The Big Grey Area:
Opioid Crisis Can Leave Seniors in Pain
BY CAROL LARSON
When we think about the more than 68-thousand people who overdosed last year, we often imagine young heroin addicts found dead in their cars, or veterans over-medicated on OxyContin. We rarely think of Grandma with her bad back and doctor-prescribed pain pills.
But here’s the reality: An estimated 25 percent of Americans over the age 65—more than 10 million people—are long-term users of opioids, according to a recent National Health and Nutrition Examination survey. In fact, between 2010 and 2015 the number of seniors with opioid-related hospitalizations rose 34 percent, with emergency room visits up 74 percent, according to the Agency for Healthcare Research and Quality.
Plain and simple, seniors are the largest under-reported demographic of opioid users. For some, opioids are essential to coping with pain. For others, opioids create a confusion of symptoms and side effects that can diminish quality of life, and sometimes kill.
In this vast grey area, I’ll share two stories. First, my own.
In 2005 when I was first treated for chronic pain, I was prescribed small doses of hydrocodone because, as my doctor said, “It’s about all we’ve got to work with.” Back then no one knew opioids were not a good long-term solution.
So, that’s what I took for 14 years, until the side effects caused greater problems than the pain. For me it was sudden deafness (I stopped taking the pills and my hearing returned). But the list of other potential side effects is long: nausea, constipation, lower bone density, trouble urinating, respiratory depression, dementia, impaired sexual function, hyperalgesia (increased sensitivity to pain) and increased fall potential.
All of the above are huge problems for seniors because side effects can worsen with age, or can be mistakenly attributed to aging, with seniors told to just “live with it.” And that’s not a diagnosis I trust.
These days, I end up doing my own research, especially on interactions between drugs. Like most seniors, I take several drugs to address multiple conditions. I mean, we’re older! More has happened to us!
Opioids don’t always play well with others. Some drug combinations cause confusion or respiratory suppression (a common cause of overdose deaths) especially if alcohol is added to the mix. Not hard to imagine how the danger of falling is greater with opioids, as is the resulting damage to older bodies and lives.
Last year I began managing my chronic pain with anti-inflammatories, yoga and meditation. It takes more work than popping a pill, but my head is clearer, my focus sharper. I’m fortunate to have alternatives.
My best friend wasn’t so lucky. Last July, her hip suddenly fractured, requiring surgery. This scenario is where opioids are a medical miracle; alleviating intense short-term pain. I thanked heaven for the drugs.
Unfortunately, that wasn’t all my friend would endure. In the fractured bone they found cancer at a stage well beyond treatment level. Opioids became a necessity, enabling her to tolerate the cancer eating away at her bones, pain that worsened as the disease progressed.
But it wasn’t a simple prescription. Last year, while policy makers and politicians grappled with the epidemic of opioid addiction, clinics and insurers were throwing new rules at the problem, with seniors and the very sick caught in the crossfire.
I listened as hospice nurses explained that my friend had to stop taking the drugs we knew worked, and go through a required “step” program of other (less expensive) options. This came at a time when the pain became extreme—and not what she needed while coming to terms with the awful reality that she was dying.
These end-of-life decisions were taken out of her hands—and those of her doctor—by new restrictions intended to reduce the availability and use of opioids. But managing my friend’s growing pain sometimes involved daily recalibrations. When the drugs worked, it was beautiful. A blessing. She was herself again, and we cherished those moments. When the drug level stopped working, she sometimes waited days for the health care system to approve a new dosage. It was agony for her, and for those who loved her.
There are plenty of villains in the opioid crisis: manufacturers who apparently turned drug addiction into a business strategy, giant pharmacies casting a blind eye on huge opioid orders, unscrupulous clinics and doctors, and insurance companies who demand faster patient consults—making a quick prescription more profitable than taking the time to discern a senior’s more complex needs.
All of this puts seniors in a precarious position. Yes, we must find opioid alternatives. Yes, keep the drugs away from those who want to get high or numb out on life. But sweeping laws and regulations that don’t take Grandma’s chronic pain into consideration, or provide humane options for the end of life, are ignoring the huge grey area of needed pain relief where many seniors exist.
Carol Larson can be reached at www.RetireeRebels.com
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