Lately, it’s been common to hear on the news about the heroin and opioid epidemics across the nation. Often times, we hear about young or middle-aged victims succumbing to their addictions, but the problem doesn’t just exist there. Seniors are also part of this drug epidemic as well. AARP reports that in 2015, nearly one third of Medicare patients (12 million people), were prescribed opioid painkillers. Also in 2015, 2.7 million Americans over age 50 reportedly abused painkillers.
One of the problems that unraveled with these painkillers is that they are often prescribed for legitimate reasons but are extremely easy for the body to become dependent on. It is possible within just a week for some individuals to become physiologically dependent on these drugs and experience adverse side effects when stopping their consumption. A common misteaching that pervaded the medical community was that that because opioids were prescribed legitimately (post-surgery, chronic pain), they weren’t considered vices of addiction.
Pharmaceutical Companies Spin “Quality of Life”
Previously, opioids were reserved only for treatment with cancer patients or for short-term relief following an accident or major surgery. However, during the ‘90s, opioids became a popular painkiller especially after the 1995 approval of OxyContin by the FDA. Opioids were lauded as the new go-to for pain relief for a new group of consumers: those suffering from chronic pain. Opioids were heavily marketed to medical professionals by pharmaceutical companies without much regard or research into the long-term consequences.
The CDC started connecting the dots when a 2006 study was commissioned to explore the link between the exponential number of deaths and the 500% increase in prescriptions written for opioid drugs. Despite their findings, there was an undercurrent of advocates for opioid use and against increased regulation on the drug. One of the main champions for fewer regulations was the University of Wisconsin’s Pain & Policies Study Group.
In 2011, an investigation revealed that this particular group had been a behind-the-scenes force in the explosion of opioid use and opioid advocacy. For about a decade, they had been setting the stage by publishing papers and promoting the use of opioid painkillers under the guise that it was in the patient’s best interest to acquire relief from chronic or debilitating pain (quality of life). Surreptitiously, this group also received $2.5 million from opioid companies during their decade-long campaign. Though their claims were almost never substantiated by extensive research, they managed to gain a stronghold in the collective conscience of the medical community, and the damage has just recently been coming to light.
Perhaps due to these or other forces at work, in 2009, the American Geriatric Society actually encouraged the prescription of opioids for pain relief. Though their stance has since been rescinded, the belief still remains pervasive that seniors/elderly are not affected by addiction.
Opioid Dangers Specific to Seniors
The general public now knows that the opioid crisis is real; these drugs are powerful and addictive. But there are effects of opioids that make the drugs even more dangerous for senior and elderly individuals.
Much of this population is already taking other prescriptions, which can enhance the negative effects or even risk contraindications of opiates. Additionally, as “downers,” opioids can depress the respiratory system, which can be dangerous if taken with other medications that have a sedative-like nature. Because the pharmacodynamics (effects drugs have on the body) and pharmacokinetics (the way the drug moves through the body) are also generally slower in seniors and elderly, dosing these heavier medications can be tricky as well and also contribute to a heightening of the medications’ effects. Additionally, with suppressed body responses and reactions, seniors and elderly can be more likely to fall or injure themselves.
Engaging in Best Practices
Unfortunately, there are some doctors who prefer to prescribe medications over finding the root of the problem, which may be able to be resolved with a non-pharmaceutical approach.
For example, if a resident is complaining of muscle pain, the “easiest” fix can be to give them a pain medication or muscle relaxant. However, a different, more productive & long-term solution may involve stretches, exercise, or physical therapy. This can provide other benefits as well: strengthening the muscles and bones to prevent from further physical damage, as well as keeping the heart active and healthy.
Of course, it is up to the team to decide what is in the best interest for the resident, and what would be most beneficial and applicable to their individual context. In some cases, medication could be the correct answer, or a combination thereof, but it is worthwhile to explore all possible avenues.
Countering the Opioid Epidemic in Assisted Living
Assisted Living provides an opportunity to make a concerted effort in reducing the dependency on opioids. With multiple medical professionals working on a team for each individual, it can help serve as a check-and-balance system and work toward unbiased care.
Part of ensuring that the rest of the team is on board with the right mentality begins in part with the hiring process. However, it also continues with support from the facility administration. One of the most important tenets in assisted living is to encourage individualized healthcare plans that focus on the true quality of life of the residents and to avoid employing practices that are merely pacifiers and not long-term solutions. Having the administration set the tone and enforce resident-centered philosophies help keep the team focused and on the right path.
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