Prescription Opioid Abuse in Elders

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The prescription opioid epidemic in the Unites States has reached unprecedented numbers. The Department of Health and Human Services states that nearly 80 people die from opioid-related overdose in the Unites States every day. These deaths come from both recreational drugs, like heroin, and prescription painkillers. Seniors are particularly at a risk because they are often prescribed these medications for pain. Luckily, acupuncture can offer immediate help with prescription opioid abuse in elders.

But first, how does opioid abuse develop? Prescription painkillers are best used to manage acute pain, meaning post-surgical discomfort or after sustaining an injury or fall. Chronic pain, such as that associated with arthritis or old injuries, is less responsive to opioid intervention and can actually create a cycle of tolerance and dependence.

How did we reach this point of widespread addiction to pain medication?

A contributing factor was the medical community’s shift to treating pain as the “fifth vital sign” starting in the 1990s. This meant that after heart and respiratory rates, blood pressure, and body temperature, doctors screened patients about pain. For patients living with pain, this was a blessing. As many chronic pain sufferers will attest, intractable pain can lead to depression, loss of income, and strained personal relationships. There is no doubt that chronic pain changes the landscape of life.

Despite their efforts to alleviate pain, the medical community’s move to prescribe high-powered medications to help millions of patients has resulted in a complex public health problem.

Although the face of the opioid epidemic is not typically portrayed as a senior aging at home, we know elders are impacted by this trend. Kaiser Health News reported that in 2011, 15% of Medicare patients were prescribed opioids after a hospital visit. Ninety days after being discharged, 42% of those patients were still taking those medications. Clearly opioid abuse is becoming a concern for elderly patients.

The Dangers of Opioid Abuse in Elders

Painkillers change pain perception by activating opioid receptors in the brain. The relationship between a pain site and the way the brain recognizes pain are altered by the addition of prescription medication. As the brain becomes accustomed to the flood of introduced opioids, its receptor sites multiply. This is why opioid drugs are so highly addictive. The body becomes chemically dependent on receiving this additional influx of opioid to function comfortably.

The side effects of opioid use in seniors are especially worrisome, including changes in cognition and poor motor control leading to falls. When taken in high amounts, these medications are particularly dangerous. For elders with memory impairment, accidentally doubling up on doses can be deadly.

Unlike younger adults seniors do not metabolize opiates at the same rate, meaning more of the drug is likely to stay in the body for a longer period of time. Family members or friends who sympathetically offer painkillers should be aware that elders carry a greater risk of overdose due to decreased liver and kidney capacity. Never share opioids with a senior.

Even when elders are appropriately prescribed opiates, these medications can bring unwanted negative symptoms, including:

  • nausea
  • constipation
  • urinary retention
  • sedation
  • skin rashes
  • compromised respiration
  • cardiac symptoms
  • lowered libido
  • heightened pain perception
  • decrease in bone density

For some patients multiple doses of opioids per day can lead to physical dependence in less than one week. It is important that elders have a recovery plan in place to transition off of these drugs as soon as possible.

This is where acupuncture can help.

Acupuncture Helps Prescription Opioid Abuse in Elders

 Pain creates neural pathways in the brain that stimulate the body to release its own naturally occurring opioids, including endorphins. When pain thresholds are exceeded, such as after surgery, the body cannot control the sense of discomfort. Prescription opioids are particularly useful in helping the body manage this type of severe pain.

Over time, as the trauma from surgery or a fall heals, communication between the pain site and the brain relaxes. In an ideal scenario, painkillers—natural and introduced—are no longer needed. When the body does not heal effectively, pain can linger, continuing to send alarm messages to the brain. Chronic pain creates a particularly insidious cycle of depletion in the body, requiring higher and higher doses of medication to provide relief.

The insertion of acupuncture needles naturally stimulates the release of endorphins, assisting the body in repairing itself. Acupuncture also combats inflammation, which reduces feelings of pain and stiffness. It increases blood flow, helping tissues flush out stagnant blood and encouraging the lymphatic system to repair compromised areas. And, most importantly, it interferes with the distressed messages ricocheting between the brain and distal pain sites, leading to a real change in pain perception.

All of this occurs over repeated acupuncture treatments. Patients suffering from chronic pain, and especially those on opioids, should expect to receive multiple acupuncture treatments to change underlying dysfunction. In some cases, acupuncture is incapable of resolving the pain entirely, especially if the trauma happened years—or decades—ago. Our goal is to help patients feel as comfortable as possible given their personal health history and constitution.

It is important to remember that acupuncture does not work like a pill. Once a patient has become accustomed to taking medication, especially an opiate, the expectation that acupuncture will bring substantial relief right away is misplaced. A course of treatment can last anywhere from two to six months, and sometimes longer, depending on the severity of the condition.

Chronic pain is a complicated problem. It requires clients, and practitioners, to be patient with the body as it repairs itself. Additionally, if a patient is addicted to opioid medications, the process of reducing prescription dependence is particularly challenging. It requires a team approach, which can include medical care, physical therapy, massage, and acupuncture. Get help when it’s needed, and don’t give up too quickly.

Alta Mira recovery center in California says that drug dependence in elders can be overlooked or dismissed because of a perceived lack of urgency. This attitude is often motivated by our cultural beliefs about the limits of old age. At Boulder Acupuncture and Herbs, we are committed to offering seniors access to drug-free alternatives that do not erode quality of life, no matter your age.

If you or a loved one is caught in the cycle of chronic pain, call us today. If you’ve sustained a recent injury, get in to see our acupuncturist right away. Acupuncture will speed up the recovery process and lower your risk of developing drug reliance. And if opioid abuse is already a concern, talk with us about how we can work with you and your doctor to break the cycle of dependence.

For more information on chronic pain in elders, see our article Pain Management in Older Adults.

 

Works Referenced

Chau, Diane, et al. Opiates and Elderly: Use and Side Effects. Clinical Interventions in Aging. 2008. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2546472/.

Esposito, Jenny. Silent Epidemic: Seniors and Addiction. U.S. News and World Report online. December 2, 2015. http://health.usnews.com/health-news/patient-advice/articles/2015/12/02/silent-epidemic-seniors-and-addiction.

Gold, Jenny. Opioids Can Derail the Lives of Older People, Too. http://www.npr.org/sections/health-shots/2016/12/20/502470255/opioids-can-derail-the-lives-of-older-people-too.

Prescription Opioid Abuse In The Elderly An Urgent Concern. Narcanon website. http://www.narconon.org/blog/narconon/prescription-opioid-abuse-in-the-elderly-an-urgent-concern/.

Sphar, Brittany. Opioid Considerations in the Elderly. Presentation at University of Colorado Internal Medicine Department of Geriatrics Grand Rounds. March 17, 2016. http://www.ucdenver.edu/academics/colleges/medicalschool/departments/medicine/geriatrics/grandrounds/Documents/15-16/GeriatricGrandRounds-Sphar-031716.pdf.

The Opioid Epidemic: By the Numbers. U.S. Department of Health and Human Services. Updated June 2016. https://www.hhs.gov/sites/default/files/Factsheet-opioids-061516.pdf.

Why Opioid Addiction in Seniors Remains a Hidden Epidemic. Alta Mira website. Posted September 2016. https://www.altamirarecovery.com/blog/opioid-addiction-seniors-remains-hidden-epidemic/.