BY SUSAN M. MATHEWS, PhD, RN, MSBE
In 2014, 240 million opioid prescriptions were written — enough to give every American adult their own bottle. Two years later, 64,000 people died from drug overdose with the bulk of those from fentanyl and fentanyl analogs, prescription opioids and heroin. According to the Department of Health and Human Services, 650,000 opioid prescriptions are dispensed daily, with 3900 people initiating non-medical use of these drugs every day.
When we hear about opioid deaths, we automatically think of young people. Shockingly, according to the Centers for Disease Control and Prevention, nearly 14,000 people ages 45 and older died from an opioid overdose in 2015.
The actual number is likely much higher, since overdoses in older people are often mislabeled as heart failure or falls.
According to a June article in AARP, almost one-third of all Medicare patients — nearly 12 million people — were prescribed opioid painkillers by their physicians in 2015. In that same year, 2.7 million Americans over age 50 abused painkillers, meaning they took them for reasons or in amounts beyond what their doctors prescribed. To add to the tragedy for the elderly and the expense for Medicare, opioid-related hospitalizations have quintupled for those 65 and older in the past twenty years.
The number of older adults seeking treatment has also skyrocketed. A study conducted by the School of Medicine at New York University found that the proportion of adults in their 50s who entered opioid treatment programs increased almost fivefold from 1996 to 2012, to more than 35%. During that period, the proportion ages 60 to 69 increased eightfold, to 12%. In many ways this is a positive sign for this older generation, one most familiar with pairing the word addiction with a personal failing rather than a chronic medical condition.
When did all of this start? Back in 1995, Purdue Pharma launched its blockbuster narcotic pain reliever, Oxycontin. Doctors were told it was safe to use and non-addictive, as long as it is given to someone in legitimate pain. That is “something we now know not to be true,” said Vivek Murthy, who left the job of U.S. surgeon general this year. When older patients suffering from chronic conditions like arthritis or back issues saw their doctor, they were prescribed Oxycontin somewhat innocently.
When we hear about opioid deaths, we automatically think of young people.
The American Geriatric Society once unwittingly believed in Purdue’s sophisticated marketing that assured physicians their older patients were less likely to become addicted to opioids. Though the Society has since revised those
guidelines, the myth persists. “Many doctors still think seniors can’t get addicted,” said Andrew Kolodny of the Physicians for Responsible Opioid Prescribing.
Sadly, it can take some patients only a week to become addicted to this powerful narcotic. The CDC issued guidelines last year recommending that doctors drug-test their patients before and during opioid therapy, to ensure that medications are taken properly. This is rarely done. Limits to the number of days prescribed were also recommended.
Nevertheless, doctors continue to overprescribe. A 2016 survey by the National Safety Council found that 99 percent of physicians prescribe opioids beyond the CDC’s dosage limit recommendation of three days.
As much as President Trump recently declared a National Public Health Emergency to bring both financial and medical resources to the issue and strip much of the red tape that comes with a burdensome bureaucracy, an inherent conflict in our system remains. “Any physician in this country can prescribe Oxycontin in high doses, but they can’t prescribe buprenorphine, a medication used in the treatment of opioid addiction, unless they have special training,” said medical epidemiologist Jay Unick of the University of Maryland, Baltimore. “You just don’t have easy access to buprenorphine. And that’s crazy in a world floodedwith opioids.”
If someone is willing to enter treatment, how can we ask them to wait in line for what would be an aide to managing or even beating their addiction and preventing overdose? Not only must patients deal with bureaucracy but with physicians and others in the addiction industry who believe prescribing medications such as buprenorphine, methadone, and naltrexone are just trading one addiction for another.
The aging process is littered with landmines, but to think that a physician’s prescription can cascade Mom, Dad, Grandma or Grandpa into an opioid addiction for simply seeking relief from back pain, arthritis or knee surgery is unconscionable. Not only are our physicians culpable for wreaking havoc with their free wheeling prescribing, but our government is complicit. It must do more and mandate a reduction in the supply of the major offender Oxycontin and remove barriers to medication-assisted treatment.
Our legislators are supposed to represent the people, not Big Pharma. Our physicians took an oath to do no harm. They both have a lot of work to do to honor their professional commitments to all of us.