Age-Related Aspects of Addiction

Koechl, Birgit; Unger, Annemarie; Fischer, Gabriele

doi:10.1159/000339095

Cited by 50 publications

(30 citation statements)

References 43 publications

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“…Older adults are particularly prone to opioid toxicity—resulting in complications such as falls and fractures—because of the age-related decline in drug metabolism, their increased exposure to multiple medications, and the high prevalence of multiple co-morbidities. 9-14 Adults ≥ 65 years are the largest consumers of prescription medications, including opioids and other psychoactive drugs. 11-13 …”

Section: Introductionmentioning

confidence: 99%

Trends in Opioid Prescriptions Among Part D Medicare Recipients From 2007 to 2012

Kuo

Raji

Chen

et al. 2016

The American Journal of Medicine

115

118

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Background There is growing concern about potential overuse of, and toxicity from, opioid analgesics. No nationally representative study has examined inter-state variations in opioid use and impact of policy on opioid use among older adults. Methods We used national Medicare data from 2007-2012 to assess temporal and geographic trends in rates of opioid prescription and relationship to opioid toxicity and different state regulations in Part D Medicare recipients. We excluded those with a cancer diagnosis. Multilevel, multivariable regression analyses evaluated rates of prolonged prescriptions for schedule II, schedule III, and combination II/III opioid for each state, adjusting for patient characteristics. Results The percent of Part D recipients receiving prescriptions for combined schedule II/III opioid more than 90 days in a year increased from 4.62% in 2007 to 7.35% in 2012. Large variations existed among states in rates of opioid prescriptions: from 2.84% in New York to 10.93% in Utah, in 2012 data. The state variation was larger for schedule III than schedule II. Individual characteristics independently associated with prolonged use included older age, female gender, white race, low-income, living in a lower education area, and comorbidity of drug abuse, rheumatoid arthritis, depression. Only state law regulating pain clinic was associated with reduction of schedule II opioid prescriptions. Prolonged opioid prescription use increased the odds of opioid overdose-related emergency room visits or hospitalization by 60%. Conclusions Analyses of Medicare Part D data demonstrated a substantial growth in opioid prescriptions from 2007 to 2011 and large variation in opioid prescriptions across states.

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Section: Introductionmentioning

confidence: 99%

Trends in Opioid Prescriptions Among Part D Medicare Recipients From 2007 to 2012

Kuo

Raji

Chen

et al. 2016

The American Journal of Medicine

115

118

View full text Add to dashboard Cite

show abstract

“…All phenotypes were adjusted for age, gender and the first 10 population principal components to correct for population stratification (Patterson et al, 2006). Age and gender were chosen as covariates in line with the previous literature (Becker and Hu, 2008;Freeman et al, 2017;Grossman et al, 2006;Immonen et al, 2017;Koechl et al, 2012). Age and gender were included as covariates also because they showed an effect on the most part of the investigated phenotypes in our samples (Supplementary Table 1).…”

Section: Discussionmentioning

confidence: 99%

Genetic basis of psychopathological dimensions shared between schizophrenia and bipolar disorder

Corponi

Bonassi

Vieta

et al. 2019

Progress in Neuro-Psychopharmacology and Biological Psychiatry

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Shared genetic vulnerability between schizophrenia (SCZ) and bipolar disorder (BP) was demonstrated, but the genetic underpinnings of specific symptom domains are unclear. This study investigated which genes and gene sets may modulate specific psychopathological domains and if genome-wide significant loci previously associated with SCZ or BP may play a role. Genome-wide data were available in patients with SCZ (n = 226) or BP (n = 228). Phenotypes under investigation were depressive and positive symptoms severity, suicidal ideation, onset age and substance use disorder comorbidity. Genome-wide analyses were performed at gene and gene set level, while 148 genome-wide significant loci previously associated with SCZ and/or BP were investigated. Each sample was analyzed separately then a meta-analysis was performed. SH3GL2 and CLVS1 genes were associated with suicidal ideation in SCZ (p = 5.62e-08 and 0.01, respectively), the former also in the meta-analysis (p = .01). SHC4 gene was associated with depressive symptoms severity in BP (p = .003). A gene set involved in cellular differentiation (GO:0048661) was associated with substance disorder comorbidity in the meta-analysis (p = .03). Individual loci previously associated with SCZ or BP did not modulate the phenotypes of interest. This study provided confirmatory and new findings. SH3GL2 (endophilin A1) showed a role in suicidal ideation that may be due to its relevance to the glutamate system. SHC4 regulates BDNF-induced MAPK activation and was previously associated with depression. CLVS1 is involved in lysosome maturation and was for the first time associated with a psychiatric trait. GO:0048661 may mediate the risk of substance disorder through an effect on neurodevelopment/neuroplasticity.

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“…Comprehensive health care for this group therefore needs to encompass interventions specific to OUD-related issues as well as standard geriatric care. Several authors have suggested the need for specialised training in addiction medicine for geriatricians, and vice versa (Koechl et al, 2012; Rosen et al, 2008). Given our findings, we would add to this a recommendation for access to hepatitis C virus screening, treatment and care.…”

Section: Discussionmentioning

confidence: 99%

Mortality among older adults with opioid use disorders in the Veteran's Health Administration, 2000–2011

Larney¹,

Bohnert²,

Ganoczy³

et al. 2015

Drug and Alcohol Dependence

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Background The population of people with opioid use disorders (OUD) is aging. There has been little research on the effects of aging on mortality rates and causes of death in this group. We aimed to compare mortality in older (≥50 years of age) adults with OUD to that in younger (<50 years) adults with OUD and older adults with no history of OUD. We also examined risk factors for specific causes of death in older adults with OUD. Methods Using data from the Veteran’s Health Administration National Patient Care Database (2000–2011), we compared all-cause and cause-specific mortality rates in older adults with OUD to those in younger adults with OUD and older adults without OUD. We then generated a Cox regression model with specific causes of death treated as competing risks. Results Older adults with OUD were more likely to die from any cause than younger adults with OUD. The drug-related mortality rate did not decline with age. HIV-related and liver-related deaths were higher among older OUD compared to same-age peers without OUD. There were very few clinically important predictors of specific causes of death. Conclusion Considerable drug-related mortality in people with OUD suggests a need for greater access to overdose prevention and opioid substitution therapy across the lifespan. Elevated risk of liver-related death in older adults may be addressed through antiviral therapy for hepatitis C virus infection. There is an urgent need to explore models of care that address the complex health needs of older adults with OUD.

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Age-Related Aspects of Addiction

Cited by 50 publications

References 43 publications

Trends in Opioid Prescriptions Among Part D Medicare Recipients From 2007 to 2012

Trends in Opioid Prescriptions Among Part D Medicare Recipients From 2007 to 2012

Genetic basis of psychopathological dimensions shared between schizophrenia and bipolar disorder

Mortality among older adults with opioid use disorders in the Veteran's Health Administration, 2000–2011

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