The number of people aged 65 years or older who are being treated for opioid addiction is skyrocketing. The opioid epidemic is a serious crisis in the United States, but this issue has particularly impacted baby boomers. As the population of aging adults continues to grow, so does their risk for dependency on opioids and other dangerous drugs. According to data from Centers for Disease Control and Prevention (CDC), more than 42 percent of deaths among people aged 55 or older were attributed to drug overdoses. Over half of these cases involved prescription painkillers like oxycodone, fentanyl, hydrocodone, methadone and morphine.
This article will discuss what you need to know about the opioid crisis within your parent's generation and those of us in the baby boomer age range.
This issue hits close to home for our family. My mother is one of those people that struggle with chronic pain. She has Rheumatoid Arthritis and is at the point she can’t stand long enough to cook her meals any longer and sometimes her day doesn’t start until 11am because it takes that long to get herself ready for the day. This is a woman that used to get up at 4:30 am and drive school bus well past retirement age. She sees a pain doctor and we are hoping for an outpatient surgery that may improve her condition by putting a disc in between her collapsed spinal vertebrae to take the pressure off her nerves and relieve the pain some. She now gets around in a scooter so she can be as independent as possible. Mom also gets meals on wheels several times a week and that helps her maintain her nutrition.
While illicit drug use typically declines after young adulthood, nearly 1 million adults aged 65 and older live with a substance use disorder (SUD), as reported in 2018 data. While the total number of SUD admissions to treatment facilities between 2000 and 2012 differed slightly, the proportion of admissions of older adults increased from 3.4% to 7.0% during this time.2
Why has this become a problem? As we age, many of us succumb to chronic degenerative diseases such as arthritis, osteoporosis, fibromyalgia, rheumatoid arthritis, falls, fractures, spinal column compression fractures, chronic back pain, and a slew of others that can lead to chronic pain. Until the opioid crisis came to a head, the most common way to treat pain was with pain medication and often times in the form of an opioid.
What puts our seniors so much more at risk? The staggering news is that we know that in as little as five consecutive days of consistent use of an opioid pain medication you can have withdrawal symptoms when you stop taking the medication. Those with younger bodies and healthier kidneys and livers can often metabolize these medications more effectively than our elders that may already have kidney or liver damage or disease. When the body’s natural detoxification system is not running as well as it could be, these medications along with others, not just opioid medications, can build up in the system and have increased or longer lasting effects. If you continue to take them before your body has detoxified them and eliminated them, you are at risk for having a greater potential of effects as the medication builds up quicker than you can eliminate them from your system.
Older adults are more likely to unintentionally misuse medicines by forgetting to take their medicine, taking it too often, or taking the wrong amount.
What can we do about this? Obviously, we do not want to suffer, have our aging parent or spouse suffer, or any other loved one for that matter suffer. What are our options?
First of all, if you are a younger generation take your health seriously and do what you can to prevent chronic degenerative disease period. Healthy eating with as much plant-based foods as you can, regular exercise, supplementation to make sure you get all the extras you can to decrease the inflammation process in your body and seek out your provider, a dietician, or a health coach to help you look at your lifestyle and see where you can have a positive impact on your health. We have talked in a previous blog post that there is even DNA Health testing available to tell you what types of chronic degenerative diseases you may be prone to. This will also give you a heads-up as to what areas that you need to especially focus on to improve your health.
If you are stuck in the mud right now, what can you do? There are many alternatives to help you deal with chronic pain. There are physician specialists that deal in pain management. This may be a great place to start. With an order from your doctor, physical therapy can also be a way to bring you relief by identifying what is causing your pain and how you can adaptive to reduce the impact of the pain on your day-to-day activities. Physical therapists deal with many causes of discomforts including vestibular concerns such as vertigo, sciatic nerve pain, pain following joint replacements, female incontinence issues, and many, more! Physical Therapy is not just for exercises any more.
Massage therapy can also help many forms of pain and discomforts. Some people have had good results with seeing a Chiropractor or an Acupuncturist. Meditation, and relaxation techniques are other ways to help keep your pain tolerable.
Dealing with chronic pain often leads to depression and other mental health concerns. It is important to try everything you can to keep the pain under control without having to resort to opioid pain medications. They have their place for sure, but they should be looked at as a very short-term solution to an acute vs. a chronic condition.
One U.S. study suggests that close to a quarter of marijuana users age 65 or older report that a doctor had recommended marijuana in the past year.12 Research suggests medical marijuana may relieve symptoms related to chronic pain, sleep hygiene, malnutrition, depression, or to help with side effects from cancer treatment. It is important to note that the marijuana plant has not been approved by the Food and Drug Administration (FDA) as a medicine. Therefore, the potential benefits of medical marijuana must be weighed against its risks, particularly for individuals who have other health conditions or take prescribed medications.
Regular marijuana use, regardless of reason at any age, has been linked to chronic respiratory conditions, depression, impaired memory, adverse cardiovascular functions, and altered judgement and motor skills.12 Marijuana can interact with a number of prescription drugs and complicate already existing health issues and common physiological changes in older adults. We have also seen chronic cyclic nausea, vomiting and acute abdominal pain associated with daily use of marijuana.
Caregivers must monitor their loved ones for signs of drug abuse - including mood changes, weight loss, increased sleepiness or agitation, confusion, or withdrawal from friends and relatives. Antonello Bonci, MD, founder and executive chairman of Global Institutes on Addictions Miami, tells WebMD Connect to Care that these are signs and symptoms of opioid misuse and addiction in the elderly:
Memory and emotional changes
Sadness and depression
Changes in sleep and eating patterns
Less social involvement
Changes in hygiene
Changes in weight
Less contact with family
“Signs of addiction can be easily overlooked in the elderly because very often, subtle symptoms can mimic other medical disorders, such as depression, major illnesses, diabetes, or dementia,” Bonci says. Over the past four decades, as an R.N. I have seen the effects of opioid addiction many times in my healthcare career. It is our job as nursing professionals to try to apply non-medication interventions to help those with pain. Sometimes it requires to think outside the box and work within what may be available for each particular patient. What works for one person may not work for someone else but you keep trying to find some alternative that helps. A positive mindset goes a very long way in dealing with chronic pain.
Often times any type of over-dose is accidental among the elderly population. It is so important to find out how well your aging parent or spouse is managing their medications. Look for empty bottles before the refill date has come, too many pills gone for one day’s use, signs or symptoms of fatigue, frequent or increasing falls, confusion when it comes to normal every-day tasks for them as paying bills or making out a grocery list. You might see increased nausea or vomiting or a lack of appetite. Contact the provider for any concerns and the first thing they can do is look at their medication list and see what may be causing the issues. Maybe it is a combination of medications such as anti-anxiety medications or sedatives, anti-depressants, and pain medications or other medications used to treat a mental health concern.
What are some other ways you can try to manage your chronic pain?
1. Heat or cold. Sometimes one works better than the other. Cold can reduce the inflammation and heat can help the muscles relax. Try a hot bath or whirlpool bath
2. Yoga or Tai Chi. Yoga may also be done in a chair. Find an instructor that offers “chair yoga” if you can’t get on the floor.
3. T.E.N.s Unit is a unit that provides some electrical stimulation to the area of pain. Often Physical Therapists assist in getting started with this process. An implanted stimulator device may also be suggested.
4. Topical Pain Relievers you can buy over the counter such as Ibuprofen type lotions or creams.
5. Non-opioid pain relievers such as Tylenol or Ibuprofen. There are some health risks even associated with these over-the-counter medications so it is important based on your health and what other medications you are taking, that you check with your provider. Be sure to ask your doctor what over-the-counter pain relief medications you can take.
6. Your doctor may suggest a Steroid Injection that may help alleviate some pain.
The opioid crisis is getting worse and we need to do something about it. As the population ages, more people are dealing with chronic pain that may be hard to manage without medication. Pain can cause depression and anxiety which leads some people to use opioids as a way of coping. We’ve shared some alternative ways you can deal with your pain at home or work so you don’t have to resort back to taking prescription drugs like morphine, oxycodone, fentanyl, hydrocodone etc.
If any of this has sparked an interest in health-related topics for over 50s then please join our email list! You'll hear from us often because we want everyone on the planet who has reached 50 years old or older to have the tools available to live their best life. There is a lot of life left after 50!!
Talking with Your Adult Patients about Alcohol, Drug, and/or Mental Health Problems: A Discussion Guide for Primary Health Care Providers: https://store.samhsa.gov/product/Talking-with-Your-Adult-Patients-about-Alcohol-Drug-and-or-Mental-Health-Problems/sma15-4584
Linking Older Adults With Medication, Alcohol, and Mental Health Resources: https://store.samhsa.gov/product/Linking-Older-Adults-With-Medication-Alcohol-and-Mental-Health-Resources/sma03-3824
Too Many Prescription Drugs Can Be Dangerous, Especially for Older Adults: https://publichealth.hsc.wvu.edu/media/3331/polypharmacy_pire_2_web_no-samhsa-logo.pdf
National Council on Aging, Issue Brief 2: Alcohol Misuse and Abuse Prevention: https://www.ncoa.org/resources/issue-brief-2-alcohol-misuse-and-abuse-prevention
2. Chatre S, Cook R, Mallik E et al. Trends in substance use admissions among older adults. BMC Health Services Research. 2017; 584(17). doi: https://doi.org/10.1186/s12913-017-2538-z
12. buhasira R, Ron A, Sikorin I, Noack V. Medical cannabis for older patients—Treatment protocol and initial results. Journal of Clinical Medicine. 2019; 8(11): 1819. https://doi.org/10.3390/jcm8111819