Not Your Usual “Drug Addicts”

A huge health problem facing the elderly is misuse of prescription painkillers. Senior citizens take 30% of all prescription medication but they make up only 12% of the population.  A recent study of Medicare recipients found that in 2011, about 15 percent were prescribed an opioid when they were discharged from the hospital; three months later, 42 percent were still taking the pain medicine.[i] In past 20 years, the rate of hospitalization among seniors that is related to opioid overuse has quintupled.[ii] Substance misuse by seniors remains “underestimated, underidentified, underdiagnosed, and undertreated.”[iii]

Older Americans and the Opioid Epidemic

A recent article in The Oregonian declared that Oregon was the state most likely to have seniors hospitalized for opiate misuse. “In 2012, Oregon providers handed out nearly 820,000 opioid prescriptions to those 65 and older. That jumped to 1.1 million in 2016, or 1.6 prescriptions per senior, according to the analysis of U.S. Census and state data.”^[iv] Oregon doctors pride themselves on being leaders in palliative care – anticipating, preventing and managing pain. They wrote prescriptions for pain relief virtually without a second thought. Then the statistics started rolling in and doctors had to rethink their position. Although there is currently no policies that target seniors, the state is working to address opiate misuse across the board. The CDC issued guidelines for use of opiates in palliative care that recognizes the special issues seniors face.^[v]

Senior Specific Treatment

“Elders are in a different stage of life and grew up in a time when having an addiction or mental illness received a great deal of stigma,” explained Nicole MacFarland, executive director of Senior Hope, Inc., an elder-focused outpatient substance use program in Albany, New York. She noted that seeking help or talking about trauma, substance use, or mental illness may even have been discouraged.[vi]

“Senior Hope offers small group elder-specific sessions that provide a comfortable space for attendees to discuss age-related or generational issues with peers. Professionals with expertise in geriatric substance use disorders lead the sessions.”[vii] Hazelden Betty Fold has a senior specific treatment program for Seniors called Recovery@50 Plus.  Accessibility is key – from wheelchair access to large print materials. “Facilitators are trained to talk more loudly and slowly, and to design group sessions to accommodate older adults’ needs.”[viii] As with many, if not most, people with substance use disorders, trauma is a constant for seniors with SUDs. It may be childhood trauma being dealt with for the first time or a new trauma based on a loss of purpose in life.

Drug reactions by the Aging Body   

As we age, alcohol and other drugs may have a very different effect on our bodies. A fit 40-year-old may behave differently when taking opioids than an 80-year-old in poor health. “Elderly adults taking opioid painkillers have 4 times as many bone fractures, are 68% more likely to be hospitalized and are 87% more likely to die as those taking over-the-counter pain medication,” according to the National Safety Council.

To make a truly informed choice about taking opioids, one must not only understand the risk and side effects but also that every patient has a right to refuse to take certain medications. An individual must also recognize that there is no extensive research on seniors and opioids. “Work with your doctor on a multifaceted approach to pain management, as recommended by the [American Academy of Neurology]. Cognitive-behavioral therapy and activity coaching have been very successful not only at lowering pain but increasing the ability to function.”[ix]

Ultimately the decision is up to the patient. Whether to take opioids needs to be viewed with a special perspective for seniors. We will all have many end-of-life decisions to face and this, it appears, is just another one for which we need to be prepared. For those who have already slipped over to a SUD, it’s never too late for treatment. Seniors do especially well in treatment and it should never be thought of as “too late” for recovery.

 

Footnotes:

[i] Jena, Anupam B., MD, PhD, et al., “Hospital Prescribing of Opioids to Medicare Beneficiaries,” JAMA Intern Med. (2016) 176(7): 990-997.

[ii] Owens PL (AHRQ), Barrett ML (M.L. Barrett, Inc.), Weiss AJ (Truven Health Analytics), Washington RE (AHRQ), Kronick R (AHRQ). Hospital Inpatient Utilization Related to Opioid Overuse Among Adults, 1993-2012. HCUP Statistical Brief #177. August 2014. Agency for Healthcare Research and Quality, Rockville, MD.

[iii] “Substance Use Among Older Adults,” SAMHSA/CSAT (TIP #26) (1998)

^[iv] Terry, Lynne, “Oregon leads U.S. in seniors hospitalized for opiates,” The Oregonian (July 10, 2017)

^[v] Dowell D, Haegerich TM, Chou R., “CDC Guideline for Prescribing Opioids for Chronic Pain – United States, 2016,”

[vi] Kuehn, Bridget M., “Substance Use Treatment for Older Adults,” SAMHSA (2015)

[vii] Id.

[viii] Id.

[ix] Robotti, Suzanne B., “Pain Docs Warn Against Opioids,” Medshadow (Jan. 13, 2015)