The face of the nation’s opioid epidemic increasingly is gray and wrinkled.
But that face often is overlooked in a crisis that frequently focuses on the young.
Consider this: While opioid abuse declined in younger groups between 2002 and 2014, even sharply among those 18 to 25 years old, the epidemic almost doubled among Americans over age 50, according to the Substance Abuse and Mental Health Services Administration.
Because of information like that, the Senate Special Committee on Aging convened a hearing Wednesday on opioid misuse by the elderly.
“Older Americans are among those unseen in this epidemic,” said Sen. Robert P. Casey Jr. (Pa.), the top Democrat on the panel. “In 2016, one in three people with a Medicare prescription drug plan received an opioid prescription. This puts baby boomers and our oldest generation at great risk.”
Unwittingly, Medicare compounds the epidemic by funding needed opioids that can be abused, but, generally, not funding the care and medicines needed to fight opioid addiction.
“Overall, one in three older Americans with Medicare drug coverage are prescribed opioid painkillers. However, while Medicare pays for opioid painkillers, Medicare does not pay for drug and alcohol treatment in most instances, nor does it pay for all of the medications that are used to help people in the treatment and recovery process,” William B. Stauffer, executive director of the Pennsylvania Recovery Organizations Alliance, in Harrisburg, Pa., said at the hearing. “Methadone, specifically, is a medication that is not covered by Medicare to treat opioid use conditions.”
Offering scary statistics and practices involving older folks, Gary Cantrell, a deputy inspector general at the Department of Health and Human Services, said “our nation is in the midst of an unprecedented opioid epidemic.”
He focused on Medicare Part D beneficiaries. Part D is the prescription drug section of Medicare, the government health insurance program covering older people. About a half-million Part D recipients “received high amounts of opioids” in 2016, Cantrell said. Almost 20 percent of that group are at “serious risk of opioid misuse or overdose,” he warned, placing the high risk in two categories — those receiving “extreme amounts of opioids” and some “who appeared to be ‘doctor shopping.’ ”
Doctor shoppers “each received high amounts of opioids and had four or more prescribers and four or more pharmacies for opioids,” Cantrell explained. “While some of these beneficiaries may not have been doctor shopping, receiving opioids from multiple prescribers and multiple pharmacies may still pose dangers from lack of coordinated care. Typically, beneficiaries who receive opioids have just one prescriber and one pharmacy.”
Many elderly get hooked on opiates through prescriptions, rather than street drugs like heroin.
“Older adults are at high risk for medication misuse due to conditions like pain, sleep disorders/insomnia, and anxiety that commonly occur in this population,” said Stauffer, who is in long-term recovery. “They are more likely to receive prescriptions for psychoactive medications with misuse potential, such as opioid analgesics for pain and central nervous system depressants like benzodiazepines for sleep disorders and anxiety. One study found that up to 11 percent of women older than age 60 misuse prescription medications. The combination of alcohol and medication misuse has been estimated to affect up to 19 percent of older Americans.”
Sixty-one-year-old Denise Holden is in long-term recovery, too, but she became addicted as a young woman seeking a heroin high. She’s been in recovery for almost 25 years, after first using drugs when she was 19. She got clean, then relapsed, as is common, then got clean again. Staying that way, even after decades clean, is not easy.
“I recently had back surgery,” the West Melbourne, Fla., resident said in an interview. “I had a spinal fusion and so I had been taking opiates for a period of time. You know, the older we get the more aches and pains we get. … We injure ourselves, we have surgeries. So, for people in recovery it’s a slippery slope because when you reintroduce that opiate to your system, your mind starts playing all kinds of tricks on you — ‘Oh you should take more, oh you should take less, oh you should throw them out. Oh no, take them all at once.’ It’s very difficult, like it’s a mind game. It is very challenging I would say, but it’s not impossible.”
Holden urged seniors to take medicines only as prescribed, and if they have suffered drug abuse to “work a very strong program of recovery.”
Addiction isn’t the only risk with opioids. Sen. Susan Collins (R-Maine), chairwoman of the committee, said, “Older adults taking opioids are also four to five times more likely to fall than those taking nonsteroidal, anti-inflammatory drugs.”
That points to a vicious cycle. Taking opioids can lead to falls, falls can lead to pain, pain can lead to opioids and opioids can be abused. On top of that, doctors might not even realize the source of an elderly patient’s problem.
“Regrettably,” Collins added, “health-care providers sometimes miss substance abuse among older adults, as the symptoms can be similar to depression or dementia.”