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Substance Abuse in Late Life

The house next to mine was busted for running a meth lab yesterday.    Scary - our whole neighborhood could have blow up.  I was interviewed about it for local TV 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

Comments

LindaB said…
Thank you, Alex for a very topical post. There is not a week that goes by in my practice where I do not encounter at least one or more elders with a long-standing substance use problem, from crystal meth to heroin to alcohol and everything in between. I can't even begin to tell stories as they are so incredibly numerous that I don't know where to begin. Thanks you for bringing the subject to light.
Janice said…
It isn't just the illegal substances (of course with Medical Marijuana that opens up a whole new world), but I also always ask, "do you take any medication that that wasn't prescribed for you?" Sharing medication is quite common in elders. When my husband's cousin had End Stage Colon Cancer his mother and his aunts were fustratated they couldn't get her pain under control with their Vicodin. None of them thought to call her PCP, Oncologist, or even me.

I did like your phrase "substance using in the setting of a boken health care system"
Dan Matlock said…
Wow, I' glad you are alright Alex.

In the news clip did you say "I was just minding my own business..." That would be awesome!

You really only need to worry about drug use and older adults in places like San Francisco. :)

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While you're reading, I'll just go over and lick this toad.

-@AlexSmithMD





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Eric: Welcome to the GeriPal Podcast. This is Eric Widera.

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Eric: Alex, I spy someone in our …