here. In retrospect, when we smelled something this summer like someone had left something on the bunsen burner too long? Well, someone had left something on the bunsen burner too long. Now we know why our neighbor always stepped outside to smoke. Thanks for that, at least.
Some people asked me tongue-in-cheek if I would post this to GeriPal. I said "no" to the first few, but then a family physician friend said that he's cared for at least two patients in their 70's who have been using meth, and denying it. Then another friend described caring for several patients at the county hospital who tried meth or crack cocaine for the first time in their 60's and 70's. "Why now?" She asked? The sad answer, "We have nothing to live for, so we thought we had nothing to lose by trying it."
Those elders may have been self-medicating their loss of purpose or dignity. Perhaps more common is when people self-medicate physical symptoms, like pain, at the end of life. The street cost of 80mg of oxycodone is $40, but for $25 a person can get a bag of heroin that is far more potent than that 80mg of oxycodone. Heroin is cheaper. The choice to use heroin is understandable for a person who has uncontrolled pain, doesn't have health insurance, and who has tried heroin in the past. This doesn't fall under substance abuse, it falls under substance use in the setting of a broken health care system.
Whatever the reason, substance use and abuse among older adults is far more common than we realize. The take home point is that we can't assume that it doesn't happen just because our patients are old, we have to consider it and ask. In medical school at UCSF we were taught to ask all patients if they used street drugs, like heroin. It only seemed goofy to ask older patients that question until the first person said "yes."
If you leave stories of elders who have used substances in late life in the comments, please keep them general and anonymous to protect patient confidentiality.
by: Alex Smith