The Dangers of Prescribing Opioids to California Seniors

Opioid abuse is a serious public health issue. Drug overdose deaths are the leading cause of injury death in the United States and a significant aspect of the drug problem in California.

According to a fact sheet from the US Department of Health and Human Services, since 1999, the rate of overdose deaths involving opioids—including prescription opioid pain relievers and heroin—nearly quadrupled, and over 165,000 people have died from prescription opioid overdoses. The drug problem in Northern California is compounded by the prevalence of heroin as a cheaper and often easier to obtain alternative to prescription opioids, due to the trafficking route from Mexico passing through the region.

Seniors at Risk

As the nation grapples with this devastating opioid epidemic, concerns have primarily focused on young people buying drugs on the street. But America’s elderly also have a problem, which shows up quite alarmingly in any study of the drug problem in Northern CA.

Over the past several decades, physicians have increasingly prescribed seniors pain medications to address chronic pain from arthritis, cancer, neurological diseases and other illnesses that become more common in later life. A recent study presented at the Gerontological Society of America found a 78 percent increase in the number of emergency department visits among older adults who misused prescription or illicit drugs. About 11 percent of the misuse was with opioid drugs, according to lead researcher Mary Carter of Towson University.

Balancing Need and Risk

Efforts to curb the epidemic have led to a great curtailment of the rate of prescriptions for these medications. Some medical practices refuse to accept patients already taking an opioid for pain, according to a recent article in the Beloit Daily News.

The difficulty enters when seniors can’t get the medications that would enable them to function. One has to ask the hard question: when is it worth the risk?

Beyond the obvious dangers of addiction, opioids can pose serious risks for seniors. Common side effects include constipation, breathing problems, confusion and problematic interactions with other medications. Seniors taking opioid medications are also four to five times more likely to suffer a fall or fracture than those taking a non-opioid pain medication.

At the same time, opioids can be a critical tool in treating debilitating pain that leaves seniors immobilized and homebound. A consulting geriatrician points out that prescribing opioids to seniors is often about helping them maintain their independence.

A key guidepost in prescription pain relief is understanding the person’s goals and how the pain is affecting their life. Also highly relevant: an examination of options and alternatives, what has worked and what has not.

In many cases, alternatives such as massage and chiropractic, topical medications and even acupuncture, can be effective agents in pain management. However, unlike prescription painkillers, these alternatives are seldom covered by insurance. For a senior on a fixed budget who cannot afford to pay full rate for the alternatives, those alternatives may as well not exist.

One in three Americans who have taken prescription opioids for at least two months say they became addicted to or physically dependent on the medications. It’s no surprise, then, that some seniors end up addicted.

One of the tenets in geriatrics with prescribing any medication is to start low and go slow. Aging results in slower metabolism of medications, which will affect people differently. Good judgment and close management are essential factors in using these drugs as tools. At the same time, making alternatives more accessible could prove an essential strategy in the battle against addiction, not just for seniors, but for everybody.

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