This post is the first in AAOA’s “Allies in Action” series, highlighting how our partners are working to raise awareness about the rights, risks and responsibilities associated with prescription opioids.
Today’s featured ally, The Gerontological Society of America (GSA), is the oldest and largest interdisciplinary organization devoted to research, education, and practice in the field of aging. GSA’s principal mission — and that of their 5,500 members — is to promote the study of aging and disseminate information to scientists, decision makers and the public.
There is an urgent need to recognize the potential for prescription opioid-related overdoses, as well as risks for misuse and abuse across the life course, regardless of age. Specifically, the rates of prescription opioid related deaths are increasing for older adults, who are more likely to have chronic pain conditions or overlapping chronic illnesses.
At GSA’s Annual Scientific Meeting in November 2021, researchers presented two new studies on prescription opioids that help bridge the gap in knowledge surrounding older adults and prescription opioid use. The research focuses on prescribing rates among Medicare beneficiaries across rural and urban areas and older adults’ knowledge, beliefs and attitudes about opioid medications. Both studies highlight the importance of continuing efforts to raise awareness of the rights, risks and responsibilities associated with prescription opioids.
Knowledge, Beliefs and Attitudes About Opioids
A study by Noell L. Rowan, Tamatha Arms and Susan Glose, “Exploring Knowledge, Beliefs, and Attitudes of Older Adults About Prescription Opioids,” begins to address the gaps in literature related to older adults and opioid use. In this cross-sectional descriptive survey of adults aged 55 and older in southeast North Carolina, participants’ knowledge, beliefs and attitudes toward prescription opioids reflect many biases.
This study shows that participants’ beliefs — including stigma about persons with opiate use disorders, consuming alcohol with opioids and correlation to health knowledge — have a direct impact on patient safety, such as side effects and impacts on functional status when taking prescription opioids. Researchers found that gender, age, work, marital status and education level all influence how the participants perceived prescription opioid use.
This study highlights the need for continued research that focuses on assisting older adults in making healthy choices when prescribed pain medication to maximize their safety, function and quality of life. Reducing harms from prescription opioid use has the potential to impact each of these goals.
Opioid Use Among Rural Medicare Beneficiaries
In another study, “Opioid Use Among Rural Medicare Beneficiaries,” Yvonne Jonk, Heidi O’Connor, Karen Pearson, Zachariah Croll, Deborah Thayer and John Gale examined the differences in opioid prescribing rates among a nationally representative sample of Medicare beneficiaries across rural and urban areas, as well as among beneficiaries with chronic overlapping pain conditions. In analyzing data between 2010 and 2017, researchers found the percentage of community and facility-dwelling beneficiaries receiving opioid prescriptions was significantly higher across all years in rural areas compared to urban beneficiaries.
Beneficiaries living in neighborhoods or boarding houses (community-dwelling) were prescribed opioids at a lower rate than those that lived in nursing homes or assisted living facilities (facility-dwelling). However, rural beneficiaries in some locations received as much as five percentage points more opioid prescriptions than their urban counterparts.
Many people who are prescribed opioids also have chronic overlapping pain conditions (COPC). Researchers note that approximately 18 percent of rural community-dwelling Medicare beneficiaries have a COPC compared to approximately 15 percent of urban community-dwelling beneficiaries. These COPCs can complicate treatment for patients and raise the likelihood of being prescribed prescription opioids. In fact, a higher proportion of rural beneficiaries with COPCs (31.4 percent) are prescribed opioids compared to urban beneficiaries with COPCs (22.2 percent) — as large as a 10-point difference.
The study concludes that the lack of alternative therapies to treat chronic pain conditions in rural communities may be contributing to the higher prescribing rates. Previous research has pointed out various reasons that may contribute to these differences between rural and urban areas. Rural populations that lack access to chronic pain specialists and alternative therapies (e.g., physical therapy) may have less access to healthcare facilities — and may face barriers such as a lack of transportation to get to these facilities.
Supporting Older Adults with AAOA Resources
It’s crucial for older adults and their caregivers to understand the facts surrounding prescription opioid use, especially because older adults are prescribed these medications at increasing rates. Moreover, since individuals in rural areas are prescribed opioids for pain at a higher rate than in urban settings, it’s important that providers and pharmacists talk to their patients about the rights, risks and responsibilities of prescription opioids.
AAOA has a host of resources for patients and caregivers on the safe use, storage and disposal of prescription opioids, including resources that address the most common misconceptions about prescription opioids. Further, AAOA’s Pharmacy Toolkit has helpful information for pharmacists to start conversations with patients and prescribing clinicians when it comes to the safe use, storage and disposal of prescription opioids.