New poll: More counseling, prescribing limits needed for seniors using opioids

Liz Seegert

About Liz Seegert

Liz Seegert (@lseegert), is AHCJ’s topic editor on aging. Her work has appeared in NextAvenue.com, Journal of Active Aging, Cancer Today, Kaiser Health News, the Connecticut Health I-Team and other outlets. She is a senior fellow at the Center for Health Policy and Media Engagement at George Washington University and co-produces the HealthCetera podcast.

Photo: Marko Javorac via Flickr

Nearly a third of older adults have received a prescription for an opioid pain medicine in the past two years, but many didn’t get enough counseling about the risks of the drug, how to reduce their use, when to switch to a non-opioid option, or what to do with leftover pills, a new poll finds.

Researchers from the University of Michigan found that three-quarters of older adults surveyed said they would support prescribing limits by doctors and other efforts to limit exposure that could possibly help combat the national crisis surrounding opioid misuse, especially due to diversion. The findings suggest major opportunities for providers and community organizations to focus on safe opioid use and disposal among older Americans, and broadens understanding of how seniors view and use this powerful medication.

“While opioids may be appropriate for acute, post-surgical pain, physicians must conduct more patient education about when to take these drugs and when to switch to other options,” said Jennifer Waljee, M.D., co-director of the Michigan Opioid Prescribing Engagement Network (Michigan OPEN) and an associate professor of surgery at Michigan Medicine. “Physicians have to be honest about managing pain expectations. Don’t lead the patient to believe they will be totally pain free, but instead, explain that pain will lessen over time following surgery.”

When it comes to chronic pain, such as osteoarthritis or lower back pain, non-narcotic options like acetaminophen and NSAIDs are much more appropriate therapies, Waljee explained in a phone interview. While these drugs also carry risks, especially when taken for long periods of time or in high doses, they are not addictive. Additionally, other non-pharmaceutical alternatives such as yoga and biofeedback, have been shown to help safely manage chronic pain with no side effects.

The National Poll on Healthy Aging surveyed a nationally representative sample of 2,013 adults between the ages of 50 and 80. It was conducted by the University of Michigan Institute for Healthcare Policy and Innovation.

Waljee and her colleagues focused not only on older adults’ own opioid use but also their storage and disposal habits, as well as their perceptions of recent policy measures around opioid prescribing.

Drug abuse among older patients is a growing problem, as The Washington Post reported. The story points out that while Medicare pays for the prescription, it does not cover drug treatment programs or medications that can help with withdrawal symptoms like methadone. This NPR story describes the saga of one older adult who became unwittingly addicted.

Common prescribing, inadequate counseling

In the Michigan poll, most of the 589 older adults who said they’d received an opioid prescription in the previous two years said it related to arthritis pain, back pain, surgery and/or an injury. While the majority remembered their doctor, pharmacist or other health care provider talking with them about how often to take the medication, fewer than half said they discussed risk of addiction (48 percent); or risk of overdose (43 percent).

Only 37 percent said their doctor had talked with them about what to do with leftover medication, while 25 percent said their pharmacist had done so. Half of those who had been prescribed an opioid said they had had pills left over, and 86 percent of those said they kept them for later potential use.

“No one wants to be in pain, so if they don’t finish their prescription, they want to hang on to the leftover pills ‘just in case,’” Waljee explained. “People should not self medicate without physician oversight.” Leftover prescription medication also opens the possibility of the drugs being used by someone else.

Disposal vs. keeping unused pills

However disposing of unused pills isn’t always easy. It may require travel to a facility such as a police station, authorized pharmacy, or community “takeback” event that can sometimes be logistically difficult for patients. Walmart became the first big box retailer to tackle the opioid disposal problem, offering safe-disposal at its retail pharmacies, according to this USA Today report. While some respondents said if they would be willing to use a a low-cost safe-disposal product which make the drug inert, the majority said they would hang on to the pills for future use.

Opioid policy opinions

The researchers suspect that older adults may fear that they will not be able to obtain pain medications when needed as new state opioid-related policies and laws target reduced prescribing.

State prescription drug monitoring programs require providers to look at patients’ prescription records before prescribing opioids, and some require patients to tell their provider if they have been taking pain medications. As this story on Wisconsin’s law shows, efforts have been largely successful. Other states have proposed special provider education, prescribing restrictions, and required return of unused medications.

The poll shows that nearly all older adults support policies such as required review of prescription records and disclosure of prior opioid medication use, despite concerns that these policies may be perceived as invading patients’ privacy. A slightly lower percentage supported requiring providers to get special training before they can prescribe opioids. But the poll team was surprised to find that 74 percent supported restrictions on the number of opioid pills, or the number of days’ supply, for which prescribers could write a single prescription. On the other hand, just under half of older adults said they’d support required return of unused medications.

Waljee said poll results indicate that health care providers who prescribe or dispense opioids should do more to help patients understand how to safely use and dispose of them, in language that patients understand. This should include a disposal plan that helps patients understand why they should dispose of extra medications, and how best to do so.

For journalists

Journalists may want to take a look at prescribing laws in their state, and availability of safe disposal sites or programs.

How easy is it for older adults to access these sites?

What are local hospitals or physician groups doing to education older patients about use and disposal of opioids or other powerful medications?

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