Ag­ing & ad­dicted

The opi­oid epi­demic af­fects older adults, too

The Progress-Index - - HEALTH - By Jenny Gold

It took a lot of con­vinc­ing for John Evard to go to re­hab. Seven days into his stay at the Las Ve­gas Re­cov­ery Cen­ter, the nau­sea and aching mus­cles of opi­oid with­drawal were fi­nally be­gin­ning to fade.

“Any sweats?” a nurse asked him as she ad­justed his blood pressure cuff. “Last night it was re­ally bad, but not since I got up,” replied Evard, 70, ex­plain­ing that he’d awak­ened sev­eral times with his sheets drenched.

Even for him, it was hard to un­der­stand how he ended up 300 miles away from his home in Scotts­dale, Ariz., at this bu­colic fa­cil­ity in the suburbs of Ve­gas. “This is the ab­so­lute first time I ever had any­thing close to ad­dic­tion,” he said. He prefers to use the term “com­plex de­pen­dence” to de­scribe his sit­u­a­tion: “It was, shall we say, a big sur­prise when it hap­pened to me.”

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. Over the past sev­eral decades, physi­cians have in­creas­ingly pre­scribed se­niors pain med­i­ca­tions to ad­dress chronic pain from arthri­tis, can­cer, neu­ro­log­i­cal dis­eases and other ill­nesses that be­come more com­mon in later life.

A re­cent study found that in 2011, 15 per­cent of se­niors were pre­scribed an opi­oid when they were dis­charged from the hospi­tal; three months later, 42 per­cent were still tak­ing the pain medicine.

One in three Amer­i­cans who have taken pre­scrip­tion opi­oids for at least two months say they be­came ad­dicted to or phys­i­cally de­pen­dent on the med­i­ca­tions, ac­cord­ing to a re­cent Washington Post-Kaiser Fam­ily Foun­da­tion poll. (KHN is an ed­i­to­ri­ally in­de­pen­dent pro­gram of the foun­da­tion.)

It’s no sur­prise, then, that some se­niors end up ad­dicted.

Evard spent his life work­ing as a cor­po­rate tax at­tor­ney. He’s spry and white haired, with a con­ta­gious grin. A few years ago he and his wife re­tired to Arizona with their eyes on the golf course. The dream didn’t last long. Just months later, a virus infected Evard’s left ear. Overnight, he lost half his hear­ing and was left with chronic pain. In Jan­uary, he had surgery to fix the prob­lem.

“From the sur­geon’s stand­point, the op­er­a­tion was suc­cess­ful. The prob­lem was, the pain didn’t go down. It went up,” he re­called.

His doc­tors pre­scribed opi­oids. “They de­creased the pain, par­tic­u­larly at first,” said Evard. “As time went on they had less and less ef­fect, and I had to take more and more.”

As the doc­tors in­creased his dosage, Evard’s once ac­tive life fell apart. He was con­fused, de­pressed, and still in pain. He couldn’t think of any­thing ex­cept the pills and when he could have the next one. He knew he was in trou­ble — de­spite hav­ing taken them ex­actly as his doc­tor in­structed.

“I was a rule-fol­lower,” he said. “And I still ended up in a mess!”

In 2009, the Amer­i­can Geri­atric So­ci­ety 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.

“You don’t see peo­ple in this age group steal­ing a car to get their next dose,” Dr. Bruce Fer­rell, chair­man of the panel that is­sued the So­ci­ety’s guide­lines, told The New York Times at the time.

Mel Pohl, med­i­cal di­rec­tor of the Las Ve­gas Re­cov­ery Cen­ter, called that con­clu­sion a “hor­ri­ble mis­con­cep­tion.”

“There’s no fac­tual, sci­en­tific ba­sis for that. The drug takes over in the brain. It doesn’t mat­ter how old the brain is.”

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 of time 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 non-phar­ma­co­log­i­cal op­tions such as acupunc­ture first and to use the small­est ef­fec­tive opi­oid dose pos­si­ble, if nec­es­sary.

Still, most of the se­niors at the Las Ve­gas Re­cov­ery Cen­ter have taken the drugs as pre­scribed by a will­ing doc­tor try­ing to ad­dress their pain, said Pohl. That pat­tern sets them apart from many of the younger pa­tients, many of whom start buy­ing drugs on the black mar­ket after be­ing turned away by physi­cians.

None­the­less, in the past 20 years, the rate of hos­pi­tal­iza­tion among se­niors that is re­lated to opi­oid overuse has quin­tu­pled. But rel­a­tively few of them end up in re­hab. Pohl said that’s due to a com­bi­na­tion of fac­tors.

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