Substance use and medical outcomes in those age 50 and older involving cocaine and metamfetamine reported to United States poison centers

Abstract

Context

Cocaine and metamfetamine use and overdose deaths among United States adults have been increasing in recent years. We examined associations of medical outcomes with co-used opioids and other substances among cocaine, and metamfetamine exposures in people age ≥50 years (N = 9300) reported to the National Poison Data System, 2015–2021.

Methods

We first described increases in these exposures over time. We fitted generalized linear models for a Poisson distribution with a log link, one for cocaine exposures and the other for metamfetamine exposures, to examine associations of medical outcomes (major effects/death versus all others) with co-used other substances, controlling for exposure year and demographics.

Results

The number of exposures increased steadily during the seven years, but metamfetamine exposures increased more rapidly starting in 2018. One-fifth of cocaine and one-sixth of metamfetamine exposures suffered major effects/death. Co-use of prescription opioids (incident risk ratio = 2.00, 95% CI = 1.76–2.28 for cocaine; incident risk ratio = 1.62, 95% CI = 1.27–2.07 for metamfetamine), illicit fentanyl (incident risk ratio =1.88, 95% CI = 1.08–3.27 for cocaine; incident risk ratio = 2.05, 95% CI = 1.04–4.06 for metamfetamine), heroin (incident risk ratio =1.62, 95% CI = 1.37–1.90 for cocaine), or amfetamine (incident risk ratio =1.73, 95% CI = 1.28–2.33 for cocaine) was associated with a higher likelihood of major effects/death.

Discussion

Increases in the number of cocaine and metamfetamine exposures among older adults reported to poison centers are of concern, and so is the increased risk of major effects/death from polysubstance use, especially prescription and illicit opioids, among these illicit psychostimulant users.

Conclusions

Healthcare provider screening of individuals at risk of cocaine and/or metamfetamine use and psychoeducation about the dangers of these substance use are needed.

Keywords:

• Poison centers
• older adults
• cocaine
• metamfetamine
• opiates
• alcohol

Acknowledgements

America’s Poisons Centers made the National Poison Data System available to the authors for this study. The findings and conclusions reported are those of the authors alone and do not necessarily represent the official position of America’s Poisons Centers. 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.

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 content. 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 declare no conflict of interest.

America’s Poison Centers maintains the National Poison Data System (NPDS), which houses de-identified records of self-reported information from callers to the country’s Poison Centers. NPDS data do not reflect the entire universe of US exposures and incidences related to any substances. Exposures do not necessarily represent a poisoning or overdose, and America’s Poison Centers are not able to completely verify the accuracy of every report. NPDS data do not necessarily reflect the opinions of America’s Poison Centers.

Additional information

Funding

This work was supported by National Institute on Aging. 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.