Release of First-Ever National Clinical Guidelines on Substance Use Disorders among Older Canadians

Published: January 21, 2020

Release of First-Ever National Clinical Guidelines on Substance Use Disorders among Older Canadians

Canadian healthcare providers now have the tools they need to better support the prevention, assessment and treatment of older adults at risk of, or living with, substance use disorders. The Canadian Coalition for Seniors’ Mental Health (CCSMH) officially launched 4 sets of Clinical Guidelines on Substance Use Disorders in Older Adults today.

According to the Honourable Deb Schulte, Federal Minister of Seniors “One in seven seniors has experienced a substance use disorder in their lifetime. The first-ever national guidelines will help us provide better care to Canadian seniors, as well as their families and caregivers, with valuable information that will enable them to make the best decision for their health. This is an important step forward in serving the healthcare needs of Canadian seniors.”

The presence of these disorders among older adults has been described as “an invisible epidemic” with special emphasis on the high risk for the aging baby boomer generation. The Guidelines, developed to provide healthcare providers with useful guidance on alcohol, benzodiazepine, cannabis and opioid use disorders among older adults are now available online at www.ccsmh.ca. The project was funded by Health Canada’s Substance Use and Addictions Program.

The development of each Clinical Guideline document was led by national working groups comprised of clinical and academic experts from the fields of seniors’ mental health, geriatrics, and substance use and addictions. Each working group included a person whose life has been directly impacted by a substance use disorder. The Guidelines all reflect the fact that older adults are much more vulnerable to the potential adverse effects of these substances and that most individuals are also taking a variety of prescribed medications and over-the-counter products which can result in dangerous interactions.

“The clinical recommendations made in each of these guideline documents were developed following a rigorous process including a thorough review and analysis of all relevant literature and a careful grading of both the quality of that evidence and the strength of each recommendation” says Dr. David Conn, project lead, Co-Chair of the CCSMH and Vice-President of Education at Baycrest. He emphasizes that “we are very hopeful these Guidelines will lead to the prevention of substance-related problems as well as to improved services for older adults who have developed a substance use disorder.”

Highlights from each Guideline Document

Canadian Guidelines on Alcohol Use Disorder in Older Adults
Alcohol is the most commonly used and misused substance among older adults. Alcohol Use Disorder (AUD) and risky alcohol consumption is common among older adults. In Canada rates of hospitalization entirely due to alcohol are highest in groups between the ages of 50 to 75.

Our Clinical Guidelines recommend Low Risk Drinking Guidelines for Older Adults that are 50% lower than those for adults under the age of 65. The Guidelines also make many other important recommendations on best practices for the screening, assessment and treatment of AUD in older adults.

Canadian Guidelines on Benzodiazepine Use Disorder in Older Adults
Benzodiazepine receptor agonists (BZRAs) are sedative-hypnotic drugs that are most often used to treat anxiety disorders and sleeping problems. They can lead to dependency and cause side effects including fatigue, impaired balance and falls and memory problems. These issues are of particular concern for older adults.

Despite wide-spread agreement that BZRAs should be avoided whenever possible in older adults, these medications continue to be frequently prescribed. Recent Canadian data suggest high rates of use persist among older adults, especially females, with 18.9% of older females reporting past-year use (Statistics Canada, 2016). The guidelines emphasize alternative non-pharmacological treatment approaches for the treatment of anxiety and insomnia and give advice on how to deprescribe these medications which generally requires gradual dosage reduction over many months to avoid severe withdrawal symptoms.

Canadian Guidelines on Cannabis Use Disorder in Older Adults
The baby boomer generation has a higher lifetime prevalence of use and past year use of cannabis than any previous generation of older adults. Despite a lack of empirical evidence, an increasing number of older adults are turning to cannabis in the hopes of coping with a variety of illnesses and symptoms such as chronic pain.

Recent legalization of non-medical cannabis use in Canada and subsequent increase in public interest among older adults, have driven the need for health professionals to be aware of the most recent research on the use of cannabis for medical and non-medical purposes. The guidelines emphasize the potential risks associated with cannabis use among older adults and highlight the urgent need for more research.

Canadian Guidelines on Opioid Use Disorder in Older Adults
In recent years, the opioid crisis has often made headline news in North America, however, the impact on older adults is often missed. In Canada, older adults are the group at greatest risk for opioid-related hospitalizations. Most opioid poisonings in older adults in Canada are accidental although intentional overdoses are not uncommon. The Guidelines provide advice on how to prevent Opioid Use Disorder by limiting the prescription of opioids in the treatment of acute and chronic pain. For older adults with Opioid Use Disorder the guidelines support the use of opioid maintenance treatment when required.

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