The Silent Epidemic

Stories about the opioid epidemic are all over the news these days, and for good reason: the opioid crisis is the deadliest drug overdose epidemic in American history. In 2015, more than 33,000 Americans died because of an opioid overdose, and experts estimate that that figure might have grown by as much as 20% in 2016. Opioid overdoses now exceed car crashes as the leading accidental cause of death in the United States.
According to numbers provided by Heather Dick, LCSW, MAC, CAADC, Regional Outpatient Director at Pyramid Health Care in Altoona; Blair County ranked #20 out of all 67 counties in the state for fatal overdoses in 2016, with 33.8 persons per 100,000 dying from drug related overdose. This rank was up from 2015 when Blair County was at #40. Blair County alone saw a 95% increase in 
drug-related overdose deaths from 2015-2016.
Often ignored in stories about the opioid epidemic and other stories about substance abuse are America’s older adults, who make up 20% of opioid overdose deaths in the United States. And while myths persist that seniors are less susceptible to addiction, the truth is just the opposite: seniors are often more at-risk than the general population of developing a serious substance abuse problem, be it to alcohol, prescription drugs, or even recreational narcotics.
While opioids have long been a useful and manageable short-term pain treatment option for patients recovering from surgeries or injuries, by the late 1990s doctors were writing long-term prescriptions for opioids to help patients manage chronic pain.
Contrary to myth, older adults are actually often more susceptible to substance abuse, including dependence, addiction, and overdose. Compared to younger generations, seniors are much more likely to experience chronic pain that can make life difficult, and pain associated with surgeries and injuries can last longer and require more treatment. Therefore, seniors are more likely to be prescribed long-term drug treatments and multiple medications, including potentially addictive opioids. While seniors comprise just 13% of the population, they account for more than a third of all prescription drug consumption. Meanwhile, their kidneys and liver function less efficiently, which means it takes longer for drugs and alcohol to filter out of the systems of older adults. Seniors are also more likely to use drugs improperly because of memory loss. Finally, seniors are more likely than other generations to view addiction primarily as a moral failing rather than as a medical condition, which can make it very difficult to admit that there’s a problem and to ask for help.
Though opioids understandably receive much of the attention, substance abuse among seniors spans across all potentially addictive materials, from prescription opioids to alcohol to recreational narcotics. In 2015, about 20% of adults aged sixty and over were affected by some kind of substance abuse, and experts expect the total number of seniors struggling with substance abuse to double by 2030. The majority of instances of substance abuse among older adults involve alcohol because it is commonly used and widely available. Additionally, older adults experience a lower tolerance to alcohol as they age, meaning it takes fewer drinks for use to become excessive or abusive. Other factors that aggravate the risk of substance abuse for seniors include emotional triggers, such as frequent deaths among family, friends, and peers, loneliness, 
co-morbidity with mental illness or physical disability, and Seasonal Affective Disorder otherwise known as the “Holiday Blues”. Pyramid Healthcare’s Heather Dick says, “This is a major factor for all ages, but particularly with older adults. They are more likely to have lost multiple close relationships, due to death or relocation, making holiday times emotionally difficult as well as isolating. During colder months people tend to experience an increase in pain due to arthritis which may lead to an increased desire for medication. The chronic pain alone, can cause an increase in depression and/or anxiety leading to increased risks of substance use/abuse. Finally, it is more difficult to get out and socialize with dangerous weather conditions further exacerbating isolation.”
While substance abuse is a serious and tragic dimension to the story of seniors and the opioid epidemic, seniors also interact with the opioid crisis in a surprising way: as suppliers. Especially as national awareness of the opioid crisis grows, doctors and pharmacists face increasing pressure to use extra caution when prescribing and distributing opioid painkillers to patients. Well-meaning older adults will simply give their excess pills away to friends and family who claim to need the medication to manage pain. And sometimes family members and others will pilfer pills from seniors without their knowledge.
Thankfully, the widespread national conversation about opioid addiction and other issues of substance abuse means that there are a myriad of resources available. Awareness is at an all-time high, and communities around the country are exhibiting an unprecedented commitment to helping addicts and substance abusers get the help they need.
Amy Lowey, a Pharmacist at Dick’s Pharmacy in Altoona, PA, sits on the Pharmacists Roundtable with Operation Our Town, a nonprofit in Blair County dedicated to preventing illegal drug use. Lowey noted that in June 2016, Pennsylvania adopted a narcotic monitoring system to help physicians and pharmacists work together to communicate better and form a first line of defense against opioid drug abuse. Now, any time a Pennsylvania physician prescribes a narcotic, they are required to report that information into a centralized data system within 24 hours. Physicians and pharmacies all have access to that information, so they can monitor patient drug use and detect early warning sides of abuse and addiction.
Lowey said that part of her work as a pharmacist includes educating consumers about proper opioid drug use. For her, it’s not just about properly filling out prescriptions, it’s also about making sure that those prescriptions are used safely and properly. “We have a conversation with the consumer regarding storage, keeping track of how much they have on hand, and also where and how to store the narcotic,” she said. She added that if a narcotic is prescribed and it seems like a gray area as to why, she will inform the consumer about the possible dangers of the medications and possible alternatives to narcotic pain management, and she suggests that they have another conversation with their doctor about the best treatment plan.
Lowey also has experience working specifically with seniors on this issue, including giving presentations about prescription medications and opioids. She pointed out that there are legitimate uses for opioid pain medications, and the risk of abuse and addiction can be mitigated with education, counseling, and monitoring. “It’s important not to scare seniors from using their medication,” she said. “If they truly need the medication, they should take it as needed.” She gave several examples of proper opioid pain management, including short-term prescriptions related to an acute injury or treatments for some long- term situations including hospice care and some serious illnesses like cancer.
Instead of scaring seniors, the best approach is to work with them to manage their treatment plans, educate them about proper prescription drug use, and monitor the pills to ensure they aren’t misused and don’t fall into the wrong hands. “If you have additional prescriptions or unwanted medications, there are ways to dispose of them,” Lowey concluded. “There are four local Police Departments in Blair County that have drop off boxes for unwanted prescriptions: Altoona, Logan Township, Hollidaysburg, and Tyrone. Times for drop off may vary, so I would check before going.”
Dick’s Pharmacy in Altoona also offers Deterra Pouches to help dispose of prescription drugs. Consumers can put up to 45 tablets into the pouch, then fill it with water and seal it. The medication dissolves so that it is no longer effective, and then the consumer can throw the whole sealed pouch into the trash.
Heather Dick provides this advice on treatment, “Treatment options for Opioid Use Disorders (OUD) are most effective with long-term treatment and start with a thorough assessment conducted by a qualified drug and alcohol professional. There are an array of community based supports including 12-step meetings and SMART Recovery. Individuals with OUD have a greater level of success the earlier they start treatment and the longer they engage in both treatment and supports.”
The opioid epidemic and broader struggles of substance abuse have hurt individuals, families, and communities around the United States, including many older adults. However, unprecedented awareness at the local and national level has created a unified national will to beat the crisis and help people in need. Through education and awareness, seniors and their families can learn about preventing addiction and detecting signs of substance abuse early.
Heather states, “Drug and alcohol treatment providers, like Pyramid Healthcare, provide the continuum of care to address and treat Substance Use Disorders. For family members who have loved ones with addiction, there are community support and peer based support services such as Al-Anon and Nar-Anon. In Blair County, we have the HOPE group aimed at providing group peer support to those who have loved ones struggling with SUD. Assist your loved one in getting connected with treatment, resources and social events. The less time they spend alone the better. Senior centers are a great way to increase social engagement and connection with peer supports. SAMHSA is a great resource to find literature and resources to educate yourself and your loved ones about Addiction.”(https://www.samhsa.gov)