The story of the senior opioid abuse epidemic is one of a Molotov Cocktail- an unpredictable situation fraught with unstable components that could explode at any time. This elderly combustible cocktail sits right in the backyard of every physician practice, hospital, and emergency department. Neutralizing it is in everyone’s best interest.
The facts are striking, troubling, and part of a complex healthcare system trying to improve health for a rapidly increasing population of seniors. Big Pharma- and that means opioids- are smack dab in the middle of it. Although people aged 65+ comprise only 13% of the population, they account for about 1/3 of all medications prescribed in the US. One-third of people between the ages of 57 to 85 use at least 5 prescriptions. Few seem alarmed by the plethora of prescriptions floating around today. Perhaps opioid statistics will provide a window into how easily pain meds are prescribed: Since 1999 the amount of prescription opioids sold in the U.S. has nearly quadrupled, yet there has not been an overall change in the amount of pain reported.
Vulnerable seniors are on the receiving end of this tsunami of opioid prescribing. According to the Centers for Disease Control (CDC), adults 40+ are more likely to use prescription opioids than those aged 20-39. That’s important to note because national statistics show that nearly 13% of new illicit drug users began with prescription pain relievers.
Even low doses of opioids can lead to addiction, a fact that should remain central in the treatment of seniors. The CDC says that among patients who are prescribed opioids, an estimated 80% are prescribed low doses of a <100 mg morphine equivalent per day by a single practitioner and these patients account for an estimated 20% of all prescription drug overdoses. Another 10% of patients are prescribed high doses of a ≥100 mg morphine equivalent per day by single prescribers and account for an estimated 40% of prescription opioid overdoses.
At a time when they are becoming increasingly fragile, both physically and cognitively, seniors are faced with managing increasingly complex, long-term medication regimens that lead to unintentional misuse. The American Academy of Family Physicians echoes this concern saying, “It can be very challenging for even the most aware person to keep track of up to 30 different pills taken in one day – all at different times and in different doses.”
For people 85+, admissions related to prescription and illicit drug use grew 87% between 1997 and 2008. For those aged 65 to 84, admissions related to prescription and illicit drug use rose by 96%.
The Substance Abuse and Mental Health Services Administration (SAMHSA) says:
- The combination of alcohol and medication misuse has been estimated to affect up to 19% of older Americans.
- Approximately 25% of older adults use prescription psychoactive medications that have a potential to be misused and abused, and they are more likely to take them for longer periods of time than younger adults.
If the prescribing of opioids and other prescriptions to the senior population were to remain static, the problem would still grow by virtue of a burgeoning population. According to the latest information available from the CDC:
- In 2010, there were 40 million people aged 65+, 13% of total population.
- By 2030, those aged 65+ will number nearly 20% of the US population.
- The 80+ population is projected to increase by 44% between 2030 and 2040
- As for the “Super Old”, those aged 85+, the US census bureau predicts that population could grow from 5.5 million in 2010 to 19 million by 2050.
What are physicians to do in light of this senior opioid abuse epidemic? Can they deny these looming numbers?
Bookmark these pages from the CDC and consider them indispensable guides as you move to manage opioid therapy:
- CDC Injury Prevention and Control: Opioid Overdose
- Know about PDMPs: A prescription drug monitoring program (PDMP) is an electronic database that tracks controlled substance prescriptions. PDMPs can help identify patients who may be misusing prescription opioids or other prescription drugs and who may be at risk for overdose.
- Be acutely aware of State-to-State Variability in Prescribing Opioids and how it may affect your patients.
- Are your patients impacted by pill mills? In 2012 providers in the highest-prescribing state wrote almost 3 times as many opioid painkiller prescriptions per person as those in the lowest prescribing state. Obviously, pain does not vary that much from state to state so what is behind that variance? Many states report problems with for-profit, high-volume pain clinics (so-called “pill mills”) that prescribe large quantities of painkillers to people who don’t need them medically.
- Know the impact of opioids on senior patients. Once again the newly released CDC Guide provides detailed information on age-related changes in patients aged 65+. These can include reduced renal function and medication clearance, and a smaller therapeutic window between safe dosages. Older adults might also be at increased risk for falls and fractures related to opioids.
A growing senior population with co-morbidities and dementia that is using prescription medications, opioids, and alcohol is indeed a Molotov Cocktail on healthcare’s doorstep. The only hope of reducing it to smoldering ashes is for each physician to take an aggressive stance toward the prescribing and management of opioid therapy, staunchly refusing to be beholden to Big Pharma or patient pressure for unrealistic opioid use.
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About the Author Deborah Chiaravalloti is an award-winning writer and former hospital executive. Her insider experience helps healthcare clients launch medical procedures, products including artificial intelligence software and knowledge sharing platforms. Deborah writes websites, blogs, opinion pieces, and marketing strategy for elder care, health care consumerism, revenue cycle management (RCM), and the business of healthcare. Her printed pieces have been published and her radio shows syndicated nationally. Deborah is a lead consultant for Upwork where she is ranked in the Top 10% of 2 million Upwork writers.