Old age is getting younger.
For the second year in a row, the life expectancy in the United States declined according to a recent bleak series of reports by various government agencies — marking a trend that hasn’t been seen here since World War I. One prime reason cited: the misuse of opioids commonly prescribed to address chronic pain.
And many experts say seniors stand to be hardest hit by opioid abuse and addiction due to a number of factors unique to the aging population, including:
- Polypharmacy — use of a number of medications at the same time, commonly prescribed to treat pain and other symptoms caused by arthritis, cancer, and neurological diseases;
- Multiple comorbidities — occurrence of two or more diseases at the same time, common in nearly 70% of the Medicare population;
- Cognitive, language, and hearing obstacles that impede understanding of proper use and dosages;
- Decreased metabolism due to decreased activity, muscle loss, and less effective chemical processing within the body; and
- Underlying issues such as depression and anxiety, unaddressed trauma, physical and social isolation and loneliness, grief and many kinds of losses — including losses of purpose, people, and prestige.
Opiates, naturally derived from the poppy plant, have been used for centuries, both to produce euphoria for recreation and as medicine to alleviate pain and other symptoms. Through time, savvy manufacturers and home chemists were able to produce copycats with similar structures for mass marketing. The versions modified by synthetic and semi-synthetic processes are technically referred to as opioids — and have become the source of much debate and handwringing of late.
Congress cracked down hard on one permutation by passing the Anti-Heroin Act of 1924, making it illegal to import or possess opium to be chemically synthesized into the narcotic known as diamorphine, or heroin. Heroin is still in use, however, often smuggled in from other countries. An estimated 80% of heroin users first misused prescription opioids.
Newer incarnations of opioids have been formulated since then — and today, many of them are commonly prescribed for older patients. They include:
- Oxycodone (common brand names: OxyContin, Percocet, Roxicodone)
- Hydrocodone (Vicodin, Hysingla. Zohydro)
- Morphine (Kadian, Avinza, MS Contin)
- Fentanyl (Actiq, Duragesic, Sublimaze)
- Carfentanil — a powerful drug also used as a tranquilizer for large animals, and
- Sufentanil (Dsuvia, Sufenta) — frequently singled out as dangerous due to its current high street value.
These drugs do not actually stop pain, but reduce a person’s perception of pain by acting on receptors in the body. In some cases, opioids can be an essential part of a plan to manage pain, and may be especially helpful in hospice care, which is usually highly monitored and limited in time.
The Downside of the Upside
But opioids can also be highly addictive, causing dependence in some patients in as little as a week. They can also be deadly — especially when taken in combination with some types of other drugs or with alcohol. Every day, more than 130 people in the U.S. die from opioid overdoses, according to the National Institute on Drug Abuse. And that dire news shows no signs of abating: Deaths attributed to opioids were nearly six times greater in 2017 than they were in 1999.
In addition to aggressive tactics by drug manufacturers, the push to purchase has come from some unlikely sources. In 2009, for example, the American Geriatric Society encouraged doctors to use opioids to treat moderate to severe pain in older patients, citing evidence that they were less susceptible to addiction. Years later, the group backtracked on that advice, urging frequent patient monitoring and reduced dosages. But many doctors didn’t seem to get the retracting memo.
In recent years, concern has mounted about the use and abuse of opioids, especially by older people. One clarion call that caught the eye of the general public was a special report, “The Opioid Menace!” published last year by the AARP. It contained the sobering statistics that:
- In 2015, doctors prescribed opioids to almost one-third of all Medicare patients — nearly 12 million people;
- That same year, 2.7 million Americans over age 50 abused painkillers, taking them beyond the prescription limits; and
- In the last two decades, the hospitalization rate due to opioid abuse has quintupled for those 65 and older.
Medical and social policy experts cop to concerns, too. “We overestimated the benefits of opioids and underestimated the risks,” admitted Deborah Dowell, senior medical adviser at the Centers for Disease Control and Prevention (CDC). “We assumed without adequate evidence that they would work as well long term as they did in the short term.” The CDC recently issued guidelines urging doctors to drug test patients prescribed opioids, both before and during the drug regimen, which it recommended limiting to three days.
And in August of 2016, then-Surgeon General Vivek Murthy wrote what was heralded as an historical letter urging doctors to help solve the epidemic of the opioid crisis. It began: “I will never forget my own patient whose opioid use disorder began with a course of morphine after a routine procedure.” He then urged them to correct the mistake: “Nearly two decades ago, we were encouraged to be more aggressive about treating pain, often without enough training and support to do so safely. This coincided with heavy marketing of opioids to doctors. Many of us were even taught — incorrectly — that opioids are not addictive when prescribed for legitimate pain. The results have been devastating.”
But many doctors didn’t get that memo either — or ignored it. A recent survey by the National Safety Council found that 99 percent of physicians prescribe opioids beyond the recommended limits.
If you or an older person you care for is prescribed opioids, there are a number of commonsense steps you might consider.
Try alternative treatments first. Non-opioid alternatives used to treat pain and other symptoms may include acupuncture, guided imagery, behavioral therapy, massage therapy, aromatherapy, chiropractic therapy, and medical marijuana.
Understand pain management. Talk to the healthcare provider openly about goals and expectations for managing pain and the potential personal risks and benefits of available treatments.
Go low and slow. If you do undertake an opioid regime, start at a low dose; experts recommend about 25-50% of the dose given to younger patients.
Take them properly. Heed the advice not to exceed the dosage or frequency prescribed, and avoid drinking alcohol and taking other contraindicated medications in tandem such as muscle relaxants and hypnotics.
Store and dispose of them carefully. Store opioids in a secure place, and do not sell or share your prescription, which is a violation of federal law. When finished with your treatment, be sure to dispose of any unused drugs safely and properly.
Get help. If you have questions, or suspect abuse or addiction, call the Substance Abuse and Mental Health Services Administration national helpline at 800-662-4357; this confidential service operates 24/7, every day of the year.