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Research & Development Addiction, Medical research, Pain

The Unusual Suspects

When most people think of psychoactive substance misuse, young people will spring to mind first. But according to a recent study, the population most vulnerable to cannabis and prescription opioid and tranquilizer/sedative (mis)use in the US is adults over 50 years of age with functional impairments.

A cross-sectional analysis of adults from the National Survey on Drug Use and Health estimated the prevalence of past-year medical and nonmedical drug use and misuse according to the number of functional impairments reported. The adjusted odds of medical and nonmedical use or misuse of each substance in relation to any impairment, the number of impairments, and specific impairments were estimated using logistic regression.

Those individuals reporting impairments were more likely to report the use of cannabis and the misuse of prescription opioids and tranquilizers/sedatives than those who did not (all p<0.05). Prevalence of (mis)use increased for each drug as the number of impairments increased (all p<0.001). Having any impairment was associated with increased odds for medical cannabis use (AOR=2.28, 95% CI=1.57, 3.30) but not for nonmedical use and with increased odds for misuse of prescription opioids (AOR=1.62, 95% CI=1.38, 1.91) and tranquilizers/sedatives (AOR=1.59, 95% CI=1.20, 2.11). Impaired thinking was associated with increased odds for the use – and (mis)use – of each substance, while impaired ability to do errands was associated with increased odds for prescription opioid misuse (AOR=1.34, 95% CI=1.01, 1.78).

Q&A

Benjamin Han, Assistant Professor at the University of California San Diego, Department of Medicine, Division of Geriatrics and Gerontology, USA

Why did you choose to study this population? 

I am a geriatrician and addiction medicine physician, so I’m particularly interested in older adults and adults living with chronic diseases and functional impairments and how they may use cannabis, as well as prescription opioids and benzodiazepines.

How did you define misuse?

We used data from the National Survey on Drug Use and Health which defines misuse as using in any way not directed by a doctor, including use without a prescription, use in greater amounts, more often, or longer than instructed to take them, or use in any other way a doctor did not direct.

Were any impairments in particular associated with use and misuse? 

In this population, misuse of prescription opioids, tranquilizers, and sedatives, as well as non-medical use of cannabis, were all associated with impairments in thinking. At the same time, prescription opioid misuse was also associated with impairments in doing errands. This likely is related to chronic pain, which affects one’s ability to carry out errands. Thus, the association of prescription opioid misuse with impairments in doing errands could reflect undertreated chronic pain.

What do these findings mean for adults with functional impairments? Should cannabis be prescribed with caution?

Older adults with functional impairments may have chronic symptoms, such as chronic pain, that can be challenging to manage especially in the setting of multiple chronic conditions and other prescribed medications. Our findings suggest that the symptoms this patient population face are not always being fully addressed. Adequately addressing these chronic symptoms often mandates a multidisciplinary approach. Cannabis certainly may have benefits for this population, but as with other psychoactive medications, such as opioids and benzodiazepines, caution is needed with use. There are not many studies that include older adults or adults with functional impairment in clinical research – especially cannabis research – so it is difficult to weigh the benefits and the risks for this population.

How will you progress with this line of research?

My focus is on better understanding how older adults and adults with chronic diseases use different substances and finding ways to mitigate harms from these substances in a population that may be particularly vulnerable to adverse effects.

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  1. B Han et al., Am J Prev Med, 246 (2021). PMID: 34288869

About the Author

Phoebe Harkin

Deputy Editor

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