September 9, 2010

Emergency Department Visits Involving Illicit Drug Use by Older Adults: 2008

Although illicit drug use more commonly is associated with young and middle-aged adults, rates of illicit drug use among adults aged 50 to 59 increased from 2.7 percent in 2002 to 4.6 percent in 2008.¹ These trends coincide with the aging of the "baby boom" generation and could result in an increased demand for substance abuse treatment among older adults. By the year 2020, researchers predict that the number of adults aged 50 or older with a substance use disorder will double.² Pharmaceutical misuse and abuse is an important issue among older adults, but so is the use of illicit drugs such as marijuana. As adults age and have increased health problems, they may be more vulnerable to the effects of illicit drugs and may suffer more medical complications as a result. This, in turn, may lead to an increased need for emergency services.

The Drug Abuse Warning Network (DAWN) is a public health surveillance system that monitors drug-related emergency department (ED) visits in the United States.³ To be a DAWN case, an ED visit must have involved a drug, either as the direct cause of the visit or as a contributing factor. Data are collected on numerous illicit drugs, including cocaine, marijuana, heroin, and illicit stimulants (e.g., amphetamines and methamphetamines). This issue of The DAWN Report focuses on ED visits involving illicit drug use by persons aged 50 or older (hereafter referred to as "older adults").

In 2008, an estimated 118,495 ED visits involved illicit drug use by older adults. Cocaine was the illicit drug most commonly reported (63.0 percent), followed by heroin (26.5 percent), marijuana (18.5 percent), and illicit stimulants (5.3 percent). Nearly one third (31.1 percent) of visits that involved illicit drugs also involved alcohol.

The majority of ED visits involving illicit drug use by older adults (71.2 percent) were made by males. More than half were made by adults aged 50 to 54 (58.2 percent) (Figure 1). Visits by adults aged 55 to 59 accounted for 25.7 percent of such visits, whereas 11.1 percent were made by adults aged 60 to 64. More than half of visits were made by non-Hispanic blacks (58.2 percent), nearly one third were made by non-Hispanic whites (31.3 percent), and nearly one tenth were made by Hispanics (9.8 percent).⁴

Figure 1. Emergency Department (ED) Visits Involving Illicit Drugs by Adults Aged 50 or Older, by Age Group: 2008

ED visits made by adults aged 50 to 64 were more likely to involve cocaine than visits made by those aged 65 or older (63.8 vs. 48.3 percent) (Figure 2). Involvement of heroin and illicit stimulants did not differ by age group.

Figure 2. Emergency Department (ED) Visits Involving Selected Illicit Drugs by Adults Aged 50 or Older, by Age Group: 2008

Cocaine was the illicit drug most commonly involved in ED visits made by non-Hispanic black older adults (79.0 percent), whereas visits made by Hispanic older adults most commonly involved heroin (61.2 percent) (Figure 3). Although ED visits made by non-Hispanic white older adults were more likely to involve marijuana (29.7 percent) than visits made by older adults of other races, cocaine was illicit drug most commonly reported in visits made by this group (45.8 percent).

Figure 3. Emergency Department (ED) Visits Involving Selected Illicit Drugs* by Adults Aged 50 or Older, by Race/Ethnicity**: 2008

Follow-up care is defined as admission to an inpatient unit in the hospital, transfer to another health care facility, or referral to a detoxification program or substance abuse treatment. Less than half of ED visits involving illicit drug use by older adults (48.1 percent) resulted in evidence of follow-up care. This varied by drug, with follow-up care resulting from 54.3 percent of visits involving cocaine, 48.1 percent involving illicit stimulants, 43.6 percent involving heroin, and 39.3 percent involving marijuana (Figure 4).

Figure 4. Follow-up Disposition of Emergency Department (ED) Visits Involving Selected Illicit Drugs by Adults Aged 50 or Older: 2008

An estimated 42,285 ED visits involving illicit drug use by older adults (35.7 percent) resulted in hospitalization. Of these, 25,333 (59.9 percent) were admitted into an "other" inpatient unit, 6,484 (15.3 percent) were admitted to a psychiatric unit, 5,746 (13.6 percent) required intensive or critical care, and 4,356 (10.3 percent) were admitted to a chemical dependency or detoxification unit.

Illicit drug use among older adults has become an increasing concern as the baby boom generation ages. As Americans continue to live longer, researchers and health professionals are attempting to understand the effects of illicit drugs on older individuals. The impaired cognitive and motor functions resulting from the use of illicit drugs may exacerbate age-related physiologic changes. Falls, other accidents, and prescription medication interactions are of special concern.

Less than half of ED visits involving illicit drug use by older adults resulted in follow-up care; therefore, continued efforts to provide referrals in the ED may help older adults to receive appropriate treatment for substance abuse problems. ED visits involving heroin use in this population had an especially low rate of follow-up care and may represent missed opportunities for intervention.

Substance abuse treatment in older adults may need to be tailored to the specific needs of this population. Because adults aged 50 to 54 make up more than half of the older adult population seeking emergency care related to illicit drug use, targeted interventions for this age group may be especially useful. Also, culturally appropriate interventions and treatment may be important because of the high percentages of ED visits made by non-Hispanic black patients that involved cocaine and visits made by Hispanic patients that involved heroin.

This page was last updated on July 13, 2010.