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Subspecialties Comprehensive, Health Economics and Policy

A Rough Deal

Sight loss and vision impairment is associated with increased risk of reaching for controlled substances and developing substance use disorder (SUD). With societies growing older, increasing numbers of older adults live with visual impairments for longer, it has been assumed that psychoactive substance use has increased; now, a team of researchers from the University of California, San Diego, and the New York University Grossman School of Medicine in New York, USA, have attempted to estimate the prevalence of substance use among middle-aged and older visually impaired patients in the US (1). 

Data from almost 44,000 of noninstitutionalized respondents aged 50 or older who reported serious difficulty seeing, even when wearing glasses, recorded by the National Survey on Drug Use and Health between 2015 and 2019, were analyzed for reported misuse of prescription opioids, sedatives, stimulants, and tranquilizers, and use of cannabis and cocaine. Prevalence of alcohol use disorder and nicotine dependence was also measured in this cohort. Women made up the larger part of the sample, at 53.2 percent, and 44.4 percent of the analyzed patients were older than 65 years. Just under 6 percent of the sample of over 50-year-olds were estimated to have a serious impairment impacting their sight. 

What did the study find? After accounting for age, sex, ethnicity, marital status, income, and presence of two or more chronic diseases, results shower a clear correlation between visual impairment and higher prevalence of cannabis and alcohol use, opioids and tranquilizer misuse, and nicotine dependence in the previous year. 

Sight loss among older adults is associated with an increased risk of isolation (2), which can lead to depression and irregular substance use. There is a risk that visual impairment coupled with intoxication can lead to injuries, as well as exacerbation of existing chronic conditions. Can anything be done to reduce the potential impact of this link? Screening for mental illness and substance use among adults suffering from sight loss could be an important first step in addressing the issue. 

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  1. BH Han et al., JAMA Ophthalmol, [Online ahead of print] (2021). PMID: 34762104.
  2. CE Coyle et al., J Aging Health, 29, 128 (2017). PMID: 26762396.
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