Substance use disorders occur when at least one substance or drug leads to distress or impairment that is clinically significant. According to the Centers for Disease Control and Prevention, the number of opioid addicts in the United States is estimated to be in the millions.
Exact numbers may never be known, as many people who are addicted to opioids try to keep it a secret or legitimately do not realize a problem exists. Some may fear the stigma and judgment that come with being an addict.
A recent study by the CDC determined over 200,000 people died in the United States between 1999 and 2016 from causes related to prescription opioids. Nebraska saw 44 deaths in 2016. While less than the national average of 13.3 deaths per 100,000, according to the National Institute on Drug Abuse, Nebraska still saw 2.4 deaths per 100,000 people.
Those over 60 are not immune. The AARP has stated in educational literature that while bipartisan efforts, public awareness of prescription drug issues, and treatment have increased, fewer efforts have been geared to the older population, whose “unique characteristics may demand different or more nuanced solutions to these problems.”
Dr. Allison Dering-Anderson is the community pharmacist in the University of Nebraska Medical Center’s Department of Pharmacy Practice and a lecturer in pharmacy law and ethics. She agrees that older adults have more medical issues that put them at risk for substance use disorders.
“People over 60 have any of a number of things that set them up in a circumstance where they need an opiate to treat pain,” Dering-Anderson says. “They are the ones most likely to have some chronic pain condition from an injury that never healed right, or arthritis that is ridiculously painful, and they need an opiate to control the pain.”
Dering-Anderson is no stranger to pain or opiates. She was prescribed opiates after a painful knee operation. Post surgery, she said she would not have been able to do anything without significant pain control, but was lucky that her body chose to accept pain medication as that and nothing more. Not everyone is so lucky. Problems may occur when the body accepts the medication, but the brain becomes accustomed to, and craves, the euphoria associated with opiates.
The problem is the scientific method, Dering-Anderson says, not one of intentional over-prescription or market pressure to sell more drugs. For example, when Tramadol (a synthetic opioid) was introduced to the American market, it was considered to have no potential for contributing to substance use disorder. But that changed after its release—as with many drugs new to market—when hidden side effects and statistical outliers were discovered.
“There have been some missteps in determining the potential for substance use disorder,” Dering-Anderson says, adding adamantly that deliberate misdirection is not the issue. “The FDA approved the Tramadol label based on studies that did not show this was a problem. Now it’s a problem, and they did all of the correct post-market things to send out new warnings to change their labeling.”
More often the problem is selective participation in treatment. Patients may avoid physical therapy or exercise, preferring the quicker results of opiates.
Jessie Thompson works in the front lines of substance use disorder treatment as a counselor at Lutheran Family Services. Her observation is that older patients may have been prescribed opiates for so long they might not necessarily realize that they are addicted.
“Sometimes I think they have pain and maybe the pain is not as bad as it was, or there are other treatment modalities that haven’t been prescribed because they’ve had chronic pain for so long,” Thompson says.
Stretching, exercise, and rest are often part of any recovery plan, but may fall by the wayside while medication takes front stage.
Thompson and Dering-Anderson agree that the pendulum has swung both ways and that, over the decades, doctors have been alternately leery of prescribing opiates for pain and then encouraged to do more to manage pain.
Dering-Anderson says seniors should know they do not have to be in pain, that not all pain medications lead to substance use disorder, and that following a complete regimen of treatment can reduce a patient’s drug load.
“If the prescriber and the pharmacists recommend ibuprofen [which is not considered addictive], give that a try, but do all of the other things that go along with pain management,” she says. “You need to rest, do your exercises, massage therapy, go to physical therapy, because it is with those professions that we have a chance at reducing your drug load and to keep you safe.”
There are many variables that go into addiction. Life circumstances, relationship status, genetic predisposition, type of substance, and medical conditions can all be factors contributing to substance use disorder. But one factor in avoiding addiction is vigilance.
This article first appeared in the January/February 2019 edition of 60PLUS in Omaha Magazine. To receive the magazine, click here to subscribe.