Drug abuse among people over 65 year olds is a hidden and growing problem globally, international experts say, and worrying trends are emerging among New Zealand's older people too.
According to the International Narcotics Control Board, which recently issued its annual report, drug use among older adults is a 'epidemic', and there has been an increase in the misuse of pain relievers, sedatives and tranquilisers.
Dr Andy Towers from the School of Health Sciences at Massey University talked with Sunday Morning about the trends in New Zealand and said a growing problem was the assumption people over 65 don't touch drugs; "Which simply isn't the case".
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Listen to the full Sunday Morning interview here
"There's not a lot of data either in New Zealand or worldwide on rates of self-medication, rates of prescription medicine misuse, or even rates of illicit drug use in people over 65. What we do know is based on a lot of evidence from things like emergency department reviews, we've seen an increase over the last 10 to 15 years not only in alcohol use in people over 65 as a reason for injuries and concerns, but also the [same concerns for those using] prescription medications.
"Worldwide... one of the reasons we have a rising concern about the rate of drug use and misuse in older adults, is because we have a baby boomer generation which is moving into the older adult range, 65 plus. It's not that we suddenly have people that are 80 or 90 who are suddenly starting to use cannabis or fentanyl, it's actually the baby boomers who are retiring, that have been using drugs.
"They basically popularised drugs in the 60s and 70s, and they're still using them now, but now they're much older."
Dr Andy Towers, Massey University Photo: Supplied
"There are increasing instances of alcohol misuse and dependence, and other drug use in retirement settings, retirement villages. And some of the people that are managing these retirement settings have asked 'how do we deal with that?'. This is not something we've had to do with before... and we don't have a playbook for dealing with that.
"There are people that both use and deal in drugs that are over 65. We know that people who've been dealing drugs are now retiring, so they're in these settings, and they're potentially dealing drugs as well.
Earlier this month a man in his 70s was arrested for importing liquid cocaine.
"And don't discount that alcohol is one of our most harmful drugs, but also our most popular drug," Towers said.
Data collected in 2015 in conjunction with the NZ Health Promotion Agency has shed some light on this:
"We know 40 percent of New Zealanders aged 50 plus are hazardous drinkers. They're drinking at a level that either they're bingeing every time they drink alcohol, or they're not necessarily having that much but they're having enough alcohol on enough days to raise their likelihood of getting things like cancer or heart disease or diabetes; that's quite high.
"We know we're probably leading the world in the numbers of adults 50 plus drinking hazardously. That's not a good record for New Zealand to hold."
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Cannabis was also in regular use in this age group, he said.
"Cannabis is our second-most commonly used drug, and it's very popular. In the Massey University New Zealand Health, Work and Retirement study, since 2006... cannabis use is around about 13 percent of our population aged 50 plus.
"They say they do use cannabis either monthly, weekly or daily. That's not far off the national average of 16 percent, that the NZ Health Survey says.
"It's not that cannabis use is unique to younger populations, it's everywhere. Cannabis actually has relatively much lower harms than alcohol, so I'd be more concerned at the moment that people aged 50 plus are using alcohol, and some are using alcohol a lot."
One of Towers' biggest concerns is indications of a rising tide of the use together of alcohol and prescription medication.
"It's people using medications prescribed by their doctors... some of those prescription medicines, alcohol can make significantly worse, so they can actually make the condition worse, or they can actually send you into overdose.
"Something like 30 percent of alcohol users in... New Zealand aged 50 plus are also taking medications that interact with alcohol. That's a serious concern. And for the most part they're not even necessarily aware that that's a harm for them."
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Towers said dealing with the underlying problems was complex.
"There are many, many different reasons for using drugs, and that's what we should be concerned about; why you're using the drug, not necessarily the drug that you're using.
"There are any number of reasons to take drugs... and it's not just to numb pain, it could just be to relax. Things like cannabis, is very well known to have a relaxing effect, and it's a recreational drug just like alcohol is. And we have to be really clear that whether a drug is illegal or legal, they all have effects that people use them for - it doesn't matter whether you're 18 or 80."
"Some of them use cannabis to take away the pain of chronic health conditions, or people use alcohol recreationally to be with other people, and others use it to numb themselves from trauma. So we can't lump every drug user into one group."
The 20th and century had not shaped a healthy approach to drugs, he said.
"We're currently in one of the most conservative policy and legal approaches to drugs ever, and it hasn't been pretty."
In 1918 legislation was passed so New Zealand bars had to close at 6pm, it lasted until 1967: "It shaped New Zealanders as binge drinkers... there were a lot of harmful outcomes of that, including generation on generation taught that binge drinking was the way to drink alcohol," Towers said.
"I don't think we've ever had a happy relationship, particularly with alcohol, but with drugs in general, in New Zealand. So, for people [now] to say 'it wasn't like that in my time', they clearly don't understand, they've never seen the data... it's always been harmful."
Towers said a 2017 UK report titled Calling Time shed light on ageism in mental health addiction services, and called for more access to age-appropriate services for those over 65, and many of the findings were applicable here, too.
"It said: we know there's a rise in older adults using both legal and illegal drugs, and some of them becoming dependent and needing support. But ... primary healthcare professionals tend not to screen for drug use in older adults - in general we don't assume that older adults don't use drugs.
"So, at the first step they're not being seen as drug users, and... if they are, we don't have referral pathways for older adults. A lot of our health and addiction services are actually set up for youth, and when you put older adults into those services it doesn't necessarily work for them as well.
"So, we have these ageist approaches that don't recognise that older adults need help, and we don't have the support there that's catering for them."