Last year Bronx nursing home Jewish Home Lifecare launched an experimental program to help deal with the rising rate of addiction among the elderly population. The program was developed in response to the large number of baby boomers with substance abuse issues entering their advanced years. Patients over 60 who are entering the facility for physical rehab after hospital-stays are now screened for addiction and substance abuse, and are offered treatment if the tests reveal chemical dependency. Initially eight beds have been set aside for patients of the program, but Jewish Home Lifecare is expecting to get around 480 patients per year once it gains momentum.

Drug Abuse a Growing Problem among the Elderly

The program is one of the first in the area to address the worsening problem of addiction among senior citizens. A 2009 study in the journal Addiction[1] predicts the number of addicts over 50 is expected to reach almost six million by 2020. Many older Americans ramp up their drinking as they get older because they think they’re past the age which alcoholism is a threat. Many may do so out of an inability to cope with the aging process. Others start abusing painkillers for an age-related condition and wind up developing an addiction. Experts are optimistic about the program’s success and hope it will be copied in other areas. As more and more baby-boomers are becoming senior citizens, individuals over 65 are becoming the fastest-growing group in the country. They’re also facing increased exposure to prescription opioid abuse.

An Easy High

The medical profession seems overly ready, if not determined, to prescribe prescription pain medications to elderly patients. In 2013 the most commonly prescribed drug under Medicare wasn’t a blood pressure drug or cholesterol medication; it was hydrocodone acetaminophen (the generic form of Vicodin)[2]. Not only was hydrocodone the most commonly prescribed medication, it was administered at more than twice the rate of the second-place drug, Simvastatin. Over eight million patients were prescribed the drug in 2013 from 691,000 care providers. More than 50 percent of these prescriptions were written by family-practice and internal-medicine physicians. Most of them were written for chronic pain.

Adding Fuel to the Fire: Unforeseen Damage

It has become impossible to ignore that the country is in the midst of a fierce prescription opiate epidemic. According to the CDC, Americans filled approximately 259 million prescriptions for painkillers in 2012[3]. This is enough to give every American adult a bottle of pills. Despite the overwhelming evidence of the dangers of these drugs, the medical community is dispensing them to seniors (the most physically vulnerable population) more than any other segment of the country. According to the National Institute on Drug Abuse, persons over 65 comprise only 13 percent of the American population yet account for more than one third of total outpatient spending on prescription medications[4].

Health officials have been concerned about the escalation of the senior painkiller abuse for years. According to the Substance Abuse and Mental Health Services Administration, nearly 30 percent of patients between the ages of 57 and 85 use at least five prescriptions. SAMHSA also reports that ER visits due to adverse reactions to prescription medications have risen 480 percent since 2005[5].

Tramadol: No Longer the “Safer” Alternative

In addition to hydrocodone, drugs like oxycodone and tramadol commonly factor into painkiller abuse among seniors. SAMHSA reports that ER admissions due to adverse reactions to tramadol rose 145 percent between 2005 and 2011 and that patients ages 65 and older accounted for 35 percent of these visits[6]. Recently reclassified as a Schedule IV controlled substance by the Drug Enforcement Administration, tramadol was initially thought to have a lower risk of addiction than other painkillers, particularly for older adults. In light of recent evidence, however, experts have reconsidered this position.

Tramadol users can experience a variety of adverse reactions, especially when the drug is mixed with other medications, including racing heart, seizures, high blood pressure, increased body temperature, respiratory problems and lightheadedness. As with any new medication, it’s imperative that patients disclose all current medications they’re taking to your physician to decrease the chances of an incident.

Increased Risk of Health Problems

The aging process makes one especially vulnerable to the perils of opiate withdrawal. Even in cases of non-abuse, prescribing physicians must pay special attention to the efficacy and the side effects of these powerful drugs. A joint study conducted by the University of the Nevada School of Medicine and the Sierra Nevada Healthcare System[7], revealed a variety of specialized challenges for seniors in coping with the effects of opioids, including:

  1. Changes in body composition such as increases in adipose tissue, decreases in lean body mass and decreases in body water can significantly affect drug distribution.
  2. Decreased gastrointestinal transit time can significantly alter the rate of medication absorption.
  3. As people get older, the rate at which they’re able to expel these medications through urinary flow (glomerular filtration rate) also becomes slower, rendering patients vulnerable to lingering side effects.
  4. Aging can reduce hepatic blood flow and volume which can decrease metabolism of drugs.

The authors of the study also suggested that tramadol should actually be avoided in elderly patients, and that prescription opioids, in general, should be prescribed at 25-50 percent the rate of which they’re prescribed to younger patients.

Viable Alternatives to Prescription Painkillers in Treating Chronic Pain

With mounting evidence to indicate the growing dangers of prescription opioids, many elderly  patients are looking for effective but less harmful forms of pain relief. There are a variety of alternative therapies that offer relief from various stages of chronic pain, including:

Massage – Massage therapy is commonly used to ease joint and muscle tension. It can also be helpful in anxiety and pain-related conditions like chronic headache and fibromyalgia.[8]

Acupuncture – Acupuncture has been used to relieve pain for over 2,000 years and endures as a viable form of pain management in clinical settings.[9]

Biofeedback– Biofeedback teaches patients to be mindful of their bodies and actively regulate normally involuntary biological functions like heart rate, blood pressure and muscle tension. It helps patients reduce their stress-related pain.[10]

Chiropractic Care – Chiropractic medicine provides effective short-term relief for chronic pain while improving flexibility, sleep and posture. It has been shown to be effective in various pain-related conditions, including lower-back pain, neck pain, carpal tunnel and headaches.[11]

As our loved ones begin to rely more and more on medication to ease their age-related pain, there’s a real danger that they could wind up developing chemical dependency. It is critical that we do all we can to limit our parents’ and grandparents’ intake and seek prompt treatment in the event of substance abuse. Behavioral Health of the Palm Beaches offers a specialized treatment program for older patients, which addresses the unique withdrawal concerns associated with the aging process. Don’t let your elderly loved one suffer in pain and indignity. There is hope, we can help.