By David Heitz
When a high school athlete ends up in the emergency room with a broken bone, often that event becomes their introduction to opioids. The next thing you know, they are that “regular kid who turned to heroin.”
Fortunately, help is available for everyone. And guess what? Elderly people who end up in the ER with broken bones – broken hips, other breaks from falls — are no different from those high school athletes.
In fact, a new study shows that if a patient on Medicare goes to the hospital and ends up with what are described in the study as “high intensity” opioid prescribers, they are more likely to end up in the hospital again within a year with another “opioid problem.”
The research looked at more than 215,000 Medicare patients with a median age of 68 who received treatment from “low intensity” prescribers, and 161,951 patients who received treatment from “high intensity” prescribers. Rates of elderly people returning with a long-term opioid use problem were “significantly higher” among those who first saw an ER doctor with high rates of prescribing opiates than among those who saw doctors with low rates of prescribing opiates, per the study.1
Long-term opioid use was defined as 180 days of opiate use, excluding the first 30 days after the visit.
The study, published in The New England Journal of Medicine and conducted from 2008 to 2011, only included Medicare patients who previously had not been given opioid medications for at least six months prior to their visit. Beneficiaries with hospice claims or a cancer diagnosis also were excluded.
Doctor Roulette Determines Opioid Prescription, Strength
Rates of prescribing among the doctors varied widely among individual hospitals – from just 7.3 percent to 24.1 percent.
Almost half of all patients in the study previously had been diagnosed with acute myocardial infarction (heart attack), and 39.5 percent suffered from depression, regardless of whether they were among the patients who saw high-intensity or low-intensity doctors.
“It is commonly thought that opioid dependence often begins through an initial, possibly chance, exposure to a physician-prescribed opioid, although data from studies to empirically evaluate this claim are lacking,” the authors write. “Our results provide evidence that this mechanism could drive initiation of long-term opioid use through either increased rates of opioid prescription or prescription of a high, versus a low, dose of opioid.”
The study underscores how some providers may believe elderly people are not at risk of becoming addicted, as well as the importance of explaining to elderly patients — who probably don’t see themselves as someone at risk of becoming hooked either — of the dangers of opioid dependence.
At 64, Joe C. Finally Says No to Drugs and Alcohol
“I had to get 64 years of age until I looked in the mirror and didn’t like the man that I saw anymore. I saw a man I didn’t like at all; I saw a dead look in his eyes. I had a wife for many years, made her my enabler,” writes Joe C. on the website Heroes in Recovery, a space where those who overcome alcoholism and addiction can share their inspirational stories.2 “I was full of arrogance and sarcasm. I made her suffer the consequences that were meant for me to take. I didn’t want to wake up to those feelings of shame and guilt anymore, I couldn’t take it anymore.
“I was shaking and smelly like a race horse, with wounds that won’t heal. Cataracts in both eyes made it impossible to see at night for me, but I drove anyway. God’s grace kept me alive while I was on the road. And God’s grace kept me alive until I found help in the rooms of a 12-Step fellowship.”
According to a story for DualDiagnosis.org, elderly people in many ways are at greater risk for the hazards that can come along with drug abuse, particularly because their bodies process controlled medications such as opioids differently.3
“Persons aged 65 and older comprise only 13 percent of the population, yet account for more than one-third of total outpatient spending on prescription medications in the United States,” NIDA reports on its website.4 “Older patients are more likely to be prescribed long-term and multiple prescriptions, and some experience cognitive decline, which could lead to improper use of medications. Alternatively, those on a fixed income may abuse another person’s remaining medication to save money.”
Elderly people underscore their risk when they combine alcohol with their prescriptions, which can be fatal, per the DualDiagnosis.org piece.
The New England Journal of Medicine study is just one more piece of research that shows not even older Americans are immune to the addictive powers of opioids.
“We found variation by a factor of more than three in rates of opioid prescribing by emergency physicians within the same hospital and increased rates of long-term opioid use among patients treated by high-intensity opioid prescribers,” the authors conclude. “These results suggest that an increased likelihood of receiving an opioid for even one encounter could drive clinically significant future long-term opioid use and potentially increased adverse outcomes among the elderly. Future research may explore whether this variation reflects overprescription by some prescribers and whether it is amenable to intervention.”
1 Barnett, M. et al. (2017, Feb. 16). Opioid-Prescribing Patterns of Emergency Room Physicians And Risk of Long-Term Use. New England Journal of Medicine. Retrieved March 9, 2017, from http://www.nejm.org/doi/full/10.1056/NEJMsa1610524#t=article
2 Johnson, S. (2016, May 25). Joe C: Come On In, I’ll Get You a Coffee. Heroes in Recovery. Retrieved March 9, 2017, from http://heroesinrecovery.com/stories/come-ill-get-coffee/
3 Heitz, D. (2016). DualDiagnosis.org. Drug Abuse Where You Might Not Expect It: Older Americans Getting Drunk, High, Too. Retrieved March 9, 2017, from http://www.dualdiagnosis.org/drug-abuse-where-you-might-not-expect-it-older-americans-getting-drunk-high-too/
4 National Institute of Drug Abuse (2014, November). Prescription Drug Abuse. Older Adults. Retrieved March 13, 2016, fromhttps://www.drugabuse.gov/publications/research-reports/prescription-drugs/trends-in-prescription-drug-abuse/older-adults