The flower elders

Many born in the 50s continue to use drugs as a way of life

By Peter Brown

The mocking image of grandparents spending their time on rocking chairs, passing a joint between them and reminiscing about their marijuana-fueled youth in the Haight and Ashbury neighborhood of San Francisco, perhaps derives its origin from the subversive imagination of R. Crumb, the underground cartoonist of the 60s. But in fact, three researchers from the US National Institute on Drug Abuse found that this image is not funny.

Gayartri J. Dolling, Susan R. B. Weiss and Timothy P. Condon reported in the Journal of Neuropsychological Pharmacology on a study they conducted among the children born during the "Baby Boom" period, the great wave of births after World War II. They found that many of them, accustomed for a long time to use illegal drugs for pleasure or to treat any disease that attacks them, continue their love story with drugs even in their old age. And medicine is only now beginning to assess the consequences of this.

The "baby boomers" born between 1946 and 1964 make up 29% of the US population today. This "hump" in the age distribution curve will swell by 2030 the age group above 65 to 71 million people. In the 60s, members of these cohorts were known to be using illegal drugs at a significantly higher rate than previous generations. In the past, researchers were convinced that with the passage of time the flower children would "get over it" and stop using intoxicating drugs. Very little evidence shows that this is actually happening today.

Doling and her colleagues examined hospital records that recorded the number of patients over the age of 55 who went to the emergency room and mentioned that they were using various drugs. The number of mentions of the drug cocaine increased from 1,400 in 1995 to almost 5,000 in 2002, an increase of 240%. Similarly, mentions of heroin increased from 1,300 to 3,400 (160%), marijuana from 300 to 1,700 (467%) and amphetamine from 70 to 560 (700%).

Data from the American National Survey on Drug Use and Health confirm this trend. In 2002, 2.7% of adults aged 50 to 59 admitted to illegal drug use at least once during the previous year. In 2005 their rate rose considerably to 4.4%. Reviewers attribute the increase to the aging of the flower children, the lengthening of life expectancy and the tendency of people to persist in the old patterns of drug use even as they age. This trend will greatly burden the health care system: according to one estimate, the number of adults over the age of 50 who will be treated for drug use will increase from 1.7 million in 2000 and 2001 to 4.4 million in 2020.

Most of all, Dowling and her colleagues are troubled by the effect of drug use on the brain. The most affected systems are those related to the neurotransmitters dopamine, serotonin and glutamate. All three systems change with age. The ability of the receptors to bind to dopamine, for example, decreases with age, a decrease that often results in impaired motor and cognitive function. Cocaine users have symptoms similar to those of the elderly, so elderly people taking cocaine may increase the damage to their brains.

It is interesting to discover that the cannabinoid system in the brain, on which marijuana works, reduced the alcohol dependence of aging mice that underwent a genetic change that made them crave the drink. As the mice got older, the cannabinoid receptor bound less often to a particular protein, and this likely reduced the mouse's attraction to alcohol. It is not known how aging affects the cannabinoid system in humans, but it has a wide-ranging effect on appetite, memory, addiction and the perception of pain and pleasure.

Aging also changes the rate of metabolism, and especially the processes in which the drug is absorbed, dispersed in the body, undergoes chemical changes and is eliminated. Doling and her colleagues believe that these changes could lead to "devastating consequences" due to alcohol consumption, drug abuse or illegal drug use. As the aging body becomes emaciated, the water content decreases and the kidneys become less efficient. The concentration of the drug in the blood therefore remains high for a much longer time than in a young person. This increases the danger of unwanted interaction of different substances remaining simultaneously in the blood in high concentrations.

It is difficult to assess the increased health hazards associated with drug use due to the ethical difficulty imposed on doctors. If the patient reports drug use, the doctor should include this in the medical file due to the possible effects this has on future treatment. But even though the law protects privacy, many doctors hesitate to take this route, because they fear legal or insurance entanglement. For these reasons (and perhaps others as well), medical teams avoid asking their patients about drug use, state Doling and her colleague. Serious medical problems may therefore go untreated.

Although the effects of drugs on older people can be hypothesized, little has been systematically studied. The lack of attention stems directly from the traditional and incorrect assumption, as demonstrated now, that old people do not consume drugs, especially not illegal drugs. But the Americans may soon discover that the problem is much more difficult than they thought until now.