Table 1 Distinguishing features of older adults who use non-medical opioid
Participant # | ||
|---|---|---|
Race | Majority of our older patients identify as Black and with our younger patients it’s a mix, but it’s more white patients who are younger that we are seeing. We see a lot of young people come into the city to buy drugs and then we see them at the syringe exchange. More of our older patients live in the inner communities in Chicago. Our younger patients who are injecting tend to identify as white | 22 |
Sex | Around two-thirds of our patients [who use non-medical opioids] are older adults in their 50’s, 60’s, and 70’s. Most of our older adults are black and usually men | 18 |
Use behaviors | ||
Use powder vs. Pills | I think heroin and fentanyl is a lot more accessible for most folks [older adults] as opposed to prescription. A prescription can only be obtained if you know of someone who has a prescription…Very often it’s powder, which is very different from younger white users I interviewed who started on a trajectory of using their parents’ medications, or they have behavioral issues so they got prescribed medications, or they’re part of a high school group in the summer where they might have had access to someone’s grandma’s pills. I think with this younger group, there is a lot of early exposure to pharmaceuticals but with older folks who I’ve interviewed, who tend to be African American, it tends to be street powders | 3 |
Pills are really expensive, so they (older adults) don’t buy that. It’s mainly heroin, and by heroin, I mean fentanyl. It’s mainly fentanyl that’s mixed with baby powder or whatever they cut it with | 20 | |
Method of ingestion: snorting | When we’re seeing older groups, they tend to be African American and don’t inject. Most of them tend to be people who snort opioids if they’re using opioids | 3 |
As far as IV vs. intranasal, a lot of people have a perception that IV use is serious use. But I’m not sure of a medical reason as to why people [older] are using intranasal | 18 | |
People who are injecting are mostly younger. Because I provide wound care…I intend to attract a lot of the younger crowd. I also see a fair amount of folks who are insufflating as well and those tend to be older and African American | 17 | |
As far as injection vs insufflation, you will have around 25% injection and 75% insufflation, split with the majority of injectors being younger than 40 | 17 | |
Particularly with African American individuals, they’re often in a treatment program and have gone through a period of abstinence from injection and they’re using the methadone and have done that practice for a while. They have resumed use. This may be because of the stigma around injecting, and they want to keep people unaware of their substance use. This is a more clandestine way to use. As a group, African Americans—you don’t see a lot injecting. It’s not a popular route of administration | 3 | |
Long term use | Most of my older adults over 50 have been using for decades and it’s been heroin. Now it’s fentanyl and it’s a 50/50 split between those who think they have heroin and its actually fentanyl and those who know they are getting fentanyl | 17 |
Majority of them [older adults] have been using for a long, long, long, long time. Also, they don’t have many overdoses. We have some patients who have been using 30 + years | 22 | |
The population we see are people who have been using for decades. It’s not someone who just got into a car accident last month and started using pills and maybe now has developed OUD. Given that its long-term use, they are less likely to use pills | 18 | |
Oftentimes, people will have been using for decades, but that decades long use is intermittent. People will kick it back up again and in older adults I see that this happens usually after a traumatic event like loss of a parent, friend, spouse | 18 | |
These are patients who, on average, have been using for decades as opposed to years. This may be very different than the perception of who the opioid epidemic has been affecting for the last 20 years | 18 | |
All patients start with ‘stop opioids altogether’ since that’s what they want us to hear as providers. You can’t stop 30 years of use with one dose of suboxone. It’s a great long-term goal, but what do you want to do for next week? | 20 | |
Intermittent use/use of lessor amounts | They [older adults] tend not to use that much, maybe 1–2 bags a day. Younger adults maybe use 6–10. It’s more chronic, long-term use in older adults. I’m not sure if this is because these are the ones who survived | 20 |
They [older adults] didn’t have as many overdoses because they may be used once a day. A lot of the older adults are more functional addicts. They tend to work and take care of their kids. I don’t see this as much in younger adults, they tend to be fully into it and their lives are usually disoriented | 20 | |
They [older adults] maybe use once or twice, or a couple times a week. Overall, majority of them use a smaller amount of heroin and fentanyl. Majority of them have been using for a long, long, long, long time. Also, they don’t have many overdoses. We have some patients who have been using 30 + years | 22 | |
It would be rare to encounter a 65-year-old patient who has been injecting 10 bags of heroin a day for a long, long, long time. Snorting a bag or two a day, a couple times a week | 22 | |
They started usually before the '90 s oxycontin scare and they have always been using heroin. The biggest issue with them is that they are not using 10 bags a day, they are using probably a couple bags a day or every other day. They may be using it just to feel normal, like everyone else, or they may have painful comorbidities | 5 | |