21% of Elderly Cardiac ICU Patients Tested Positive for a Psychoactive Substance | Research

The takeaway

Among 760 elderly patients in French cardiac ICUs, 21% tested positive for at least one psychoactive substance, with cannabis detected in 18% of those testing positive, three times less than younger patients.

Cardiologists, geriatricians, ICU clinicians, public health researchers

21% of elderly cardiac ICU patients tested positive for at least one psychoactive substance

What the researchers found

Among 760 elderly patients (65+) in 39 French cardiac ICUs, 21% tested positive for psychoactive substances. Of those testing positive, benzodiazepines were most common (44%), followed by opioid medications (42%), cannabis (18%), tricyclic antidepressants (9%), and cocaine (7%). Elderly patients had 3-fold lower cannabis use than younger patients (18% vs. 53%) but 2-fold higher benzodiazepine use (44% vs. 22%).

Why it matters

Psychoactive substance use in elderly cardiac patients is rarely screened for and may interact with cardiac medications. This study reveals that one in five elderly ICU patients test positive, a prevalence that likely surprises most clinicians and suggests routine screening could improve care.

The numbers in context

1,499 total patients; 760 elderly (65+); 21% tested positive; 5% positive for recreational drugs; cannabis 18% of positives in elderly vs 53% in younger; benzodiazepines 44% in elderly vs 22% in younger; 22% of positive patients had multiple substances; 39 French centres

How the study worked

Systematic prospective urine screening (NarcoCheck) of all consecutive patients admitted to 39 French ICCUs over a 2-week period in April 2021. Both recreational drugs and psychoactive medications were tested.

What this study cannot tell us

Cross-sectional urine screening captures recent use only, cannot distinguish chronic from acute use, French healthcare context may not generalize, NarcoCheck sensitivity varies by substance, 2-week window in April 2021 may not be representative

How to read the evidence

Large multicenter prospective study with objective biological testing; strong methodology but limited to French cardiac ICUs over a 2-week window

When this study was published

Published 2025

The bigger picture

The shift from cannabis to benzodiazepines as the dominant substance in elderly cardiac patients reflects generational patterns but also raises its own concerns, as benzodiazepines carry significant cardiovascular and cognitive risks in older adults.

Questions still open

How does psychoactive substance use affect cardiac outcomes in elderly patients? Should routine substance screening be standard in cardiac ICUs? Is the lower cannabis rate in elderly patients changing as the legalizing-era generation ages?

Common questions

How common is substance use among elderly cardiac patients?

In this study of 760 elderly patients across 39 French cardiac ICUs, 21% tested positive for at least one psychoactive substance through urine screening, with 5% testing positive for recreational drugs.

Do elderly cardiac patients use cannabis?

Cannabis was detected in 18% of elderly patients who tested positive for any substance, about three times less than younger cardiac patients (53%). Benzodiazepines were twice as common in elderly patients.

Read the original research

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

Archives of cardiovascular diseases, 118(6-7), 356-364

View on PubMed ↗Publisher’s paper ↗

Citation

Bouali, Nabil; Benmansour, Othmane; El Bèze, Nathan; Trimaille, Antonin; Bouleti, Claire; Brette, Jean Baptiste; Schurtz, Guillaume; Lim, Pascal; Millischer, Damien; El Ouahidi, Amine; Gonçalves, Trecy; Gall, Emmanuel; Lequipar, Antoine; Singh, Manveer; Thuaire, Christophe; Piliero, Nicolas; Noirclerc, Nathalie; Andrieu, Stéphane; Fauvel, Charles; Florence, Jeremy; Delmas, Clément; Toupin, Solenn; Dillinger, Jean Guillaume; Henry, Patrick; Pezel, Théo. (2025). Psychoactive substance use in elderly patients: Insights from the addiction in intensive cardiac care units (ADDICT-ICCU) study.. Archives of cardiovascular diseases, 118(6-7), 356-364. https://doi.org/10.1016/j.acvd.2025.02.007