Melbourne, Sep 1 (The Conversation) The perception that drug overdose deaths primarily concern young individuals is being challenged by new findings from Australia's Annual Overdose Report, published Sunday. These insights spotlight a troubling rise in overdose deaths among older Australians over the past two decades. Since 2001, unintentional overdose fatalities have decreased by roughly a third among those under 30. However, defying this trend, the death rate for individuals aged 50–59 has tripled, while the 60–69 age bracket has seen nearly double the fatalities.
So, why are more older Australians succumbing to drug overdoses, and what steps can be taken to address this issue? The report reveals that the median age for unintentional drug-induced deaths continues to rise, spanning nearly all drug categories. In Australia, opioids remain the predominant drugs involved in unintentional overdose deaths, including both illicit opioids like heroin and prescription painkillers such as oxycodone and codeine.
The latest findings indicate a sharp increase in opioid-related overdose deaths among older adults, with the most significant surges since 2001 seen in those aged 40 to 69. Between 2019 and 2023, individuals aged 40–49 accounted for roughly a third of all heroin-related deaths (704 deaths), while the 50–59 age group comprised one in five fatalities (451 deaths).
Pharmaceutical opioids show an even more pronounced concentration of deaths among older demographics. A significant portion of these deaths involved individuals aged 50 or older, with 38% of fatalities occurring in this age group. The 40–49 age group represented 28% of deaths (619 fatalities), followed by 23% among 50–59 year-olds (508 deaths), and 15% among those aged 60 and above (330 deaths).
Why is this happening? Older individuals face unique challenges, as they typically have multiple health conditions and use more prescription drugs, some of which can dangerously interact with other substances. Opioids pose particular risks as they can slow heart rate and breathing, and when combined with alcohol or sleeping pills, the danger of unintentional overdose rises. Additionally, as people age, their metabolism changes, with slower liver and kidney function potentially leading medications to accumulate to hazardous levels, even at doses that previously seemed safe.
Media and policy discussions often emphasize preventing drug-related harm among younger populations, yet the specific vulnerabilities of older adults frequently remain unaddressed. Older individuals who use illicit substances or misuse prescription medications frequently encounter stigma, which might discourage them from seeking help. Moreover, healthcare professionals might hesitate to discuss substance use with older patients, as research indicates they are less likely to query older adults about this issue compared to younger individuals.
An additional factor is the ‘ageing cohort theory,’ which suggests that drug-related deaths affect the same individuals who were at risk decades ago. This group, which began using drugs in the 1980s or 1990s, is now middle-aged. Australia's pattern of drug-related deaths mirrors that of the UK, where fatalities peak among 40–49 year-olds, and the incidence falls among younger cohorts. Furthermore, fewer young Australians are initiating drug injection.
National estimates reveal a shift in the median age of drug injectors from approximately 28 years old to over 43, accompanying a rise in the average age of first injection from the late teens (18–20 years) to the late 20s or early 30s (30–34 years). This supports the notion that drug-related deaths affect an ageing group, rather than a new wave of drug users.
As this cohort ages, they are likely to develop additional health conditions and have more extensive medication use, further elevating their risk of overdose.
On a positive note, effective treatments exist for individuals grappling with opioid issues, including "opioid agonist treatments" like methadone and buprenorphine, which effectively help patients cease or reduce opioid use and enhance their overall health. Research confirms these treatments can halve the risk of overdose death.
Despite their effectiveness, many individuals do not access these treatments, facing barriers such as cost, stigma, and restrictive treatment regimens that may not be conveniently available. For instance, the requirement to visit a community pharmacy daily for dosing can deter individuals from seeking care. Yet, new treatments offering monthly dosing could potentially improve treatment accessibility.
Nonetheless, the demand for treatment still surpasses existing capacity. In Australia, approximately one-third to half of those who require drug treatment cannot access it because there aren't sufficient treatment facilities.
Thus, significant effort is needed to make these life-saving treatments more accessible. In Australia, naloxone has become obtainable in pharmacies and other harm reduction services free of charge and without a prescription. This medication can reverse opioid overdoses and can be easily administered by a trained non-professional.
Specifically targeted resources for older adults who utilize opioids for pain management emphasize opioid safety and naloxone usage, including evaluating individual risk with current medications and establishing personalized safety plans.
Addressing the overdose crisis in Australia necessitates an expanded view of drug-related harms — it's no longer solely a "youth issue," but a growing concern for individuals in midlife and beyond. This shift demands a responsive health system that caters to older adults' needs, with reduced stigma and more accessible treatment options. Conversations about substance use must become a routine part of care for all age groups. Recognizing and addressing existing health conditions, alongside informing about safe medication practices, could diminish older populations' overdose risk. (The Conversation) GSP
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