members of the health care team for older patients who may be at risk for drug overdose.
The goal of this activity is for members of the healthcare team to be better able to describe 20-year trends in drug overdose, including intentional and unintentional overdoses, among older adults in the US, based on a new analysis of Centers for Disease Control and Prevention data.
Upon completion of this activity, participants will:
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Awarded 0.25 contact hour(s) of nursing continuing professional development for RNs and APNs; 0.00 contact hours are in the area of pharmacology.
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CME / ABIM MOC / CE Released: 5/5/2023
Valid for credit through: 5/5/2024
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As the number of chronic comorbidities increases with aging, older people are at risk for polypharmacy involving prescribed substances. Unrecognized mental health issues, such as depression and anxiety, and chronic pain may contribute not only to polypharmacy but also to use of illicit drugs.
Confusion accompanying the cognitive impairment of aging or resulting from metabolic imbalances such as hypoglycemia may increase risk for unintentional overdose. Different clinical and policy strategies are needed to address intentional and unintentional overdose.
Drug overdose deaths among US adults aged 65 years and older quadrupled over roughly the last 20 years, according to new findings that have policy implications for the ongoing overdose epidemic.
“Current proposals to improve mental health and [substance use disorder (SUD)] coverage within Medicare, for example, applying mental health parity rules within Medicare, acquire greater urgency in light of this study’s results,” note investigators from the Stanford University School of Medicine and the David Geffen School of Medicine at the University of California, Los Angeles, both in California.
“It’s also important to shift the way we think about overdose. It’s not just a problem for younger people. There is concern for older adults, too,” study investigator Chelsea Shover, PhD, told Medscape Medical News.
The study was published online March 29 in JAMA Psychiatry.
The researchers used data from the Centers for Disease Control and Prevention (CDC) to calculate annual overdose deaths from 2002 to 2021 among people aged 65 years and older.
Overall, they found that fatal overdoses quadrupled, going from 1060 in 2002 (3 per 100,000) to 6702 (12 per 100,000) in 2021, with the highest rates in the Black population (30.9 per 100,000).
“I expected that overdoses would have gone up among older adults, just as we’ve seen pretty much across the population. But the magnitude of the increase, quadrupling over 20 years, is pretty surprising,” said Dr Shover.
By 2021, 1 in 370 deaths among seniors was caused by an overdose. More than half (57%) of the overdose deaths involved opioids, 39% involved stimulants, and 18% involved a combination of both.
“As clinicians or public health practitioners, we want to make sure that we are providing targeted education and resources, including naloxone, to older adults who might be using opioids, whether those are prescribed or illicitly,” Dr Shover said.
During the study period, the share of all-cause mortality attributable to drug overdose in seniors jumped 359%, going from 0.06% to 0.27% during the study period (P<.001).
In 2021, about 13% of overdoses were intentional, 83% were unintentional, 4% were undetermined, and less than 1% were homicide. Older women accounted for 57% of intentional overdoses and 29% of accidental overdoses.
By race/ethnicity, 38% of overdoses among Asian people were intentional compared with 18% among White people and 2% among Black people.
Most unintentional overdoses (74%) involved illicitly made drugs (synthetic opioids, heroin, cocaine, and methamphetamine); about 1 in 5 (19%) involved both prescription and illicit drugs.
Most intentional overdoses (68%) involved prescription opioids, antidepressants, benzodiazepines, or antiepileptics and sedative-hypnotics.
The investigators note that safer prescribing initiatives, such as addressing opioids and benzodiazepines, which are underway in many healthcare systems, may help reduce the risk for overdose among older adults.
Support for this research was provided by grants from the Veterans Affairs Health Services Research and Development Service and the National Institute on Drug Abuse. The authors have disclosed no relevant financial relationships.
JAMA Psychiatry. Published online March 29, 2023.[1]
