AAOA welcomes guest bloggers to share their perspectives on how to prevent the misuse and abuse of prescription opioids. This is the second post in our “Spotlight Series” in collaboration with AAOA partner PA Foundation on how PAs across the country are working to raise awareness about the rights, risks and responsibilities associated with prescription opioids. The post comes from Kristine Correira, PA-C, DScPAS, MHP, DFAAPA, a member of the PAs in Hospice and Palliative Medicine specialty organization.
Older Adults, Polypharmacy and Safe Prescribing
During my nearly 30 years serving as a PA, I’ve found that older adults face unique challenges when it comes to pain management. For example, many older adults experience multiple chronic conditions, which often means they take several medications. In fact, Kaiser Family Foundation found that 89 percent of adults 65 and older take prescription medicines, and more than half of older adults take four or more prescription drugs. Taking multiple medications increases the opportunity for drug interactions, so healthcare providers should always review current medications with patients, including over-the-counter medications and supplements, to confirm that prescription opioids are safe to prescribe. Additionally, providers should also have a conversation with their patient to make sure no new prescriptions have been recently added by another provider.
Prescription Opioid Use Among Older Adults
Providers consider many factors before prescribing opioids. The National Institute on Drug Abuse estimates that 4-9 percent of adults 65 and older use prescription opioids for pain relief. Older adults may use opioids as part of their cancer treatment, to recover from pain associated with a recent surgery, to help relieve chronic pain, or to treat other conditions. Older adults metabolize medications differently than younger adults and are more likely to experience side effects. When it comes to prescription opioids, these side effects can include medical and safety concerns such as excessive sedation, respiratory depression, and impairments in vision, attention and coordination, which also increase the risk of falls.
Alternatives to prescription opioids may be excellent options for some patients, but for older adults, they are often not practical. For example, over-the-counter medications such as Tylenol cannot be used by older adults with liver issues. Older adults may even be limited in the types of prescription opioids they may take, as renal issues can cause certain opioids to accumulate in the body. Non-steroidal anti-inflammatory medications must be used with caution in patients with gastrointestinal or cardiovascular risk factors, both commonly occurring in older adults. Similarly, physical therapy may not be a practical alternative for those with limited mobility.
Promoting Safe Storage and Disposal
Safe storage and proper disposal are key components of reducing abuse and misuse of prescription opioids for all ages. For older adults, these steps can be even more important because their living situations and caregiver interactions may mean there are individuals who have easy access to these highly addictive medications, which are controlled substances and have strict prescribing guidelines.
Many older adults depend on family members or friends to pick up their medications from pharmacies. They may also depend on caregivers to dispense the medications and place refill orders. In these situations, it is important to ensure the medication is not diverted away from the intended patient. Safe storage is also important when grandchildren, neighbors and others are visiting the home of an older adult. A lockbox or location outside of the traditional medicine cabinet may help keep medicine secure. I always encourage my patients to only tell those closest to them about their prescriptions to avoid unwanted attention.
Proper disposal is also critical. A healthcare provider may advise a patient that they no longer need to take a prescription opioid, and disposal of that medication helps prevent them from confusing it for another one. We also see that older adults may be prescribed larger quantities of prescription opioids for end-of-life care, leading to significant amounts of leftover medication when they pass. In both situations, patients and their caregivers should have plans in place for properly disposing of the medication.
Education Essential to Reducing Abuse and Misuse of Prescription Opioids
When treating older adults, is essential to provide information on the rights, risks and responsibilities associated with prescription opioids. Keeping in mind challenges older adults may face, it is important for healthcare providers to fully understand the care a patient is receiving from others on the healthcare team before prescribing opioids. I always encourage my colleagues to consider the current health situation of a patient and determine if they are on the most appropriate dosage and regimen. I also consider alternative treatments and options to see if they are viable alternatives. When counseling patients and their caregivers, I encourage them to share their medication lists and medical histories with all their providers and always ask about alternative options.
Prescription opioids can be helpful for older adults if used as prescribed by their healthcare provider. My experience has shown that many patients are not fully informed about the side effects and potential issues surrounding opioids when they are first prescribed. Taking the time to walk through concerns and monitor the patient’s holistic health can help improve health outcomes. AAOA has many resources for both patients and providers to help guide the conversation around safely using prescription opioids. By working together, healthcare providers, patients and caregivers can all play a role in keeping older adults as healthy as possible and preventing unintended consequences of prescription opioids.