As the nation grapples with a devastating opioid epidemic, concerns have primarily focused on young people buying drugs on the street. But America’s elderly also have a problem, according to a report from Kaiser Health News (KHN). During the past several decades, physicians have increasingly prescribed pain medications to seniors to address chronic pain from arthritis, cancer, neurologic diseases, and other illnesses that become more common in later life.
A study published in July in JAMA Internal Medicine found that, in 2011, 15% of Medicare beneficiaries were prescribed an opioid when they were discharged from hospitals; three months later, 43% were still taking the pain medication.
One in three Americans who have taken prescription opioids for at least two months became addicted to or physically dependent on the medications, according to a recent Washington Post–Kaiser Family Foundation poll.
It’s no surprise, then, that some seniors end up addicted, the KHN article says.
In 2009, the American Geriatric Society (AGS) came out strongly in favor of opioids, recommending that seniors with moderate-to-severe pain be considered for opioid therapy. The panel cited evidence that seniors were less likely than others to become addicted.
The problem is that chronic pain is common as people age, and there aren’t many good options to treat it. Even aspirin and ibuprofen carry bleeding risks. The 2009 AGS guidelines are no longer in use, but opioid medications remain a crucial tool to treat pain in older people. Most people are able to take opioids in small doses for short periods without a problem.
“We really don’t use opioids necessarily as the first line of treatment because we understand what the risks are. But we also don’t want to see our patients suffering needlessly if we can provide them with relief,” said Dr. Sharon Brangman, past president of the AGS. The trick, she said, is to try nonpharmacological options, such as acupuncture, first and to use the smallest effective opioid dose possible, if necessary.
According to a report issued in August 2014 by the Agency for Healthcare Research and Quality, the rate of hospitalizations related to opioid overuse among seniors has quintupled, but relatively few seniors end up in rehab. That’s due to a combination of factors, according to Dr. Mel Pohl, medical director of the Las Vegas Recovery Center.
“They’ve grown up in an era where drug addiction and alcoholism [were] evil, and I think that’s internalized for some of the folks that I’ve seen,” he said, so they don’t seek help, particularly from an inpatient facility. Another problem is patients whose addictions have been misdiagnosed as dementia.