Pubdate: Sun, 13 Aug 2017
Source: Knoxville News-Sentinel (TN)
Copyright: 2017 The Knoxville News-Sentinel Co.
Author: Anita Wadhwani

Pain pills are sending more senior citizens to the hospital in
Tennessee, according to data that sheds new light on how opioid
addiction has spread to the state's aging population.

The rate of hospitalizations for Tennesseans 65 years and older due to
painkillers has more than tripled in a decade.

Older adults are being hospitalized for reasons that range from falls
and auto accidents after taking pain pills to unintentional overdoses,
interactions with other medications and weakened kidney or liver
functions in aging bodies that fail to metabolize the drug in the same
way as younger people.

Experts say physicians and family members are more likely to overlook
addiction in senior citizens -- even after opioids require a trip to
the hospital.

"It's not that easy to believe your grandmother has a drug abuse
problem," said Dr. Peter Martin, a psychiatrist and director of the
Vanderbilt Addiction Center.

"The biggest problem is that no one in the past was worried about an
elderly person becoming an addict," Martin said.

"But opioids affect the brain no matter how old you are. If a person
in their 60s and 70s is running out of their prescription early, most
physicians are less likely to look on that with suspicion" as they
might do with a younger person, he said. "They're thinking, 'Oh, they
probably forgot it somewhere.' "

The U.S. Agency for Healthcare Research and Quality data ranks
Tennessee No. 6 in the nation for the rates of opioid-related hospital
admissions among senior citizens. In 2005, 467 out of every 100,000
people aged 65 and older spent time in the hospital for opioid-related
use. In 2015, that rate shot up to 1,505.

There were more opioid prescriptions than people in Tennessee in 2015.
More people died of opioid overdoses than vehicle accidents, homicide
or suicides in 2012. Between 2010-2015, opioid abuse claimed the lives
of 6,039 Tennesseans.

Tennessee is grappling with an epidemic that claims more lives than
car accidents, straining courts, jails and hospitals and exhausting
the limited treatment options. Tennessee, along with Alabama, tops the
nation in the number of per-person opioid prescriptions with an
average of more than two prescriptions written for every man, woman
and child.

In his Nashville practice, gerontologist Dr. Jim Powers addresses the
problem where it typically starts -- in the exam room.

The conversations can be awkward when patients have regularly taken
opioids for legitimate pain.

Some patients began taking opioids a decade or more ago when they were
in their 40s and 50s and suffered back pain or arthritis at a time
when opioids were considered the first line of pain treatment, he
said. They never stopped.

"It's a difficult conversation to have when you're a physician and
seeing a new patient," Powers said. "Most physicians have to
negotiate, and say, 'We'll continue this, but let's try other things.
Let's get an X-ray.' About 90 percent of physicians will continue
(opioid) prescriptions although they have misgivings."

Powers works with those patients over time to introduce alternatives
- -- physical therapy or spinal injections of cortisone. About a third
of his patients are eventually willing to try to stop taking opioids,
he said.

Other patients "need professional help. They need tapering," he said.
"But the system is not ready to receive as many older patients with
substance abuse disorder. As the population has grown older, we have
not seen a corresponding increase in drug treatment programs."

Federal data shows that seniors continue to be more likely to be
prescribed opioids.

One-third of seniors enrolled in Medicare Part D prescription coverage
filled at least one prescription for an opioid last year -- about 14.4
million people, according to the U.S. Department of Health and Human

More than half a million of those beneficiaries received
higher-than-average opioid dosages for at least three months.

Federal and Medicare data doesn't make distinctions between people in
their 60s and 70s and those who are in their 80s or 90s.

Experts say it's more likely that baby boomers on the younger end of
that spectrum are using -- and in some cases abusing -- opioids.

"There's a definite difference between baby boomers and the generation
above them who lived through the Great Depression and are in their 80s
and 90s and are much more likely to say 'I don't want to be on a
pill,' " Powers said.

Baby boomers are also more likely to have experience with drugs and
alcohol, perhaps making them more likely to turn to pain medications,
Martin said.

The huge spike in opioid-related hospitalizations left some advocates
who work with seniors puzzled.

Could a key to the problem not be opioids themselves, but the way
they're prescribed to seniors who are known to respond to medications

"We know that as America grows older there's going to be more hip
replacements or more falls, but I don't think that counts for a nearly
fourfold increase in opioid hospitalizations for this group," said
Grace Sutherland Smith, executive director for the Council on Aging of
Middle Tennessee.

"We have to ask whether doctors are taking into account how someone
over 65 metabolizes medications differently than a young person," she
said. "Whereas you and I might be able to work, an older person might
become sleepy or numb or incoherent."

In 2014, there were 864 Tennessee children whose parents had their
rights terminated. Experts say the state's opioid addiction epidemic
is a key driver.

There were more opioid prescriptions than people in Tennessee in 2015.
More people died of opioid overdoses than vehicle accidents, homicide
or suicides in 2012. Between 2010-2015, opioid abuse claimed the lives
of 6,039 Tennesseans.

Seniors who do seek addiction treatment may face challenges in finding
and paying for it.

Medicare covers inpatient detoxification, partial hospitalization,
residential treatment and outpatient individual and group therapy,
according to information provided by BlueCross BlueShield of Tennessee.

It does not cover intensive outpatient treatment or
medication-assisted treatment for addiction. The latter can be a key
treatment for opioid addicts, substituting a maintenance drug that
allows people to abstain from opioids.

But there are signs that more older individuals want help.

At a Nashville admissions center for Foundations Recovery Network, a
nationwide network of treatment facilities for mental health and
addiction, there was a 55 percent increase in calls from people in the
65-plus age group seeking treatment between January 2015 and January

"Many people assume that addiction is impacting only young people,"
said Lee Pepper, chief marketing officer at Foundations Recovery
Network. "As our population is living longer and aging we are seeing
addiction impact our parents and grandparents. Treatment options for
elderly Americans become more difficult due to lack of access because
of medical complications and mobility."
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