Pubdate: Sat, 07 Jan 2017
Source: Orlando Sentinel (FL)
Copyright: 2017 Orlando Sentinel
Contact:  http://www.orlandosentinel.com/
Details: http://www.mapinc.org/media/325
Note: Rarely prints out-of-state LTEs.

AGING AND ADDICTED: THE OPIOID EPIDEMIC AFFECTS ELDERLY, TOO

[photo] Oxycodone pain pills.

It took a lot of convincing for John Evard to go to rehab. Seven days into
his stay at the Las Vegas Recovery Center, the nausea and aching muscles
of opioid withdrawal were finally beginning to fade.

"Any sweats?" a nurse asked him as she adjusted his blood pressure cuff.
"Last night it was really bad, but not since I got up," replied Evard, 70,
explaining that he'd awakened several times with his sheets drenched.

Even for him, it was hard to understand how he ended up 300 miles away
from his home in Scottsdale, Ariz., at this bucolic facility in the
suburbs of Vegas. "This is the absolute first time I ever had anything
close to addiction," he said. He prefers to use the term "complex
dependence" to describe his situation: "It was, shall we say, a big
surprise when it happened to me."

As the nation grapples with a devastating opioid epidemic, concerns have
primarily focused on young people buying drugs on the street. But
America's elderly also have a problem. Over the past several decades,
physicians have increasingly prescribed seniors pain medications to
address chronic pain from arthritis, cancer, neurological diseases and
other illnesses that become more common in later life.

A recent study found that in 2011, 15 percent of seniors were prescribed
an opioid when they were discharged from the hospital; three months later,
42 percent were still taking the pain medicine.

One in three Americans who have taken prescription opioids for at least
two months say they became addicted to or physically dependent on the
medications, according to a recent Washington Post-Kaiser Family
Foundation poll. (KHN is an editorially independent program of the
foundation.)

It's no surprise, then, that some seniors end up addicted.

A new study provides the first-ever look at the relationship between
medical marijuana laws and individual opioid use. Sept. 16, 2016.

A new study provides the first-ever look at the relationship between
medical marijuana laws and individual opioid use. Sept. 16, 2016.

Evard spent his life working as a corporate tax attorney. He's spry and
white haired, with a contagious grin. A few years ago he and his wife
retired to Arizona with their eyes on the golf course. The dream didn't
last long. Just months later, a virus infected Evard's left ear.
Overnight, he lost half his hearing and was left with chronic pain. In
January, he had surgery to fix the problem.

"From the surgeon's standpoint, the operation was successful. The problem
was, the pain didn't go down. It went up," he recalled.

His doctors prescribed opioids, including Oxycontin. "They decreased the
pain, particularly at first," said Evard. "As time went on they had less
and less effect, and I had to take more and more."

As the doctors increased his dosage, Evard's once active life fell apart.
He was confused, depressed, and still in pain. "I was effectively
housebound. I couldn't play golf anymore. I couldn't go to social events
with my friends or my wife."

He couldn't think of anything except the pills and when he could have the
next one. He knew he was in trouble despite having taken them exactly as
his doctor instructed.

"I was a rule-follower," he said. "And I still ended up, in a mess!"

In 2009, the American Geriatric Society came out strongly in favor of
opioids, recommending that seniors with moderate to severe pain be
considered for opioid therapy. The panel cited evidence that seniors were
less likely than others to become addicted.

"You don't see people in this age group stealing a car to get their next
dose," Dr. Bruce Ferrell, chairman of the panel that issued the Society's
guidelines, told The New York Times at the time.

Mel Pohl, medical director of the Las Vegas Recovery Center, called that
conclusion a "horrible misconception."

"There's no factual, scientific basis for that. The drug takes over in the
brain. It doesn't matter how old the brain is."

The problem is that chronic pain is common as people age, and there aren't
many good options to treat it. Even aspirin and ibuprofen carry bleeding
risks. The 2009 AGS guidelines are no longer in use, but opioid
medications remain a crucial tool to treat pain in older people. Most
people are able to take opioids in small doses for short periods of time
without a problem.

"We really don't use opioids necessarily as the first line of treatment
because we understand what the risks are. But we also don't want to see
our patients suffering needlessly if we can provide them with relief,"
said Dr. Sharon Brangman, past president of the AGS. The trick, she said,
is to try non-pharmacological options such as acupuncture first and to use
the smallest effective opioid dose possible, if necessary.

Still, most of the seniors at the Las Vegas Recovery Center have taken the
drugs as prescribed by a willing doctor trying to address their pain, said
Pohl. That pattern sets them apart from many of the younger patients, many
of whom start buying drugs on the black market after being turned away by
physicians.

Nonetheless, in the past 20 years, the rate of hospitalization among
seniors that is related to opioid overuse has quintupled. But relatively
few of them end up in rehab. Pohl said that's due to a combination of
factors.

Click to view slideshow."They've grown up in an era where drug addiction
and alcoholism 1/8were3/8 evil, and I think that's internalized for some
of the folks that I've seen," he said, so they don't seek help,
particularly from an in-patient facility. Also, some rehabs not are
equipped to deal with the complex medical problems common among older
people.

Another problem are patients whose addictions have been misdiagnosed as
dementia. "We'll have a family come 1/8visit3/8, three weeks into
treatment, and it's like 'Oh my God, you're back! I haven't seen that
glimmer in your eye in 20 years!'" said Pohl.

It took John Evard about a week to get over the vomiting and flu-like
symptoms of detox, which can be particularly hard on older patients. He's
speaking out now because he doesn't want other seniors to fall into the
same trap.

"Don't just take the prescription because it's part of the checkout
process from the hospital," he cautioned. "It's your body, take charge of
it, and push for alternatives at all costs. And if you do go on, get off
them as fast as you can."
- ---
MAP posted-by: