Examples of screening questions which may be useful: “Have you used street drugs more than five times in your life?”;“How many times in the past year have you used an illegal drug or used a prescription drug for non-medical reasons?”13


Little data exists relative to treatment of illicit substance abuse in the elderly. Complicating matters, substance abuse is frequently co-morbid with depression/bereavement, anxiety disorders, and adjustment disorders.12

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Family participation and history remain significant even into older adulthood, as does addressing negative influences in shaping patient outcomes.14

Other factors impacting treatment include15:

  • Elderly more prone to adverse psychotropic effects of abused substances and vulnerable to deliriogenic effects of certain treatments, e.g. opioids, sedative-hypnotics, and anticholinergics.
  • Physiologic changes relative to hepatic metabolism and renal clearance.
  • Elderly with underlying cognitive impairment (even mild) are more prone drug-induced delirium and more likely to have a prolonged recovery from an episode.


Illicit drug use in the elderly, both early-onset and late-onset, is growing. Clinicians should have a high index of suspicion relative to illicit substance use/abuse in the elderly. Ask proper questions and do appropriate testing, e.g. urine test. We need more data in this area and a reliable/validated screening tool. Overall, prompt detection and appropriate treatment can improve the quality of life of older adults and their families.

George T. Grossberg, MD, is Director of Geriatric Psychiatry in the Department of Neurology & Psychiatry at the St. Louis University School of Medicine


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