HEALTH November 2016
A Healthy Age
By Amy Abbott
While the mainstream media reports on the opiates epidemic, another concern about opioid use hide in plain sight. Nearly 12 million Medicare recipients received at least one prescription for an opioid painkiller last year, according to a federal report.
“The magnitude of opioid use among seniors is astounding,” according to Frederic Blow, director of addiction research at the University of Michigan medical school, in “StatNews.” The article also noted that nearly a third of Medicare beneficiaries receive prescriptions for commonly abused opioids, including OxyContin, Percocet, Vicodin, and Fentanyl or generic equivalents.
Why should seniors and caregivers be mindful of opioid usage?
Suzanne Robotti, founder of MedShadow, a New York-based consumer advocacy group, spoke to Senior Wire News Service about why seniors are often prescribed opioids.
“Here’s a common scenario. Seniors may experience back pain, migraines, hip pain, arthritis knees, pulled muscles, or whatever.” She said. “Some people will not take NSAIDs — ibuprofen or naproxen — because stomachs and aging kidneys will not tolerate them.”
Robotti said many seniors do not like to take acetaminophen (Tylenol) because the difference between an effective dose and a toxic dose is just too close. She added that a physician might suggest a patient “take an Aleve and give yourself a couple of days.”
Many seniors will come home with an opioid instead of the other options, and sometimes it may be prescribed by a dentist for a procedure like a root canal.
“In aging bodies, metabolism slows down. Our kidneys and liver are organs through which drugs pass, and the organs now move more slowly. Drugs are in the body much longer, so the half-life is longer,” she said. “A drug that might last six hours in a 50-year-old body could last 50 percent longer in a senior.”
She explained that older people often don’t want to challenge their physicians. “It is typical that if a medication indicates ‘take at breakfast and dinner for ten days or as needed, that patient will take at breakfast and dinner for ten days’ whether necessary or not.”
Why Do These Drugs Act Differently in Aging Bodies?
According to Robotti, “They up your dopamine level and slow down your pain receptors so that you feel less pain.” These benefits explain why opioids are beloved.
But, as she continued, “The medications slow everything down. For some seniors, slowing of systems is a bad idea.” Robotti spoke of new drug for opioid-induced constipation due to slowing of bowel function for older adults. Constipation may lead to yet another medication.
Anyone with breathing problems should be mindful. “Opioids typically depress respiration in all age groups. Of course, older adults are more likely to suffer from COPD and other respiratory diseases from long-term smoking to simply living a long life. Many things like pollution and asthma may cause respiratory problems.”
Many opioids, alone or in conjunction with other prescribed drugs or over the counter medications, may impair cognition. This may lead to a higher risk of falling, and the consequence of a broken bone.
Robotti also worries about herbal remedies and supplements because they are unregulated by the FDA, which only gets involved if there is a problem. If someone needs an herbal remedy or supplement, Robotti recommends consulting a pharmacist about which brand is the best. Not all supplements and herbal remedies are created equal, and Robotti believes pharmacists can help make an informed decision.
What’s the Wise Health Consumer to Do?
Robotti offered suggestions: talk to your medical provider and pharmacist, use the Beers Criteria, and try non-drug options. “And don’t just say ‘should I take this drug’ but ask ‘how does this work in my body. Is there a non-drug alternative for me?’”
- Medical providers: The Beers Criteria is a great go-to for information on medications. The list is available online at www.americangeriatrics.org. According to Robotti, “The Beers criteria goes through all the scientific documentation and notes which drugs should not be given to seniors. This list is clear, simple, and trustworthy and is the first place I turn to when I need information.”Robotti believes that the fewer drugs taken, the more options open. She says “Delay, delay, delay.” To clarify, Robotti is not recommending seniors abandon all prescription medication, but rather be involved in an active, ongoing dialogue with all medical providers about the drugs’ benefits and concerns.
- Pharmacists: Robotti cites a resource right under our nose, our local pharmacy. “Pharmacists know which drugs will interact and can suggest alternatives. Go to your neighborhood drug store and just as you do at your doctor’s appointment, hand your pharmacist a list of your prescriptions. You will want to include every supplement and herbal remedy as well, as they can also have multiple side effects.Robotti admits to a fondness for pharmacists because “doctors are healers and diagnosticians, but pharmacists are drug experts.”
- Non-drug options: Robotti is a champion of non-pharmacologic options. Many seniors turn to opioids for pain, when meditation and physical therapy may do the trick.
“There have been several studies that have shown pain can be effectively managed by non-drug options. Our society has an attitude that nobody should be in pain for any moment of the day. I am not suggesting that people live with chronic pain. If the pain is temporary and you know there is a cause for it, try meditation, ice packs, cognitive behavioral therapy, and putting your feet up. Give yourself the chance to heal before reaching for an opioid.”
Robotti started MedShadow borne of her own experience – she was exposed to the synthetic hormone Diethylstilbestrol (DES) while in her mother’s womb. She formed the group to help consumers understand that many drugs have unintended consequences. DES was prescribed from 1938 to 1971 to women at risk of miscarriage and other problems of pregnancy. It was taken off the market 45 years ago when discovered a relationship with cancer in the children born from women who took the synthetic estrogen.
Final word? Please consult your personal health care provider about what is best for you.