By Stephanie Rose, MSW
Department of Health Sciences, University of Central Arkansas
With the increase among the aging Baby-Boomer population, there has been an overall increase of prescription drug use. Many older adults struggle with co-morbid diagnoses, contributing to multiple prescriptions being consumed at one time (Dowell, 2016). Older adults are also more likely to be victims of medication theft (Collins, 2018). With the rising amounts of opioid overdoses, the use of opioids for pain-management among older adults is a growing concern (Dowell, 2016). Historically, there has been more of a focus on younger adults and opioid misuse; however, the average age (50 or older) of treatment admissions for opioid abuse is rising. One in four older adults have used a prescription drug that has the potential for addiction (Carew, 2018). The U.S. Department of Health and Human Services found that while 500,000 older adults were prescribed higher than recommended amounts of opioids, 90,000 of these individuals were identified as high risk for abuse and/or overdose (Collins, 2018).
It is projected that the amount of older adults who abuse illicit substances will double by 2020 (Carew, 2018). Misuse and abuse of prescription opioids in older adults is associated with higher levels of pain, depression and low-level physical disabilities. In 2012, 2.9 million adults, age 50 or older reported using their prescription medications for reasons other than prescribed. Pain-medication accounted for almost half of drug-toxicity related visits to the emergency room for those ages 50 or older (Chang, 2018). This highlights the need for increased attention on older adults and opioid misuse/abuse.
There are a number of initiatives being developed and implemented in order to address these concerns. The CDC has developed guidelines regarding better management of chronic pain (Loreck, 2016). These guidelines address pain management strategies including the oversight of prescription and opioid use, appropriate opioid selection, patient education, when to cease opioid prescriptions, as well as appropriate follow-up (Dowell, 2016). Additional risks and concerns are associated with ceasing opioid prescription-management too quickly, particularly if the person is not provided adequate follow-up and resources for pain-management (Collins, 2018). This is especially concerning due to the rise of heroin use among older adults, as well as, an increase in those who are ages 50-70 receiving methadone treatment (Carew, 2018).
Knowing the warning signs of substance abuse can assist with intervention that may save lives. It is important to increase awareness of what interventions are available and what to do should there be a concern. Some helpful tips include:
- Knowing what resources exist to assist older adults is important. Proper treatment is essential, particularly since higher rates of depression and anxiety were reported among those ages 50 and older and who misused/abused their opioid prescriptions. Factors that can affect the rates of abuse may include use of opioids as an attempt to cope with the multiple changes that occur in this life-stage, as well as perceived greater pain (Chang, 2018).
- Look for warning signs of substance abuse. Several warning signs include slurred speech, hostile and/or depressed mood, memory loss, confusion, and increased isolation. (Hazelden, 2018).
- Increasing social engagement can be helpful, particularly since increased opioid use is associated with increased isolation (Chang, 2018).
- Identifying supportive resources, including housing and food assistance, as well as addiction education that addresses issues of empowerment, decreasing stressors and enhancing coping skills. (Hazelden, 2018).
It is of further importance to select the right treatment. Due to the complex needs of an individual struggling with addiction, it is important for treatment to seek appropriate practitioners with expertise. Addiction is influenced by a variety of issues, including genetics, mental health, environmental and health factors. An array of practitioners with special skills and training who can appropriately address substance use disorders are available. Some examples of special certifications in Arkansas include Licensed Alcoholism and Drug Abuse Counselor (LADAC), Licensed Associate Alcoholism and Drug Abuse Counselor (LAADAC), Advanced Alcohol and Drug Counselor (AADC) and Certified Alcohol and Drug Counselor (ADC). These credentials require years of additional experience and education focused on addiction. Many times, these are additional credentials and education that general licensed mental health providers (LPC, LCSW, PsyD, PhD, etc.) acquire in order to provide adequate treatment to those struggling with addiction. Being well versed on the treatment options available can be especially beneficial.
The rise of opioid misuse and abuse among older adults continues to be a growing concern and challenge. There are a number of related dangers and outcomes on the rise, particularly since the population of older adults continues to increase. Many of the needs and risk factors of older adults using opioid prescriptions are unique and require well-informed interventions. The UCA Addiction Studies Program prepares students to work in the addiction field by providing comprehensive education in the field of addiction. Students obtain knowledge of addiction including mental health, counseling skills, prevention, as well as, epidemiology and etiology of addiction. The program also requires an internship experience within the field of addiction treatment. UCA Addiction Studies Program continues to prepare students with a special skill-set to address this ever-growing need.
Carew, A. M., & Comiskey, C. (2018). Treatment for opioid use and outcomes in older adults: A systematic literature review doi:https://doi-org.library.capella.edu/10.1016/j.drugalcdep.2017.10.007
Chang, Y. (2018). Factors associated with prescription opioid misuse in adults aged 50 or older doi:https://doi-org.library.capella.edu/10.1016/j.outlook.2017.10.007
Collins, S. (2018). Older Americans and opioid misuse: supporting an often overlooked populations in the opioid crisis. Retrieved August 29, 2018
Dowell, D., Haegerich, T., & Roger, C. (2016). CDC guidelines for prescribing opioids for chronic pain-United States. Retrieved August 27, 2018 from: https://www.collins.senate.gov/newsroom/older-americans-and-opioid-misuse-supporting-often-overlooked-population-opioid-crisishttps://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fmmwr%2Fvolumes%2F65%2Frr%2Frr6501e1er.htm
Loreck, D., Brandt, N. J., & DiPaula, B. (2016). Managing opioid abuse in older adults: Clinical considerations and challenges. Journal of Gerontological Nursing, 42(4), 10-15. doi:http://dx.doi.org.library.capella.edu/10.3928/00989134-20160314-04
Hazelden Betty Ford Foundation. (2018). Older adults deserve recovery from alcoholism, addiction to prescription drugs. Retrieved August 29th, 2018 from: http://www.hazelden.org/web/public/ade60306.page
Substance Abuse and Mental Health Services Administration. (2017). Opioid use in the older adult population. Retrieved August 27, 2018 from: https://www.samhsa.gov/capt/sites/default/files/resources/resources-opiod-use-older-adult-pop.pdf