Researchers involved with the University of Michigan’s National Poll on Healthy Aging polled a nationally representative sample of 2,000 Americans, aged 50 to 80, about what their health-care providers talked about when prescribing opioid medication to them. In the past two years, 589 said they filled an opioid prescription. This group knew how often to take the medication, but the majority didn’t recall their doctors or pharmacists talking about the risk of addiction, the risk of overdose, or what to do with leftover pills. About 40 percent said their doctors didn’t talk to them about the side effects of opioid use or guide them on when to cut back on pain medications.
Drug policy makers and researchers I spoke with about these findings weren’t surprised by the evidence that health providers might be neglectful. Doctors failing to communicate effectively with patients is an ongoing issue, they said. A lot of doctors are burned out. Others don’t have enough time to spend with their patients. They’re often overcommitted because their offices are understaffed and underresourced. And many fumble with relatively new technology such as prescription-drug-monitoring programs (PDMPs), statewide electronic tools that are meant to improve opioid prescribing by helping states keep track of where substances are going, says Gary Franklin, the vice president of Physicians for Responsible Opioid Prescribing.
The hospital is no place for the elderly.
Working with older people can also just be different, and perhaps inherently more challenging, than working with younger people—especially when it comes to opioid prescriptions, says Shannon Skowronski, a specialist at the Department of Health and Human Services’ Administration on Aging. “The prevalence of chronic and acute conditions that might result in pain, along with the physiological changes in the body as you grow older … that’s really complicated,” she says. In fact, the Washington State Agency Medical Directors’ Group has started to address the elderly as a special population, because “aging is associated with unique biological, psychological, and social factors that all play an important role in pain management.”
To further complicate matters, Baby Boomers, who are included in the new poll, “have used alcohol and other drugs at higher rates compared to other generations of older people that have preceded them,” says Sheila Vakharia, a policy manager at the Drug Policy Alliance, “which means these same people are at higher risk of overdose and adverse effects because they may be drinking a little bit more often and a little heavier than some folks who are in their 80s.” And opioids can make it harder to breathe, cause confusion, and increase falls, which are harder for older adults in general to deal with.
In the moment when a doctor is prescribing pain-relief pills to an older patient, the physician might not go into the nitty-gritty details of using opioids, because they assume only young patients are at risk. “The messages that doctors give to patients are largely dictated by how they perceive patients,” Vakharia told me. “You don’t often see the elderly as a population at risk for developing substance-use disorders.” Yet older adults are likely to have higher levels of pain compared to younger populations, which can inspire misuse and abuse. And though older adults have lower rates of abusing opioids than young adults, when they do have opioid-use disorder, they appear to be at a higher risk of death, according to a report from the Administration for Community Living co-authored by Skowronski.