Exposure reasons, other substance use, and medical outcomes of poison control center cases aged 50+ involving opioids, 2015–2020

Abstract

Context

Rates of prescription opioid (PO) prescribing and filling remain high, and illicit opioid (IO) use has increased among late middle-aged and older adults. Research on PO and IO poisoning and their impacts among these age groups is needed.

Methods

Data came from 2015 to 2020 poison control center cases aged 50+ (N = 83,135). We used χ² tests to examine changes over the study period in the numbers of PO and IO cases, type of opioids used, exposure reasons, and medical outcomes. We fit multinomial logistic regression models to examine the associations of medical outcomes with exposure reasons and other medication/substance involvement.

Results

Between 2015/2016 and 2020, the numbers and shares of PO-only cases steadily declined, but IO cases, with or without PO, nearly tripled, constituting almost 10% of all PCC opioid cases aged 50+ in 2020. The rates of intentional misuse/abuse increased among both PO-only and IO (with/without PO) cases during the study period, and the death rate among IO cases sharply increased in 2020. Compared to adverse reactions or other unintentional exposures, intentional misuse/abuse and suspected suicides were associated with significantly higher risks of serious outcomes (e.g., risk of death from intentional misuse/abuse: RRR = 22.11, 95% CI = 16.74–29.20 in PO-only cases and RRR = 6.95, 95% CI = 2.37–20.39 in IO cases with/without PO). The use of most other medications and substances was also significantly associated with serious outcomes.

Discussion

Among older adults, medical outcomes in opioid poisoning cases have become more serious in recent years as intentional misuse/abuse became more common. Opioid use disorder treatment should be readily available and accessible, and alternatives to PO prescribing should be considered.

Conclusions

Among individuals aged 50+, PO poisoning cases decreased, but IO cases increased sharply from 2015 to 2020 with concomitant increases in intentional misuse/abuse and serious medical outcomes.

Keywords:

• Older adults
• opioid poisoning
• therapeutic error
• intentional misuse/abuse
• suicide intent
• death

Acknowledgements

The American Association of Poison Control Centers made the National Poison Data System (NPDS) available to the authors for this study. This study’s findings and conclusions are those of the authors alone and do not necessarily represent the official position of the American Association of Poison Control Centers or participating poison control centers.

Author contributions

All authors contributed to conceptualization. SDB applied for and obtained the de-identified NPDS data and provided overall guidance on the data system and analysis. NGC conducted data analysis and drafted the paper. BYC provided consultation on pharmaceutical and medical contents. CNM provided statistical consultation, and DMD contributed to editing the paper and provided feedback. All authors agree to the publication of the paper.

Disclosure statement

The authors report no potential conflict of interest.

Additional information

Funding

This research was supported by grant, P30AG066614, awarded to the Center on Aging and Population Sciences at The University of Texas at Austin by the National Institute on Aging. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.