By Mark Gold, MD
Alcohol use is very prevalent among Americans - more than half of U.S. adults drank last month - and alcohol is the third leading cause of preventable death after tobacco and poor diet/physical inactivity.1,2 When coupled with prescription opioid use, drinking becomes especially dangerous.3 Women are at high-risk of experiencing these adverse health effects, which worsen with age. A recent study illuminates the repercussions of concurrent alcohol and prescription opioid use in older women.
Where: Community outreach initiative run by the University of Florida closely examined habits of substance use and co-use among older women.
Participants: 2,370 women aged 50 years and older who participated. Any person who self-identified as female was included in this study. Women of all racial, economic, and educational backgrounds were included.
Initial interviews were conducted with the participants to assess overall health and to place them into one of four groups:
70% reported neither hazardous alcohol use nor prescription opioid use in the past month
12% reported hazardous alcohol use only (three or more drinks a day) in the past month
15% reported prescription opioid use only in the past month
3% reported using both substances in the past month
Why are women at greater risk?
Although women are less likely to drink heavily than men, they are more susceptible to the harmful consequences associated with harmful alcohol use, like liver disease, brain disease, and cancer.4 Despite this, women are 50% more likely to be prescribed opioids than men. Additionally, older women are also prescribed more opioids than younger women (18% of women over 40 have a prescription versus 8% of younger women).5
What can we do to help?
This study confirms the need for provider education about prescribing opioids to older patients and the importance of thorough screenings in all health care settings to intervene in risky substance use before serious health conditions develop.
The first step is for medical providers to be consistent and non-judgmental when asking their patients about substance use and performing screenings as needed. If the patient reports alcohol consumption, The Short Michigan Alcoholism Screening Instrument–Geriatric Version (SMAST-G), can be used.
The SAMHSA Guidelines for implementing SBIRT (Screening, Brief Intervention, Referral to Treatment) recommend that a short screening (like the SMAST-G) be used and understood as the first step in the process. Screening alone can be inadequate because patients, especially those using substances in risky or harmful ways, are not always honest about their habits of use. Because of this, brief behavioral counseling is a critical component of effective screening and has been demonstrated to reduce alcohol misuse among older adults.
Looking to the Future
Because Americans are living longer, the percentage of our older population is growing. Right now, about one in seven people in the US are age 65 or older - by the year 2030, it will jump to one in five.6 As this trend plays out, the societal and economic cost of health conditions affecting older people (in general and as a result of alcohol use) will continue to increase. These predicted risks could be further compounded by the fact that in 2017, a study found that heavy use, misuse, or dependence among older adults was rising at unprecedented rates—which is alarming given that the amount of alcohol deemed safe to consume decreases with age. By illuminating the risks of concurrent prescription opioid use and drinking, we can empower health care providers to improve care for older patients, support alternative therapies to opioids, and bolster interventions to this demographic.
Serdarevic, M., Gurka, K. K., Striley, C. W., Vaddiparti, K., & Cottler, L. B. (2019). Prevalence of Concurrent Prescription Opioid and Hazardous Alcohol Use Among Older Women: Results from a Cross-Sectional Study of Community Members. Journal of community health, 44(1), 172-177.
Dedert, E., et al. (2014). e-Interventions for alcohol misuse. Washington (DC): Department of Veterans A airs.
Alcohol Facts and Statistics | National Institute on Alcohol Abuse and Alcoholism (NIAAA). [Online]. https://www.niaaa .nih.gov/alcohol-health/overview-alcohol-consumption/alcoh ol-facts-and-statistics. Accessed 04 August 2016.
Koechl, B., Unger, A., & Fischer, G. (2012). Age-related aspects of addiction. Gerontology, 58(6), 540–544.
Gudin, J. A., Mogali, S., Jones, J. D., & Comer, S. D. (2013). Risks, management, and monitoring of combination opioid, benzodiazepines, and/or alcohol use. Postgraduate Medicine, 125(4), 115–130.
Cicero, T. J., Lynskey, M., Todorov, A., Inciardi, J. A., & Surratt, H. L. (2008). Co-morbid pain and psychopathology in males and females admitted to treatment for opioid analgesic abuse. PAIN, 139(1), 127–135.
Colby, S. L., & Ortman, J. M. (2015) Projections of the size and composition of the US population: 2014 to 2060. US Census Bureau, Ed., pp. 25–1143.
Dr. Mark S. Gold is a teacher of the year, translational researcher, author, mentor and inventor best known for his work on the brain systems underlying the effects of opiate drugs, cocaine and food. Read more by Dr. Gold here.