Addiction in older adults 

While significant progress has been made in reducing substance use among youth, as highlighted by the National Institute on Drug Abuse, addiction among older adults remains a critical and under-recognized issue. 

Tobacco and opioid use in older populations 

Tobacco smoking, for instance, persists among nearly 30 million adults in the United States, predominantly those aged 45 and older. Unlike the reductions seen for younger age groups, smoking prevalence among adults 65+ has remained unchanged for two decades. For some groups, such as those living below the federal poverty line, it has actually increased from 13% to 15.8% between 2011 and 2022. Similarly, fatal opioid overdoses have disproportionately impacted adults 55 and older, especially Black Americans, revealing a “silent epidemic” that demands our attention.  

Further troubling is that tobacco and other addictions often co-occur, with one systematic review estimating that approximately 80% of people in addiction treatment smoke cigarettes compared to 30% of matched population samples. An older adult who survives an opioid overdose but continues to smoke is likely to face years suffering and early death from tobacco-related diseases that are diagnosed in older age (e.g., lung cancer and chronic obstructive pulmonary disease). Yet, the representation of older adults in addiction research remains woefully inadequate—less than 1% of studies in leading aging and addiction journals address this population. And estimates suggest that only around 25% of addiction treatment programs have services tailored to the needs of older adults. 

Embracing age-friendly care 

Recently, the “5 Ms” framework for age-friendly care has been proposed as a critical element of addressing the needs of older adults living with addiction with a focus on five elements of patient needs: Matters Most, Medications, Mind, Mobility, and Multicomplexity.6 Principles of addiction medicine, including patient-centered care, medication-based treatment, and harm reduction, align well with the 5Ms. Harm reduction principles are specifically important for patients who may not be interested or able to completely quit their substance use. For example, making sure patients at risk of opioid overdose have access to naloxone. Or working with patients who smoke tobacco to reduce their smoking or switch to lower harm, smoke-free products, if complete abstinence isn’t feasible.   

Attending to older populations 

Older adults using substances deserve tailored research and treatment approaches that acknowledge their unique vulnerabilities and lived experiences. These needs include increased likelihood of multimorbidity and a higher level of dependence on substances. Over 550,000 people die each year due to tobacco and opioid-related causes—most of them older adults from historically marginalized groups. Without addressing these realities, the health disparities will only deepen as the global older adult population doubles in the next 25 years. These staggering numbers highlight the need to expand our focus beyond youth and recognize addiction as a lifelong issue. 

This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.