Psychoactive substance use in elderly patients: Insights from the addiction in intensive cardiac care units (ADDICT-ICCU) study - 02/04/25

Doi : 10.1016/j.acvd.2025.02.007

Nabil Bouali ^a,^b, Othmane Benmansour ^c, Nathan El Bèze ^d,^e,^f, Antonin Trimaille ^g, Claire Bouleti ^b, Jean Baptiste Brette ^h, Guillaume Schurtz ⁱ, Pascal Lim ^j, Damien Millischer ^k, Amine El Ouahidi ^l, Trecy Gonçalves ^d,^e,^f, Emmanuel Gall ^d,^e,^f, Antoine Lequipar ^d,^e,^f, Manveer Singh ^d,^e,^f, Christophe Thuaire ^m, Nicolas Piliero ⁿ, Nathalie Noirclerc ^o, Stéphane Andrieu ^p, Charles Fauvel ^q, Jeremy Florence ^d,^e,^f, Clément Delmas ^h, Solenn Toupin ^d,^e,^f, Jean Guillaume Dillinger ^d,^e,^f, Patrick Henry ^d,^e,^f, Théo Pezel ^d,^e,^f,⁎
for the ADDICT-ICCU investigators
^a Department of Cardiology, centre hospitalier de Saintonge, 17100 Saintes, France
^b Department of Cardiology, Poitiers University Hospital, Clinical Investigation Centre (CIC) Inserm 1402, University of Poitiers, Poitiers, France
^c Centre de diagnostic et thérapeutique, hôpital Hotel Dieu, AP–HP, 75004 Paris, France
^d Department of Cardiology, Lariboisière University Hospital, AP–HP, université Paris Cité, 2, rue Ambroise-Paré, 75010 Paris, France
^e Inserm UMRS 942 “MASCOT”, Lariboisière University Hospital, 75010 Paris, France
^f Multimodality Imaging for Research and Artificial Intelligence Core Laboratory (MIRACL.ai), Lariboisière University Hospital, AP–HP, 75010 Paris, France
^g Department of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospitals, 67000 Strasbourg, France
^h Department of Cardiology, Rangueil University Hospital, 31400 Toulouse, France
ⁱ Department of Cardiology, Lille University Hospital, 59000 Lille, France
^j Intensive Cardiac Care Unit, Henri-Mondor University Hospital, 94000 Créteil, France
^k Department of Cardiology, hôpital Montfermeil, 93370 Montfermeil, France
^l Department of Cardiology, Brest University Hospital, 29609 Brest, France
^m Department of Cardiology, centre hospitalier de Chartres, 28630 Le Coudray, France
ⁿ Department of Cardiology, CHU de Grenoble-Alpes, 38130 Échirolle, France
^o Department of Cardiology, centre hospitalier Annecy-Genevois, 74370 Epagny Metz-Tessy, France
^p Department of Cardiology, hôpital Henri-Duffaut, 84902 Avignon, France
^q Department of Cardiology, CHU de Rouen, Inserm U1096, université Rouen-Normandie, 76000 Rouen, France

^⁎Corresponding author: Department of Cardiology, Lariboisière University Hospital, AP–HP, université Paris Cité, 2, rue Ambroise-Paré, 75010 Paris, France.Department of Cardiology, Lariboisière University Hospital, AP–HP, université Paris Cité2, rue Ambroise-ParéParis75010France

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 02 April 2025

Graphical abstract

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Highlights

•	Psychoactive substance use is common in elderly patients.
•	The psychoactive substance used most frequently by the elderly is benzodiazepine.
•	Recreational drug use in the elderly is also not uncommon (5%).
•	Differential patterns of substance use are seen in elderly and younger patients.
•	58% of elderly recreational drug users underdeclared their recreational drug use.

Le texte complet de cet article est disponible en PDF.

Abstract

Background

The United Nations has recently highlighted a global epidemic of psychoactive substance use among elderly people. Although several studies have established the important prognostic impact of psychoactive substance use in terms of cardiovascular events, the epidemiological characteristics of this consumption in elderly patients hospitalized in intensive cardiac care units (ICCUs) are not well established.

Aim

To assess the prevalence of psychoactive substance use in all consecutive elderly patients hospitalized in ICCUs from the Addiction in Intensive Cardiac Care Units (ADDICT-ICCU) trial. We described the epidemiological characteristics of this consumption to identify the consumption pattern in elderly and younger patients.

Methods

Systematic prospective screening for psychoactive substances was performed by a urine test (NarcoCheck®) in all patients admitted to an ICCU in 39 French centres from 7th to 22nd April 2021. The primary outcome was the prevalence of psychoactive substances, including recreational drugs (cannabis, cocaine, ecstasy, amphetamine, opioids) and psychoactive medications (benzodiazepines, methadone, buprenorphine, barbiturates, tricyclic antidepressants).

Results

Among the 1499 patients included in the study, 760 (51%) were elderly (≥ 65 years). Among the elderly patients, 157 (21%) tested positive for at least one psychoactive substance, 38 of whom (5%) tested positive for a recreational drug. The psychoactive substances most frequently detected were benzodiazepines (44%), followed by opioid substitution medications (42%) (methadone [24%] and buprenorphine [18%]), cannabis (18%), tricyclic antidepressants (9%), cocaine (7%) and opioids (3.2%). Multiple psychoactive substance detection was frequent (22% of positive patients). Compared with younger patients, elderly patients had a 3-fold lower cannabis consumption (18 vs. 53%; P<0.001), but a 2-fold higher benzodiazepine consumption (44 vs. 22%; P<0.001).

Conclusions

This study highlights the significant prevalence of psychoactive substance use among a large cohort of elderly patients hospitalized in ICCUs. Differential patterns of substance use were observed in elderly and younger patients.

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Keywords : Elderly, Psychoactive substance, Recreational drug, Recreative drug, Intensive cardiac care unit