Opening the Conversation about Opioids & Older Adults
People of all ages, genders, races, and income levels fall victim to the opioid crisis. Older people in our community are no exception. People in their 60s, 70s, 80s, and beyond are filling opioid prescriptions at a rising rate, and increasingly running into trouble.
At a convening hosted by Public Health—Seattle & King County on September 30, 2019, community members and providers discussed the impacts of the opioid crisis on older adults and looked to solutions.
One in three Medicare Part D beneficiaries received a prescription opioid in 2016
Older adults are frequently prescribed opioids to cope with painful, chronic conditions—one in three Medicare Part D beneficiaries received a prescription opioid in 2016. Yet, research shows that opioids’ effectiveness in providing pain relief is mixed and that older adults may suffer from side effects and develop dependence. Across the United States, older adults have the fastest growing rate of opioid use, opioid-related hospital visits, and opioid-related deaths.
Local data from the King County Medical Examiner’s Office echo these trends:
- Rates of opioid-related deaths among 65-74-year-olds have increased sharply since 2011.
- Suicide deaths involving opioids are highest among 60+ year-olds and increased sharply since 2017.
These statistics are deeply personal for many. King County Council Member and King County Board of Health Chair Jeanne Kohl-Welles opened the convening with a heart-felt reflection on her mother’s experience.
“The medications she was taking changed her behavior. Whereas before she was animated and engaged, over a quick period of time, she began to withdraw. We would all be having a conversation and I would look over at her and see her head dropping.”
Councilmember Kohl-Welles believes that her mother’s dependence on multiple opioid prescriptions eventually contributed to her rapid decline and death.
Cathy MacCaul, Advocacy Director at the Washington State Office of AARP, told a similar story.
“My mom was prescribed opioids to address chronic pain associated with a life-long battle with scoliosis, and that is when things started to go downhill.” Cathy was quick to recognize the signs of misuse and intervened. “When we got Mom off the meds by choosing physical therapy, she soon got back to her routine of walking a mile a day and her vibrant personality returned.”
Tough decisions for treating chronic pain
Determining whether or not an opioid prescription is the right approach for a patient is a complex decision for providers, patients and family members. Dr. Mark Sullivan, Psychiatrist at UWMC Center for Pain Relief and Regional Heart Center, asked the group to consider a hypothetical example:
Sabina is an 82-year-old woman with low back pain. She shares with her health provider that over the past month, her pain has become more constant and severe. She reports cutting back on exercising, volunteering work, and dancing that she has been doing for years.
Her provider diagnoses her with spinal stenosis. Neither Sabina nor her provider believe surgery is a good treatment due to the risks posed by her advanced age.
Sabina’s provider asks whether she would be interested in a prescription for hydrocodone to treat her pain and allow her to pursue activities that are important to her. She doesn’t know what to say. She is bothered by the pain but afraid of addiction and falling and worries that the medicine might not work later “when I really need it.”
Navigating when to take opioids and when to abstain is challenging for providers and patients. Studies are mixed on the extent to which opioids are effective in addressing chronic pain in older adults. There is evidence that some patients will transition to chronic use or dependency.
At the end of the day, people like Sabina need to carefully evaluate the potential risks and benefits, think about what they love to do and what they want to avoid, and make an informed choice.
Seeking help for older adults
When opioid use becomes misuse, it’s not always clear where to turn for help. Victor Loo, from Asian Counseling and Referral Services, shared that his organization offers a Wellness and Wisdom Program that provides treatment and support for older adults age 60 and older with substance use disorders. Medicaid case managers from the Aging and Disability Services have successfully referred people to this program since 2015.
The challenge is that most behavioral health agencies do not have this type of tailored approach for older adults. Interventions such as Medication Assisted Treatment and overdose-reversing drugs such as Naloxone have not yet been adopted and embraced for older adults in the same way that they have for younger generations.
Getting to solutions
What can be done to prevent opioid misuse among the older population? Several ideas were discussed at the convening:
- Provide patients and families with better tools to make informed decisions about opioid use and to recognize the signs of misuse.
- Expand access to alternative methods to address chronic pain, such as physical therapy, and the Program to Encourage Active, Rewarding Lives (PEARLs), which addresses loneliness and depression.
- Provide training to aging services providers about opioid misuse and where to refer people to get the help they need.
- Understand the needs of people with opioid dependence who are admitted to institutional settings such as adult family homes and skilled nursing facilities.
- Encourage people not to hold on to their meds—make safe medicine return convenient and easy for older people, including those with limited mobility.
There is no single solution to solving the opioid crisis. Deepening our understanding of how different, specific populations are uniquely impacted and developing tailored approaches is an essential ingredient for long-term success. PHSKC looks forward to partnering with attendees to further support older adults and their families.
Recovery Hot Line: For help finding recovery resources, including a referral for behavioral health or medicine to treat opioid use disorder, call 866-789-1511 (open 24/7/365) or text M–F 9 a.m.–9 p.m.
Take Back Your Meds: Any medicine that is no longer prescribed should be safely disposed of. To find a safe disposal site nearby, text MEDS to 667873.
Community Living Connections: Information and support service for older adults, adults with disabilities, and their caregivers. Call toll-free 1-844-348-5464.
Overdose Prevention: Helping individuals and communities in WA respond to prevent opioid overdose including how to get naloxone the overdose reversal medication. For more information, visit kingcounty.gov/overdose.
Contributed by Public Health—Seattle & King County. Originally published 11/21/19 in Public Health Insider.