Opioids And Older Adults

Opioids And Older Adults: Addressing Both The Epidemic And Undertreated Pain – Huffington Post – Aug 2016 – Terry Fulmer, PhD, RN, FAAN P

Millions of older people experience chronic, even debilitating pain and desperately need relief.

We must take a balanced approach so that older adults can continue to make contributions to their communities and families and continue to live well as they age.

While I applaud Ms. Fulmer in calling for fewer opioid restrictions on older people, I’m disappointed that she says nothing about the  virtual prohibition of opioids for other people with chronic pain.

The addiction/recovery industry has painted such a dismal view of opioids for pain patients in the national consciousness that people don’t even realize how prejudiced they are against pain patients.  

Chronic pain should not be a constant companion simply because we age.

While concerns about addiction are warranted, we must also ensure adequate pain management in older people. Almost half of all adults over age 65 routinely live with pain, part of a larger and important public health challenge.

Chronic pain in older adults comes from a variety of (and often multiple) sources—degenerative arthritis, nerve damage (from fibromyalgia, shingles and diabetes) and cancers.

She writes as though chronic pain in younger people just didn’t exist. Perhaps she truly believes PROP: anyone taking opioids for more than 3 months is an addict.

Still, undertreatment remains a significant problem.

Treating pain is a critical aspect of good health care, and sometimes opioids are the best option.

A review of studies showed that short-term use of opioids in older non-cancer patients can be safe and effective, and the risk of abuse is negatively associated with age.

Tightened restrictions on opioid use may present difficulties for the nearly 30 percent of those enrolled in Medicare Part D in 2015 who had at least one opioid prescription, as described by The New York Times‘ Paula Span.

Beyond opioids: drug and non-drug alternatives

With aging, metabolism slows and side effects such as nausea, vomiting, constipation and falls are more frequent.

In many cases, alternative therapies should be considered first.

From what I’ve read, most legitimate pain patients initially resisted opioids wanted to try alternative treatments.

Some older people may be able to eschew opiates all together, with combinations of non-opioid drug and non-drug alternatives, and manage their pain to tolerable levels.

Moving to action

The opioid epidemic remains a national crisis, one that requires actions at all levels. The solutions must take the special needs of older people into account.

But also people with chronic pain at a younger age.

The FDA, CDC and other groups have offered responses, for example, placing limits on various opiate formulations, constraining how clinicians can call in opiate refills, and providing a clearer sense of who will benefit from opioids and who should not receive them. These efforts should include a focus on older adults.

This makes sense because by 2030 the population of people over the age of 65 will increase two-fold in the United States.

But efforts should be extended to all people suffering from pain, not just the elderly.

At the same time, we need an approach that avoids unintentionally exacerbating the undertreatment of pain in elders.

The undertreatment of pain in middle-aged or even young people has been equally exacerbated by the CDC guidelines.

We need action that includes:

  1. Further development, testing and prescription of pharmaceutical and non-pharmaceutical alternatives to opioids;
  2. Clinical support necessary to help older people take on and manage drug and non-drug options for their pain; and
  3. A commitment to more research into opioid use and its efficacy for chronic pain management.

Ms. Fulmer makes a reasonable case for opioids for the elderly, not explicitly excuding other groups but just ignoring them, and I wonder if she deliberately restricted her arguments to the senior population to rally more support.

When talking about pain patients in general, the public has been conditioned by the media to imagine depraved drug addicts lurking in seedy alleys.

But who wants to let grandma and grandpa suffer in their feeble and defenseless old age?

This article may be a clever ruse to at least open the door to loosening the restrictions on opioids in general. If so, I congratulate Ms. Fulmer.

Perhaps some of us pain patients could stress our status as a senior citizen when pleading for more sane and science-guided opioid policies. After all, seniors are becoming a larger voting group every year.

See also two previous posts about PMC articles focused on the elderly and pain:

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