Fran Lowry

December 13, 2012

AVENTURA, Florida — The problem of prescription pain medication abuse in the elderly is a rapidly growing concern, new research suggests.

An epidemiologic study presented here at the American Academy of Addiction Psychiatry (AAAP) 23rd Annual Meeting & Symposium shows that approximately 20% of individuals aged 65 years and older take analgesics several times per week and that rates of abuse or addiction in those with chronic pain is 18%.

Furthermore, oxycodone, hydrocodone, and methadone were the drugs that were most often involved in up to 40% of opiate misuse–related deaths.

The researchers also found that most of the illicit pain-relieving drugs came from a well-meaning friend or relative.

"What happens is that people get prescription pain medications from a friend or a relative, not from a drug dealer on the street. Or they get it from one physician. For instance, the patient goes to the dentist for a root canal or tooth extraction and gets 30 Vicodin.

Dr. Louis Trevisan

"Of course, not all are used, and the rest goes into the medicine cabinet. Then a friend gets a headache, and the person offers a Vicodin for the pain. That is the route by which many elderly obtain these medications," study investigator Louis Trevisan, MD, Yale University School of Medicine, New Haven, Connecticut, told Medscape Medical News.

At 38 million, individuals older than 65 years make up 13% of the US population, and this number is expected to increase by 7% to 10% by 2020. Furthermore, the elderly currently use one third of all medications prescribed, and data from the Substance Abuse and Mental Health Administration (SAMHSA) indicate that 2.8 million seniors abused prescription drugs in the last year. SAMHSA estimates suggest that this number is expected to reach over 4.4 million by 2020.

"As the baby boomers move into the geriatric age range, they are going to be more amenable to taking drugs to alleviate pain than their parents were," Dr. Trevisan told Medscape Medical News.

The generation that came of age during World War II tended to be much more stoic and very leery of taking any kind of drugs. But this is not the case with baby boomers: "Not so the baby boomers," Dr. Trevisan said.

"Baby boomers are from the 'me-me' generation, interested in living longer and taking care of themselves. They were also exposed to marijuana, LSD, and other drugs, and of course, alcohol has always been there, so they are much more inclined to use drugs. They have a different attitude about using substances," he said.

Warning Signs

Dr. Trevisan said the following are warning signs that an elderly patient may be abusing pain meds:

  • They have multiple medical problems.

  • They have a higher than average incidence of chronic pain.

  • They experience common mood disorders.

  • They are multiple prescribers.

  • They insist on prescription of a controlled substance at the first office visit.

  • They physician shop.

  • They keep pain appointments but miss others.

  • They appear grossly dishevelled or impaired.

  • They request early refills.

  • They report their pain med prescription has been lost or stolen.

Grandma Could Be an Addict

When physicians see elderly patients in their office, they should strive to keep in mind that these patients probably have comorbid medical problems and that they may have some cognitive problems, depression, or other mental illness.

"Be just as careful monitoring and scrutinizing [the elderly] as you would a younger person," he said

Dr. Trevisan also stressed that opioid-based pain medications are extremely addictive and that if a patient has been taking them for a long time, he or she could develop withdrawal symptoms when taken off them.

"We tend not to be as careful scrutinizing and screening the elderly. I mean, how could grandma be hooked on Oxycontin? Unfortunately, yes, she could be. So take extra care," he said.

Physicians should also exercise good care and judgment when prescribing opioid medications for noncancer pain, Dr. Trevisan said.

"In general, they should be more careful about prescribing opioid medications for noncancer pain, and if they are prescribing these medications, they should prescribe them in small volumes and not give them a 3-month supply, but a couple of weeks or a smaller amount. They should keep such patients on a shorter leash, because they do get into the hands of family members, and this is where it can get to be a street problem."

An Epidemic

Dr. Joseph Liberto

Commenting on the study, Joseph Liberto, MD, Veterans Affairs Maryland Health Care System, Baltimore, said the researchers tackled "an important topic."

"Opioid analgesic abuse has reached epidemic proportions in the United States, and one important area that needs special emphasis is pain medication abuse in the elderly," he said.

Healthcare providers need to be prepared to see a growing number of older opioid analgesic abusers, especially as a large number of baby boomers with generally higher rates of illicit substance use age.

Dr. Liberto also pointed out that the elderly often pose significant diagnostic challenges to clinicians, because criteria that are appropriate for younger populations not always apply, and the signs and symptoms of addiction in some cases may be misinterpreted as products of normal aging.

In addition, polypharmacy, medical comorbidity, and the physiologic changes that accompany aging often complicate the treatment landscape.

"Dr. Trevisan and colleagues have done a good job highlighting the epidemiologic trends that support prescription pain medication abuse in the elderly as a growing problem," Dr. Liberto said.

"In addition, they have outlined some of the most relevant diagnostic considerations and treatment principles for identifying and treating elderly patients. As the authors conclude, further research aimed at improving diagnosis and treatment options in the older population is needed."

Dr. Trevisan and Dr. Liberto have disclosed no relevant financial relationships.

American Academy of Addiction Psychiatry (AAAP) 23rd Annual Meeting & Symposium. Abstract 25. Presented December 8, 2012.