Opioid Dependency Affects Older Adults, Too

By Deborah Jeanne Sergeant

Most people associate the opioid epidemic with younger people. While it’s true that the average person struggling with opioid addiction is younger than 45, a growing number of older people become dependent.

According to AARP, nearly one-third of those using Medicare, numbering about 12 million people, received prescriptions for opioid painkillers in 2015. The same year, 2.7 million Americans 50-plus took painkillers off-label, either for reasons for which they were not prescribed or in excess of their prescription.

AARP further related that in the past two decades, the rate of opioid-related hospitalization for people 65 and older quintupled.

“If people are not very careful in following the instructions for using opioids, they can become addicted,” said Patrick Seche, director of Strong Recovery/Addiction Psychiatry Division. “Just as it’s prevalent in younger adults, it’s similar with older adults. It’s highly addictive in all segments of the population.”

Mature adults with opioid dependence usually begin taking an opioid painkiller after an injury or surgery. If the pain lingers, the patient may shorten the time between pills or take a higher dose than prescribed. Within a short time — even mere days — the patient can become dependent.

Unlike some their younger counterparts, mature patients with opioid dependency don’t tend to turn to street drugs when their prescription runs out. Seche, who is also a clinical chief chemical dependency and associate clinical administrator of UR Medicine’s department of psychiatry, said that they try to obtain as much prescription medication as they can from different doctors, although fail-safes implemented in the past few years have helped curb this strategy.

Seche said the next most common source is a friend or relative. While young adults may pilfer from their grandparents’ medicine cabinets, an older adult seeking prescription opioids may ask a friend or relative who has leftover pills. In sympathy, they often get what they want. Some also have someone else refill a prescription for painkillers, claiming they’ve lost pills or that their doctors did not prescribe enough refills.

By this time, “it’s part of the daily routine,” Seche said. “It’s how they start the day and it’s part of normal activities. It progresses until they can’t do normal activities, like work. Another sign is using more than they need or intend to use.”

Beth McNeill, community education coordinator at De Paul’s National Council on Alcoholism and Drug Dependence in Brighton, has been involved in education and training for more than 20 years. She is also an adjunct assistant professor at Monroe Community College.

McNeill said many prescriptions have been written for longer than what the patient will actually need pain relief. Typically thrifty, many older adults hold onto leftover drugs in case they need them in the future; however, their stockpile creates a temptation for themselves or someone else.

Many of the signs of opioid addiction mimic some of the signs of dementia, making it difficult for loved ones to identify, including disorientation, poor balance, poor hygiene, mood swings and isolation. It’s easy for loved ones to mistake opioid dependency for dementia.

McNeill believes older adults resist seeking help more than younger people because of the stigma associated with substance dependency.
“Denial is a big barrier to seeking help,” she said.

Another issue is that many older adults simply follow their doctor’s directions explicitly and take the entire prescription whether they still need pain medication at that level or not.

Chris Pulleyn, licensed marriage and family therapist in private practice in Rochester, said that half of people 65-plus live with chronic pain. She recommends seeking non-medicinal methods for reducing the need for painkillers, including mindfulness.

“You can also use psychotherapy to control thoughts about pain before it becomes out of hand,” Pulleyn said. “These are really underused.”

She said that using complementary pain management can help improve the effectiveness of intervention like nerve blocks and cortisone injections.

“It’s your own mind that gets in the way most of the time,” she added. “I’d like to see more integration of massage, acupuncture, acupressure and meditation. There is a lot of evidence that they work.”

But instead of seeking less powerful methods of painkillers, some older adults fill their opioid prescriptions irrespective of their pain level throughout their recovery.

“They say, ‘What’s the big deal? My doctor prescribed it and my insurance paid for it,’” said Jennifer Faringer, director of De Paul’s National Council on Alcoholism and Drug Dependence in Rochester. “They never imagined they’d be in that situation.”

Talking about painkillers with a doctor can help start the path to recovery.

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